Max is an 80-year-old male with a history of gastroesophagea
Max is an 80-year-old male with a history of gastroesophageal reflux disease (GERD), hypertension (HTN) CC: “I have stomach pain.” HPI: Max is an 80-year-old male with a history of gastroesophageal reflux disease (GERD), hypertension (HTN), and a pacemaker placed 10 years ago for third-degree heart block. He presents today with a complaint of abdominal pain. You suspect a bowel obstruction in Max, an 80-year-old patient with complaints of cramping abdominal pain, nausea, and vomiting for 4 days. Describe six (6) ROS questions you would explore further with him to determine the location, severity, and timing of his pain. PE: On exam, the abdomen appears distended, Max has generalized tenderness over the epigastric region on palpation. He is guarding so the exam is limited. Bowel sounds are decreased. His vital signs are normal. He describes his abdominal pain as 7/10. As the APRN, you order an abdominal x-ray. Test results: The abdominal x-ray is indeterminate. What are your next diagnostic choices to determine a bowel obstruction in this patient? List at least three differential diagnoses for abdominal pain. The CT scan shows that Max has a small bowel obstruction. What is your next step? Expert Answer and Explanation Focused SOAP Note Small Intestine Obstruction Patient Information: Max, 80 years, male, African American S CC: “I have stomach pain.” HPI: Max is an 80-year-old male of African American origin who came to the health clinic complaining of abdominal pain. The pain is located in the abdominal area. It started four days ago. The character of pain is cramping and intermittent. Associated signs include nausea and vomiting. The patient notes that the severity of the pain is 7/10. Current Medications: No medications. Allergies: No food, dug, or environmental allergies. PMHx: Past major illnesses include hypertension (HTN), gastroesophageal reflux disease (GERD), and a pacemaker placed 10 years ago for third-degree heart block. He does not remember when he took tetanus or pneumonia shots. Soc and Substance Hx: He took alcohol in his thirties and quit over 45 years ago. He comes from a working family. No history of illicit drug or tobacco use. He says that he has smoke detectors in his house and wears seat belts while driving. His support system is his son and two daughters. Fam Hx: His father died from colon cancer. His mother died from type II diabetes. His older son died in an accident at the age of 28. His second child has type two diabetes. His grandchildren are healthy. Surgical Hx: He reports a knee operation at 33 years old. Mental Hx: No mental health disorder diagnosis and treatment. No history of self-harm. Violence Hx: No history of violence. Reproductive Hx: He is sexually inactive and has no reproductive health. ROS GENERAL: He reports fatigue and weakness. No fever or chills. HEENT: Eyes: No visual loss. Ears, Nose, Throat: No congestion, sneezing, hearing loss, sore throat, or runny nose. SKIN: No rash or itching. CARDIOVASCULAR: No chest discomfort, pressure, pain, or edema. RESPIRATORY: No shortness of breath. GASTROINTESTINAL: No diarrhea or anorexia. GENITOURINARY: No burning on urination. NEUROLOGICAL: No dizziness, headache, paralysis, or syncope. MUSCULOSKELETAL: No joint or muscle pain. HEMATOLOGIC: No anemia. LYMPHATICS: No enlarged nodes. O Physical exam: Vitals: BP 139/92, Temp 35, P 78, Ht. 5’9, Wt. 87kgs. Cardiovascular: No cracks in the chest. No edema. Respiratory: No breathing distress. No wheezes or crackles. No fluids in the lungs. Genitourinary: No urinary retention. No renal angle tenderness. No tender bowel loops. No abdominal masses. Gastrointestinal: Bowel sounds absent on inspection. Distension of the abdomen on auscultation. Diagnostic results: The abdominal x-ray is indeterminate. Since an x-ray is indeterminate, a CT scan should be ordered. A CT scan combined with X-ray images. Dou et al. (2022) noted that a CT scan combined with multiple X-ray images will show intestinal obstructions. Blood test: A blood test will be used to identify whether the patient has intestinal infections. A Differential diagnoses: Small intestine obstruction: The primary diagnosis for this case is small intestine obstructions. According to Jackson and Cruz (2018), the symptoms of small intestine obstructions include vomiting, crampy abdominal pain and comes and goes, constipation, loss of appetite, swelling of the abdomen, and inability to pass gas or have a bowel movement. Small intestine obstruction is the main diagnosis because the patient complains of crampy abdominal pain, nausea, and vomiting which are major symptoms of the disease (Jackson & Cruz, 2018). Physical exam results (bowel sounds absent on inspection, distension of the abdomen on auscultation) also show that the patient has a small intestine obstruction. Appendicitis: The second diagnosis is appendicitis. The symptoms of appendicitis include flatulence, loss of appetite, vomiting and nausea, sudden pain that starts in the lower abdomen, pain that worsens when one coughs, diarrhea and constipation, low-grade fever and might increase if the illness progresses, and abdominal bloating (Talan & Di Saverio, 2021). The disease has been included because the patient reports abdominal pain, nausea, and vomiting which are part of the clinical manifestations of appendicitis. However, it is a secondary diagnosis because the patient does not have a low-grade fever, diarrhea, or pain in the lower abdomen. Intestinal Infection: The last diagnosis is an intestinal infection. The symptoms of intestinal infection include headache, vomiting, nausea, diarrhea, crampy abdominal pain, and fever (Guo et al., 2021). The disease has been ruled out because the patient does not have a headache or fever. P The patient will be recommended to undergo a CT scan combined with a series of X-ray images of the small intestine. The patient will also undergo blood tests. These tests will help identify the actual disease affecting the patient. Since it is suspected that the patient has small intestine obstructions, he should be hospitalized (Ten Broek et al., 2018)). The pain should be stabilized by placing an intravenous (IV) line into the patient’s arm so that he can be given fluids. Abdominal swelling should be relieved by putting a nasogastric tube inside the patient’s nose into his stomach to suck out fluids
Rough Draft Qualitative Research Critique and Ethical Consid
Rough Draft Qualitative Research Critique and Ethical Considerations Rough Draft Qualitative Research Critique and Ethical Considerations Write a critical appraisal that demonstrates comprehension of two qualitative research studies. Use the “Research Critique Guidelines – Part 1” document to organize your essay. Successful completion of this assignment requires that you provide rationale, include examples, and reference content from the studies in your responses. Use the practice problem and two qualitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment. In a 1,000–1,250 word essay, summarize two qualitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. Expert Answer and Explanation Research Critique Guidelines – Part II (Quantitative Studies) Dealing with postoperative pain, nausea, and vomiting is one of the issues that patients encounter after surgical procedures that affect their comfort and satisfaction and outcomes. Dealing with these challenges can affect the recovery process of the patient and may even prolong the discharge period. Several studies have tried to pinpoint different interventions that can assist in dealing with the issue of postoperative pain nausea and vomiting, with each having different results. The PICOT question, therefore, aimed to establish whether in adult patients undergoing general anesthesia, does giving preoperative analgesic and antiemetics decrease pain, nausea and vomiting postoperatively and provide better patient outcomes as compared to not receiving preoperative meds. Quantitative Studies To answer the PICOT question, this paper selected two quantitative research studies that had evidence-based interventions of dealing with postoperative pain nausea and vomiting. The selected studies were conducted by Elgohary et al. (2017) and Chetna et al. (2014). Some of the elements identified from the studies are detailed in the subsequent sections Background The first quantitative article reviewed was an article by Elgohary et al. (2017). The study wanted to carry out a comparison between the effectiveness of the ERAS program and the conventional perioperative care in patients who have undergone elective colorectal surgery. The author notes that the ERAS program has been revolutionary is assisting patients who have undergone colorectal surgery, among other surgical procedures, to respond better to stress and improving postoperative outcomes. The authors also note that the main aim of the ERAS pathway is to reduce the duration of hospitalization and allow the patient to recover quickly. However, the adoption of the program, especially in developing countries, has been slow despite sufficient evidence showing the effectiveness of the program. Therefore, the authors wanted to carry out a supportive investigation on the effectiveness of the ERAS pathway in patients after undergoing elective colorectal surgery. The findings collected in this study holds major significance in nursing practice since the results collected will facilitate the adoption of the ERAS pathway as a viable intervention in improving postoperative patient outcomes. The main aim of the research conducted by Elgohary et al. (2017), was to examine the feasibility and safety of the ERAS pathway in elective colorectal surgery. The research question identified from this objective can be quoted as “is the ERAS pathway feasible and safe for use in patients who have undergone elective colorectal surgery. The second quantitative study selected was conducted by Chetna et al. (2015). The study elaborated on the use of gabapentin for postoperative pain relief for patients who have undergone upper abdominal surgery. The researcher noted that in patients who have undergone upper abdominal surgeries, postoperative pain not only causes them distress but also leads to inadequate respiratory effort and cough reflexes, therefore, a need to have a pain relief strategy. The authors go further to site the efficacy of gabapentin in dealing with pain on patients who have undergone other types of surgical procedures. Therefore, the study was purposed at identifying whether the drug will still be effective in dealing with postoperative pain, for patients who have undergone upper abdominal surgery. The findings obtained in that research are relevant in enhancing patient recovery period and outcomes by eliminating postoperative pain, and in turn, improving respiratory efforts and cough reflex of the patient. The research question used in the study can be quoted as follows “How effective is gabapentin in reducing postoperative pain in patients who have undergone upper abdominal surgery?” How do these two articles support the nurse practice issue you chose? The main aim of the PICOT question was to establish viable methods of dealing with postoperative pain, nausea, and vomiting. The two articles provide evidence-based interventions on how postoperative pain can be dealt with. The first article by Elgohary et al. (2017) focuses on the ERAS pathway on reducing postoperative pain while the second article by Chetna et al. (2015) focuses on gabapentin on dealing with postoperative pain in patients who have undergone upper abdominal surgery. The finding on both studies will be used as a basis of assessing the effectiveness of using preoperative analgesics and antiemetics to decrease pain, nausea, and vomiting in patients postoperative as intended by the PICOT question. The first study was majorly focused on patients who have undergone elective colorectal surgery, while the second article was focused on patients who have undergone upper abdominal surgery. For both studies, the participants were placed in two groups. The first study by Elgohary et al. (2017) used the conventional recovery pathway as their comparison group, while the second study placed their comparison group under placebo. The intervention groups were placed under different perioperative pain regimen. This will be the same approach to be used by the PICOT question, with the difference being the target participants. The PICOT question used adult patients who had undergone general anesthesia
Identify your selected healthcare concern in your city or
Identify your selected healthcare concern in your city or state that needs your advocacy Identify your selected healthcare concern in your city or state that needs your advocacy with an elected official. What is the impetus and rationale for your selection? What is your solution to this concern? Describe the model of policy making that you feel would be best applied to your policy concern and the rationale for selecting this model. Expert Answer and Explanation The selected Healthcare Issue and Rationale for the Selection Mental health is the selected concern, and it encompasses various mental disorders and conditions. Examples are depression, phobia and schizophrenia. There is disparity in access to the mental health services, and people with mental health problems often face discrimination. In Texas, these concerns can impede efforts focused on meeting the health needs of people with mental illnesses. This is a key rationale for the selection of the mental illness as a problem that requires advocacy (Boehme, Biehl, & Mühlberger, 2019). Another reason why healthcare professionals need to advocate for the issue is to help reduce mortality rates based on mental health concerns. The Solution for the Concern The key solution for this concern is the expansion and funding of programs focused on increasing screening and treatment of people with mental health problems. In this case, it is important to call for the state government to allocate more funds into programs which address this particular health concern. The funds can be used to purchase medications, and resources which create awareness about mental health problems. However, subsidizing costs of treating this healthcare concern, through government-managed insurance plans, can equally help address the problem (Li et al., 2021). The Suitable Model of Policy Making and Rationale The institutional model would apply to the policy concern. Under this model, the authority lends legitimacy to the laws, and these laws equally apply to everyone. This is the rationale for the selection of the model. Using this model, the government can come up with policies which require the allocation of resources and funds to help manage the mental health challenges (Niedziałkowski & Putkowska-Smoter, 2020). It can use the local authorities or agencies which are responsible of enforcing the laws. References Boehme, S., Biehl, S. C., & Mühlberger, A. (2019). Effects of Differential Strategies of Emotion Regulation. Brain sciences, 9(9), 225.Doi: https://doi.org/10.3390/brainsci9090225. Li, Y., Scherer, N., Felix, L., & Kuper, H. (2021). Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis. PLoS ONE 16(3), e0246454.Doi: https://doi.org/10.1371/journal.pone.0246454. Niedziałkowski, & K., Putkowska-Smoter, R. (2020). What makes a major change of wildlife management policy possible? Institutional analysis of Polish wolf governance. PLoS ONE 15(4), e0231601. Doi: https://doi.org/10.1371/journal.pone.0231601. Place your order now on the similar assignment and get fast, cheap and best quality work written from scratch by our expert level assignment writers. Other Solved Questions: SOLVED! How would your communication and interview SOLVED! Describe the difference between a nursing practice SOLVED! Discuss how elimination complexities can affect SOLVED! Case C 38-year-old Native American pregnant ANSWERED! In a 1,000–1,250 word essay, summarize two [ANSWERED] Students will develop a 1,250-1,500 word paper that includes [ANSWERED] Post a description of the national healthcare ANSWERED!! Explain how you would inform this nurse ANSWERED!! In a 4- to 5-page project proposal written to the
[ANSWERED] Recommend one FDA-approved drug, one off-label drug, and
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents Assignment 1: Prescribing for Children and Adolescents Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use. —Agency for Healthcare Research and Quality Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug? For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents. Reference: Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html To Prepare • Your Instructor will assign a specific disorder for you to research for this Assignment. Persistent Depressive Disorder • Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents. The Assignment (1–2 pages) • Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents. • Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug? • Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration. • Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources. By Day 7 of Week 3 Submit your Assignment. Answer and Explanation Special Considerations Related to Prescribing for Children and Adolescents Anxiety disorder is a psychiatric health condition under the category of mood disorders. It is a condition characterized by intense panic and worries, even during usually day-to-day events. The CDC estimates that 9.4% of children aged 3-17 years, roughly 6 million children have some form of anxiety disorder (CDC, 2021). This post will evaluate the available treatment options for anxiety disorder, the risk assessment for the FDA-approved drug, and the clinical practice guidelines for the condition FDA-Approved Medication Treatment of anxiety disorder in children needs special consideration, given the nature of medication and attached side effects. Selective serotonin reuptake inhibitors (SSRI) are the first-line medication for anxiety disorders among children. One of the SSRIs that can be used to treat anxiety disorders is Escitalopram. In a study by Strawn et al. (2020), the researchers found that Escitalopram is effective in reducing anxiety disorder symptoms in adolescents and is well tolerated. Other than SSRIs, there are other classes of medication that are off-label but still effective in treating anxiety disorder. One of the off-label medications that can be used to treat anxiety disorder is Gabapentin. This is a drug that is usually used to treat patients who have depression with anxiety and bipolar (which is quite a common occurrence). In a study by Markota and Morgan (2017), there was a positive response pattern of gabapentin on anxiety disorder. Another article by Ahmed et al. (2019) also supported the same findings. Pharmacological approaches are usually more effective when combined with other behavioral interventions. One of the effective nonpharmacologic approaches is the use of cognitive behavioral therapy (CBT) to assist the patient in coping with situations that cause anxiety. CBT such as cognitive restructuring has been found effective in reducing the symptoms attached to anxiety disorder (Carpenter et al., 2018). Risk Assessment One of the risk assessments that I would conduct to inform the treatment plan for a child with anxiety disorder is a suicide risk assessment. Some of the medications that help relieve the symptoms attached to anxiety disorder have suicide ideation as one of the side effects. As such more tolerable medication should be given priority. One of the benefits attached to Escitalopram is that is well tolerated. However, its risk is that it has certain side effects that may affect an individual functioning like insomnia, lethargy, and headaches. One of the risks of using gabapentin is that it may not be as effective as an SSRI medication and, at the same time, can result in mood changes, sleepiness, nausea, and swelling o the arms and legs. Clinical Practice Guidelines for Anxiety Disorder According to Gautam et al. (2017), patients should be placed on medication for 6 to 12 months. Therefore, one should consider how the side effects will impact the patient in the long run before prescribing a medication. Additionally, Gautam et al. (2017) recommend the combination of both pharmacological approaches and physiotherapeutic approaches to further improve patient outcomes. This is also a way of reducing overdependence on psychopharmacological treatment. Conclusion Various treatment modalities can be used to help children and adolescents with anxiety disorder, some of which include SSRI medication, benzodiazepines, psychotherapy, and prescription of off-label
Reflect on the mission, vision, values, and goals of your
Reflect on the mission, vision, values, and goals of your healthcare organization and provide examples of how individual employees, departments Assignment: This assignment has two parts: an essay and a business plan. PART I – develop an essay to address the following information: Reflect on the mission, vision, values, and goals of your healthcare organization and provide examples of how individual employees, departments, and work units support all four of these as a foundation for directional strategies. Describe positive and negative aspects of abandoning traditional healthcare strategic planning processes and adopting a contemporary approach. How does complexity influence budget strategies and their implementation? Give examples. Discuss the process of external and internal environmental analyses, and then speculate on scenarios that may result if these steps in strategic planning are omitted or are not done well. Discuss mechanisms that nurse manager can use to ensure they make the best decisions for supporting the financial goals of the organization. PART II – develop a Business Plan Identify an opportunity for implementing a new service or a cost-reducing idea in your organization and write a business plan to describe your idea: explain the need (why) for it, identify stakeholders (who) will be impacted, discuss the benefits versus the disadvantages, describe the costs/expenses for the idea, and outline the implementation plan. Expert Answer and Explanation PART 1: Strategic Healthcare Management Planning is a concept that is used every day in our personal lives and the same behavior also translates into the management of organizations. The top leadership of organizations usually formulate strategies to meet the mission and vision of their organization. It is important because with every organizational activity, risk and resources are usually involved and they have to be adequately managed lest the organization loses its ability to function properly. The purpose of this paper will be to expound on different aspects concerning the application of strategic management practices in healthcare. Support for Mission Vision, Values, and Goals The organization is usually driven by its mission, vision, values, and goals formulated. The efforts of all individuals and organs functioning within the organization should be aligned to realize the accomplishment of these elements. A mission statement is one that highlights where the organization is going (Cronin & Bolon, 2018). For example, the mission for the healthcare facility I work for is “to provide quality and compassionate healthcare accessible to everyone.” Vision on the other hand is the future position of where the organization wants to be, while the values are the beliefs and practices uphold by the organization (Lahey & Nelson, 2020). The values for the organization I work for include teamwork, integrity, excellence, innovation, and compassion. Our goals are aligned to meet the said mission and vision of the organization while using our core values during our transactions with other stakeholders. The role of individual employees, departments, and work units in accomplishing this mission is to ensure that they channel all their efforts into fulfilling this mission. This includes identifying and removing any barriers that may hinder collaboration or promote conflicts due to differences in personal goals and objectives (Lahey & Nelson, 2020). It is also the role of individual employees and work teams to collect information on behalf of the organization on what other competing organizations are doing to accomplish goals employees can also support all the four elements by ensuring that they align how they discharge their duties with the values of the organization. Impact of Adopting a Contemporary Approach to Strategic Planning Strategic planning was developed due to the increased complexity of how the economy and organizations operate (Esfahani et al., 2018). The used traditional approach was a systematic process that emphasized on the mission and vision of the organization without considering other factors as equally important. The processes also involved coming up with the short term, medium, and long-term objectives, which were to be followed to the latter to gain a competitive edge. However, this approach had its drawbacks which made it be abandoned for a contemporary approach that was considered to be more responsive to the current business environment (Grube & Crnkovich, 2017). One of the positive aspects of abandoning the traditional approach to strategic management and transitioning to the contemporary approach is that a more responsive process that factors in day to day operational issues is considered. This means that organizations can easily make adjustments to their strategic decisions based on the current changes in operations. Another positive aspect of adopting a contemporary approach is that it treats strategic planning as a process and not an event (Grube & Crnkovich, 2017). This means that it is continuous and adjustable to changes in both the internal and external organization environment. The negative aspect is that the contemporary approach does not offer a predictable methodology or timeframe to strategic planning as it was with the traditional approach. Budget Strategies The current environment in the management of healthcare organizations has become more and more complex with increasing risks and stakeholders to transact with. This has also made healthcare financial managers restructure their methods to adjust to these complexities; this includes the budget-making process and implementation. One of the complexities has been the adoption of the contemporary approach to strategic planning that requires adjustment of organizational strategies with changes in the internal and external business environments (Walsh, 2016). Given that these adjustments can be abrupt, it becomes difficult to forecast and give accurate budgetary figures in an environment of uncertainty (Hill, 2016). Another factor is the addition of more stakeholders involved in decision making. This means that more data needs to be collected to make accurate budgetary forecasts which can also be time-consuming (Hill, 2016). As such, there is also a likelihood that the budget implementation timelines will also be affected. Process of External and Internal Environmental Analyses In the strategic management process, one of the core steps is to carry out an internal and external organization analysis. This allows the organization to collect its efforts in response to the findings of the two analyses. The process of carrying out environmental analysis is a five-step process that includes; first an analysis of the external environment (Esfahani et al., 2018). This
Mrs. J is a 63-year-old married woman who has a history of
[ANSWERED] Mrs. J is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD) It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span. Evaluate the Health History and Medical Information for Mrs. J., presented below. Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below. Health History and Medical Information Health History Mrs. J is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD. Subjective Data Is very anxious and asks whether she is going to die. Denies pain but says she feels like she cannot get enough air. Says her heart feels like it is “running away.” Reports that she is exhausted and cannot eat or drink by herself. Objective Data Height 175 cm; Weight 95.5kg. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin. Intervention The following medications administered through drug therapy control her symptoms: IV furosemide (Lasix) Enalapril (Vasotec) Metoprolol (Lopressor) IV morphine sulphate (Morphine) Inhaled short-acting bronchodilator (ProAir HFA) Inhaled corticosteroid (Flovent HFA) Oxygen delivered at 2L/ NC Critical Thinking Essay In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following: Describe the clinical manifestations present in Mrs. J. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered. You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. EXPERT ANSWER AND EXPLANATION Patient Assessment and Treatment One’s physiological wellbeing depends on a wide range of factors including lifestyle behaviors. The prolonged use of the psychotic substances, for example, can expose one to the risk of developing health problems, and the nature of the medical condition one develops depends on the substance they use. For instance, smoking tobacco exposes smokers to the risk of developing respiratory issues. Equally, the type of food one eats and their levels of physical activity can have a certain level of impact on their physiological wellbeing. It is imperative to explore the case of patient with COPD, in terms of the effectiveness of the intervention she receives, and examine the contributors to the heart failure. Mrs. J’s Clinical Manifestations Based on the Mrs. J’s medical history and subjective data, she exhibits a number of clinical manifestations. One of these manifestations is the acute exacerbation of the chronic obstructive pulmonary disease (COPD). Another clinical manifestation present in the patient is acute decompensated heart failure. These two conditions explain the reason why she experiences difficulties breathing, and her heart rate is irregular. She has Congestive Heart Failure (CHF). Mrs. J also shows sign of hypertension considering that her blood pressure level is 90/58, and this is more than the 120/80 average (Lin et al., 2016). Additionally, the patient has fever, and besides this fever, she cannot perform Activities of Daily Living (ADLs). She coughs blood-tinged sputum, and this indicates a possible respiratory problem. Assessment of the Effectiveness of the Nursing Interventions Mrs. J takes a number of medications to help promote her recovery, and while these medications are effective, some may not be necessary in her case. She takes IV furosemide, and this intervention is appropriate based on her case. This is because this medication would help relieve her heart failure problem by helping improve the heart’s blood-pumping capacity. Given the patient’s
A mother comes in with 9 month old girl. The infant is 68.5cm
A mother comes in with 9 month old girl. The infant is 68.5cm in length (25th percentile per CDC growth chart) DQ1: Consider the following patient scenario: A mother comes in with 9 month old girl. The infant is 68.5cm in length (25th percentile per CDC growth chart), weighs 6.75kg (5th percentile per CDC growth chart), and has a head circumference of 43cm (25th percentile per CDC growth chart). Describe the developmental markers a nurse should assess for a 9–month–old female infant. Discuss the recommendations you would give the mother. Explain why these recommendations are based on evidence-based practice. DQ 2: Child abuse and maltreatment is not limited to a particular age—it can occur in the infant, toddler, preschool, and school-age years. Choose one of the four age groups and outline the types of abuse most commonly seen among children of that age. Describe warning signs and physical and emotional assessment findings the nurse may see that could indicate child abuse. Discuss cultural variations of health practices that can be misidentified as child abuse. Describe the reporting mechanism in your state and nurse responsibilities related to the reporting of suspected child abuse. DQ 1: Expert Answer and Explanation Health Assessment for Infant For a 9 month female infant at 25th percentile of height and head circumference, yet only in the 5th percentile in terms of weight demystifies that the infant is underweight. The CDC provides essential developmental markers that a nurse should consider when assessing the nine-month-old female infant (CDC, 2019). For instance, at the age of 9 months, the infant ought to have developed social and emotional markers such as being afraid of strangers, recognizing favorite toys, and being clingy to familiar adults. Communication makers include the ability to copy sound or gestures, use finders to point, and understanding “no.” In terms of the cognitive and physical development, the infant should be able to watch the path of a falling object, put items in mouth, move objects from one hand to the other, sit without support, crawling, and standing while holding on to something (CDC, 2019). The assessment can also include the nutritional and dieting aspect of the infant. As a nurse, I would recommend improvements regarding nutrition and diet, increased movements, and mental alertness. The recommendation is in light of the infant’s underweight appearance. I would first discuss with the mother the importance of a proper diet and nutritional value to the growth of the baby both physically and mentally (Green, 2018). I will also inquire about the breastfeeding routines if the infant is being given other formulas that improve their growth. It is essential for the mother to comprehend the relevance of breastfeeding and the type of food that an infant can begin to eat after the six months following the delivery. It is also essential to offer the mother nutrition awareness materials such as handouts so that she can refer and offer the child with appropriate meals for weight gain. References CDC. (2019). What developmental milestones is your 9-month-old reaching? Retrieved 18 May 2020, from https://www.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html Green, S. (2018). Health assessment: Foundations for effective practice. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/ Alternative Expert Answer Developmental Markers for a 9-Month Old Baby When assessing a 9-month old female infant for any developmental issues, a nurse has to look at the developmental markers for a child at this age. On average, a female baby at this age weighs 8.2 kg. For a child at this age, still, their average length is 70.1 cm, and the size of their head is 44.5 cm. Although a baby starts to crawl when they reach this age, not all crawl when they hit 9 month after birth, and they may start walking after the 12 month. The baby also sits, babbles and express interest in picking things. Additionally, they reach for objects while sited, and they may pool themselves up using tables or chairs (Tandon, 2017). The child may express anxiety when separated from their parents. When examining this child, the nurse would need to take to consideration the fact that a baby at 9 months can respond to their name, and they know their parents (Breiner et al., 2016). The baby in the case seems to be experiencing the developmental issues. The baby’s weight is 6.75 kg which is lower than the average 8.2 kg. Their length is 68.5 cm, and this is slightly below the average length of 70.1 cm for female babies at this age. The circumference of her head is also slightly lower than that the average. As a nurse, I would recommend to the parent to encourage the baby to move. This would be important in helping build the baby’s muscles. The parent may hold the baby’s hands and pull them while they walk together (Tandon, 2017). It is also important for the parent to consider feeding the child a meal rich in protein so that the child gets to meet her nutritional needs. This would help her gain weight. These recommendations can translate to better clinical outcomes because a number of studies link practice and nutrition to the improved child development (Tandon, 2017). References Breiner, H., Ford, M. A., Gadsden, V. L., & National Academies of Sciences, Engineering, and Medicine (U.S.). (2016). Parenting matters: Supporting parents of children ages 0-8. Washington: National Academies Press. Tandon, M. (2017). Early Childhood Mental Health: Empirical Assessment and Intervention from Conception through Preschool, An Issue of Child and Adolescent Psychiatric Clinics of North America. Amsterdam: Elsevier. DQ 2: Expert Answer and Explanation Child Abuse and Maltreatment Child neglect is the most common form of child abuse that school going children go through. The maltreatment has the capacity to negatively affect all aspects of their lives while in school. Poor grades and low self-esteem are some of the negative results of this form of maltreatment in school-going children (Zeanah, & Humphreys, 2019). Physical abuse is the second form of child maltreatment that is common in school-going children. Physical abuse may present itself in different forms. Beatings, stabbing, punching and kicking are ideal examples of physical abuses meted upon school going children. There are
[ANSWERED 2023] Among the Resources in this module is the Rutherford (2008) article Standardized Nursing Language: What Does It Mean for Nursing Practice? In this article
Among the Resources in this module is the Rutherford (2008) article Standardized Nursing Language: What Does It Mean for Nursing Practice? Among the Resources in this module is the Rutherford (2008) article Standardized Nursing Language: What Does It Mean for Nursing Practice? In this article, the author recounts a visit to a local hospital to view the recent implementation of a new coding system. During the visit, one of the nurses commented to her, “We document our care using standardized nursing languages but we don’t fully understand why we do” (Rutherford, 2008, para. 1). How would you respond to a comment such as this one? To Prepare: Review the concepts of informatics as presented in the Resources, particularly Rutherford, M. (2008) Standardized Nursing Language: What Does It Mean for Nursing Practice? Reflect on the role of a nurse leader as a knowledge worker. Consider how knowledge may be informed by data that is collected/accessed. The Assignment: In a 2- to 3-page paper, address the following: Explain how you would inform this nurse (and others) of the importance of standardized nursing terminologies. Describe the benefits and challenges of implementing standardized nursing terminologies in nursing practice. Be specific and provide examples. Be sure to support your paper with peer-reviewed research on standardized nursing terminologies that you consulted from the Walden Library. Answer Importance of Standardized Nursing Terminologies The emphasis on delivery of the safe care is growing, and this warrants the need for the nursing practitioners to clearly, and accurately document clinical information including the details of the patient assessment and interventions. The accuracy and clarity with which these providers document the information is dependent on whether they use the Standardized Nursing Terminologies (SNTs). The SNTs consist of the terminologies which users can use to share and document information. This prevents cases where the lack of the clarity of the information which stems from the provider deciding not to use the SNTs, affects its meaning (McGonigle & Mastrian, 2017). This study examines the approach of informing nursing practitioners the SNTs’ benefits, and the benefits and risks associated with the implementation of these terminologies. Communication and Benefits The idea of communicating the essence of the SNTs to the nurses is important because it helps them be aware of the availability and usability of these SNTs, and the person doing the communication can realize this objective by utilizing various methods. One of the most effective approach to communicating these benefits is organizing a conference meeting where nurses can meet, and directly informing them of the benefits they are likely to accrue if they use the SNTs. The organizational memo can also be an effective way of delivering this information. When using it as a platform for communication, the individual delivering the message concerning the benefits of the SNTs may either post the memo on the strategic areas within the hospital premises, or send the memo to nurses’ emails addresses. However, they can also utilize the journals (Rutherford, 2008). The professional nursing journals can particularly be useful when it comes to communicating the value of the SNTs. Benefits and Challenges While the implementation of the SNTs can be important, it can present various challenges. A key benefit that an organization can derive from implementing the SNTs is effective communication. The SNTs present common terminologies which can be effective in relaying clinical information, and this ultimately makes it possible for the clinicians to effectively share information. Sometimes, the need arises for the information to be in a form which only the providers can internalize. The use of the SNTs makes this possible in the sense that the codes or the taxonomies only make sense to clinicians, and people who do not know the meanings of these terminologies may not understand the conveyed message (Thew, 2016). This ultimately helps secure the clinical data. The visibility of the nursing care, furthermore, becomes more noticeable with the use of the SNTs given that the conventional approach in which the nurse verbally communicate to colleagues presents visibility issues (Macieria et al., 2019). However, the SNTs do not have atomic level terminologies, and this can hamper the efforts aimed at developing the SNTs. Conclusion Reflecting on the discussion of the SNTs, it is clear that incorporating the SNTs into clinical practice can have significant benefits to the hospital, and it is therefore important that nurses understand the usefulness of the SNTs. Informing nurses about the merits of these terminologies may help them adopt a more positive attitudes towards the use of these terminologies. Consequently, they are likely to accommodate and encourage the use of these terminologies to document information. The security of the clinical information, and the improved visibility of the clinical intervention are some of the outcomes linked to the use of the SNTs. References Macieria, T. G. R., Smith, M. B., Davis, N., Yao, Y., Wilkie, D. J., Lopez, K. D., & Keenan, G. (2017). Evidence of progress in making nursing practice visible using standardized nursing data: A systematic review. AMIA Annual Symposium Proceedings, 2017, 1205–1214. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977718/. McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning. Rutherford, M. A. (2008). Standardized nursing language: What does it mean for nursing practice? Online Journal of Issues in Nursing, 13(1), 1–12. doi:10.3912/OJIN.Vol13No01PPT05. Thew, J. (2016, April 19). Big data means big potential, challenges for nurse execs. Retrieved from https://www.healthleadersmedia.com/nursing/big-data-means-big-potential-challenges-nurse-execs. Place your order now for a similar assignment and get fast, cheap and best quality work written by our expert level assignment writers.Use Coupon Code: NEW30 to Get 30% OFF Your First Order Resources McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning. Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535) Chapter 26, “Nursing Informatics and the Foundation of Knowledge” (pp. 537–551) American Nurses Association. (2018). Inclusion of recognized terminologies supporting nursing practice within electronic health records and other health information technology solutions. Retrieved from https://www.nursingworld.org/practice-policy/nursing–excellence/official-position-statements/id/Inclusion-of-Recognized-Terminologies-Supporting-Nursing-Practice-within-Electronic-Health-Records/ Macieria, T. G. R., Smith, M. B., Davis, N.,
Assume you are a nurse manager on a unit where a new nursing
Assume you are a nurse manager on a unit where a new nursing documentation system is to be implemented. You want to ensure that the system will be usable and acceptable for the nurses impacted. You realize a nurse leader must be on the implementation team. To Prepare: • Review the steps of the Systems Development Life Cycle (SDLC) and reflect on the scenario presented. • Consider the benefits and challenges associated with involving a nurse leader on an implementation team for health information technology Portfolio The Assignment: (2-3 pages) In preparation of filling this role, develop a 2- to 3-page role description for a graduate-level nurse to guide his/her participation on the implementation team. The role description should be based on the SDLC stages and tasks and should clearly define how this individual will participate in and impact each of the following steps: • Planning and requirements definition • Analysis • Design of the new system • Implementation • Post-implementation support Expert Answer and Explanation Role of the Nurse Informatics in System Development and Implementation The development of the informatics systems encompasses the different stages that collectively form the Systems Development Life Cycle (SDLC). For a manager and a leader in a healthcare organization, the knowledge of the SDLC is crucial in the sense that it facilitates their preparation, making it possible for them to be aware of the requirements at different levels of system development. When involving a graduate-level nurse (GN) in SDLC, a unit nurse manager should present a role description, describing the nurse’s role at various stages of the SDLC (Risling & Risling, 2020). Focusing on the SDLC stages, it is important to describe the GN’s role in SDLC, highlighting the various ways in which they would participate in the implementation of an informatics system. Planning and Requirements As the initial stage of the SDLC, planning involves various tasks such as defining an issue that necessitates the development of the system, and outlining the system requirements. During this phase of the SDLC, the GN contributes to defining the system’s objectives and scope. Given their experience and expertise, they understand the different professionals who are likely to use the system. Accordingly, they would identify the stakeholders that are likely to contribute to the adoption of the system. Their role during the planning also involves participating in performing needs assessment, identifying the areas of concern (McGonigle & Mastrian, 2022). For instance, they may identify the challenges associated with the paper-based documentation systems, and work with nurse leaders to come up with meaningful solutions. System Analysis Analysis stage emphasizes defining the requirements by collecting, analyzing and validating data, and at this point, the GN collaborates with the other parties involved in the project implementation, evaluating the workflow including the efficiency of the clinical operations. In their capacity as nurse leaders, their input into the SDLC involves determining the barriers that may slow down the development of the system, and contributing to the assessment of the risks (Agency for Healthcare Research and Quality, n.d.a). This identification of the risk is important because it helps inform the formulation of the meaningful solutions that can help avert the risks. Because capturing the clinical requirements in the design of the system can be a challenge, involving the GN is important because they can act as a link between those working in clinical setting and the team tasked with implementing the system. System Design The GN’s role is critical during the system design stage which involves transforming the requirements including what is captured into the plan, to a plan that defines the technical measures to be undertaken to complete the system. At this point, the GN adopts a collaborative approach, working together with the stakeholders involved in system development, to come up with a technical plan that comprises the workflow including the user interface. Additionally, they share pertinent information that can assist with designing of the system (Singletary & Baker, 2019). For instance, they may recommend the details about the features that that can improve the usability of the system or make it user-friendly. Considering their experience, they can share information about the challenges they faced while using a system. The designers can design the system with this information in mind, designing a more potent system with desirable features. System Implementation When it comes to the system implementation, the GN’s role becomes more noticeable as they perform various tasks including training members of the clinical staff on how to use the system. While this training is meant to equip the staff with adequate technical skills that they can apply in using the system, the training helps them understand the expectations and the benefits associated with the system. Given the challenges associated with adopting a new system, they may work closely with the change managers, ensuring that the process of shifting to a new system succeeds (Hauschild et al., 2022). At this phase, still, they test the system to determine whether it is functioning effectively according to the requirements. In case they notice any issue with the system, they involve the technical team to rectify the issue or recommend replacing the dysfunctional system parts. Post-Implementation Support During the post-implementation phase, giving of the feedback becomes necessary because this feedback helps with gauging the effectiveness of the system. This feedback particularly comes from the nurses or other health workers who use the system, and it may range from the problems experienced by users while using it, to any suggestions that may help improve user experience. Leveraging this feedback, the implementation team can decide how to improve the performance or optimize usability (Agency for Healthcare Research and Quality, n.d.b). Following the implementation, they may be responsible of monitoring how the clinical staff uses it, ensuring that they use it a way that conforms to the required safety and data security standards. Conclusion In overview, the engagement of the GN in SDLC is crucial because they can immensely contribute to the adoption of the new system given
[SOLVED 2023] In this assignment you will analyze a case involving public safety versus an individual’s privacy
In this assignment you will analyze a case involving public safety versus an individual’s Unit III Case Study Right to Privacy Case Study Certain freedoms such as civil liberties and civil rights are concepts highly revered by Americans; however, there are times when these two concepts conflict in the name of safety and national security. The Digital Age is having a profound effect on the privacy of individuals in both their daily and private lives. With technology like cameras and smartphones, the activities of people are being recorded more, whether it is running a red light, entering a building, playing in a park, or using an ATM machine. In this assignment you will analyze a case involving public safety versus an individual’s privacy. Read the following article from the New York Times concerning Carpenter v. United States, a case recently decided by the Supreme Court. Liptak, A. (2018, June 23). Warrant required for cellphone tracking data. New York Times, p. A1(L). Retrieved from http://link.galegroup.com.libraryresources.columbiasouthern.edu/apps/doc/A543973598/ STND?u=oran95108&sid=STND&xid=753160e8 For more background on the case, here is a link to the actual opinion written for this case: https://www.supremecourt.gov/opinions/17pdf/16-402_h315.pdf Please answer the following questions concerning this case. Address the questions in a cohesive essay. It should be at least two pages in length and should be double-spaced, and typed in 12-point Times New Roman font. Please be sure to provide an introduction to your essay, Which part of the Constitution addresses individual privacy rights? Do you believe that, with today’s technology, the Constitution still adequately protects those rights? Why, or why not? Describe the issue that was debated in this case. How was the need for public safety and security balanced with individual civil liberties and civil rights impacted by the final ruling in this case? Do you agree with the majority opinion or the dissenting opinion in this case? Explain your response. Where do you personally draw the line in this privacy issue? Explain how historical thought and tradition affect civil liberties and rights as they pertain to the issue presented in this case. Describe how politics can intersect with civil rights. What consequences do you support for those who violate constitutional rights? What, if any, compensation do you recommend for individuals whose rights have been violated by others? You must use at least two sources, in addition to the article given, to support your response. Make sure that all sources are cited and referenced using APA style. Expert Answer and Explanation Unit III Case Study Among the most discussed civil liberty in the US is the right to privacy. This is especially in the light of technology advancement, where in the recent past, there has been numerous technological advancements that infringe the rights of privacy by accessing personal data of individuals, especially through different telecommunication providers. The digital age has affected the private lives of Americans as they can be recorded when entering a building, passing a red light in traffic, playing in parks or even using ATM machines (Citron, 2018). This assignment involves an analysis of the Carpenter v. United States case, where privacy and phone location data as well as other elements are highlighted. Part of Constitution that Addresses Individual Privacy Rights and the Capacity of the Constitution to Protect those Rights The fourth amendment is the part of the constitution that protects individual privacy rights in an extensive way. Under this section of the constitution, which was added in December 1791, people are protected from searches that are unlawful or even seizures by authorities (Henderson, 2017). The police need to have a warrant to access your house and conduct extensive search. Issue debated in the Case In the Carpenter v. United States case, the issue debated about was the question as to whether or not the police, or other authorities, have the right to have unrestricted access to customer data through the telecommunications service providers (Chaudhari & Prasad, 2019). It was an issue that was raised in response to the anti-terrorism procedures set by the police of accessing different gadgets held by citizens to prevent unsafe digital activities. My Agreement in the Majority Opinion in the Case The majority opinion in the case held that there should be a warrant for the police to access the site location or other information of a citizen from a cell phone company. This majority opinion was held by Chief Justice Roberts, and was joined by justices Sotomayor, Kagan, Ginsburg, and Breyer (Chaudhari & Prasad, 2019). I agree with this opinion as it is among one of the only few ways that customers of telecom companies can feel safe using the devices to communicate amongst themselves. How Historical Tradition affects the thoughts as Pertaining to this Case One of the historical traditions that affected the thoughts pertaining to the case is that the police are meant to provide security for citizens, and that citizens should be willing to cooperate in all ways they are asked to. This traditional opinion dismisses the fact that some of these members of the police taskforce may be ‘dirty,’ and hence infringing the privacy of citizens would have the wrong beneficiaries. Intersection of Politics with Civil Rights Politics affect civil rights in a large way. In the Carpenter v. United States case, four justices including Justice Alito, Justice Gorsuch, Justice Kennedy, and Justice Thomas, has dissenting opinions, and several analysts argued that their indifference to the issue of privacy was on a political basis. Consequences for those Who Violate Constitutional Rights Violation of constitutional rights is a serious criminal offense, and I support the legal punishment of culprits of the same. However, there should be adequate warnings before serious actions are taken on the affected individuals. Compensation I Recommend for Individuals whose Rights are Violated by others A public pardon is best when a crime committed exposes a citizen to public shame. In other violations, I believe financial compensation to the individuals whose rights are violated should be done. I also believe that the culprits should compensate all other damages associated with the violations. References Chaudhari, N., & Prasad, S. K. (2019). Carpenter v. United States: State Surveillance and Citizen Privacy. NALSAR Stud. L. Rev., 13, 129. Citron, D. K. (2018).