What: Is the condition? Are some ways to get this condition? Causes the condition?

/in /by

What: Is the condition? Are some ways to get this condition? Causes the condition?

Medications would most likely be given (classification)

Who: does it impact most? Community, race, gender?

When: does it occur? Is it spontaneous, inherited, idiopathic?

Why: Does it happen?

How: Does it present? (How does it present itself signs and symptoms)

Must also provide education on 2 medications related to this condition. Explain some expected side effects, when to call the doctor, any special recommendations?

I am in need of a Gap Analysis to be put together in a power point presentation at least 10 slides with grafts in at least 2 slides. 

/in /by

I am in need of a Gap Analysis to be put together in a power point presentation at least 10 slides with grafts in at least 2 slides.

The Gap Analysis is on Policies within the Hospital that I work at.

The Attachments:

-Policy Gap Analysis–the past current and future status of the where we are

-Policy Question–A survey was given to the staff on what policies they felt were needed

-Policy Survey–Results of the survey.

Holtz Children’s & The Women’s Hospital

/in /by

Holtz Children’s & The Women’s Hospital

1 / 2

Q2 Are there any other policies (not mentioned above) that would be most important to consider in our first phase.

Answered: 37 Skipped: 42

# RESPONSES DATE

1 Labor and delivery policies for different medications 6/29/2022 3:44 PM

2 Intra hospital ratio for our patients, because we’re always struggling. 6/16/2022 11:00 AM

3 Intra hospital transport for floor patients. 6/16/2022 10:59 AM

4 Transitional care 6/15/2022 11:26 AM

5 Labor and delivery 6/13/2022 10:46 PM

6 no 6/10/2022 5:51 PM

7 all 6/10/2022 8:27 AM

8 Misoprostol, 6/9/2022 12:39 PM

9 Staffing ratios, first priority 6/9/2022 9:32 AM

10 Staffing ratios , first priority 6/9/2022 9:31 AM

11 Precepting readiness. 6/9/2022 7:09 AM

12 Magnesium sulfate for PEC and neuro protection. Specifically how long should they stay for recovery post delivery

6/9/2022 4:16 AM

13 Newborn Glucose management: admission to MB, mother GDM Newborn Mag exposure. Newborn thermoregulation

6/8/2022 3:50 PM

14 Guidelines for monitoring antenatal testing resulting in transfer of care or admission effects both antenatal testing out patient and 7B ; diabetic monitoring, orders and the antepartum/postpartum patient

6/8/2022 7:55 AM

15 No 6/8/2022 6:14 AM

16 Vacuum assisted deliveries 6/8/2022 4:01 AM

17 Specific policies for L&D such as pitocin management 6/8/2022 2:56 AM

18 medications 6/8/2022 12:16 AM

19 Feeding protocol 6/8/2022 12:01 AM

20 Policies for magnesium, pitocin, miso for IUFD, penicillin desensitization 6/7/2022 10:19 PM

21 Every policy regarding how things needed to be done. 6/7/2022 8:28 PM

22 Appropriate Staffing for standard of care 6/7/2022 8:07 PM

23 Managing labor and delivery patients 6/7/2022 5:15 PM

24 Cooling blanket policies ECMO policies Patient acuity policy (patient to nurse ratio based on acuity) IVH bundle policy

6/7/2022 11:48 AM

25 TOO NEW TO KNOW. EVERYTHING! 6/7/2022 10:19 AM

26 Diabetic policies 6/5/2022 1:58 AM

27 N/A 6/3/2022 1:53 PM

28 Safety 6/3/2022 1:30 PM

29 neonatal ecmo management. neonatal hypothermia management. neonatal respiratory 5/30/2022 7:08 PM

 

 

Holtz Children’s & The Women’s Hospital

2 / 2

distress, neonatal infection control. peripheral line management aseptic techniques vs sterile technique for picc and central lines.

30 1.How often and how much to administer for cheek painting 2. Documentation in the 3 different level of care 3. Glucose monitor frequency in the different level of care and for baby on insulin. 4. DNR policy for NICU ( currently we have no parental consent form) 5. Please please please a policy on dose to administer nasally for Versed for procedure.(currently doctors have an agreement nurses do not have anything in writing.

5/27/2022 10:45 AM

31 PACU/Recovery 5/27/2022 7:54 AM

32 Medication administration and compatabilities. Neonatal development 5/26/2022 9:47 AM

33 N/A 5/26/2022 9:37 AM

34 No 5/26/2022 9:35 AM

35 N/a 5/26/2022 9:35 AM

36 1.Report guidelines ie history of the mother as well as the baby especially on admission. 2. Blood draw guidelines ie nurses should be trained to obtain all blood draws and not be restricted. This should include blood cultures and should be coordinated with IV insertions. 3. Noise control guidelines ie loud talking over the baby’s bed/isolette especially during admissions and parents having their phones on speaker within inches of the infant’s face.

5/26/2022 7:40 AM

37 not at this time 5/23/2022 8:46 AM

 An older client was recently discharged from the hospital for evaluation of seizure activity.

/in /by

An older client was recently discharged from the hospital for evaluation of seizure activity. His history reveals that he has late-stage Alzheimer’s disease, Parkinson’s disease, hypertension, and type II diabetes mellitus, which is controlled by diet. He lives at home, where his wife and daughter take care of him. His discharge medications include phenytoin (Dilantin), 100 mg BID; hydrochlorothiazide (HydroDIURIL), 50 mg QD; levodopa (Sinemet), 25/100 TID; and haloperidol (Haldol), 1 mg before bed. The client has been referred for home care nursing follow-up.

Questions:

  1. On the initial home visit by the nurse, what assessments should be made?
  2. The wife and daughter need teaching about his antiepileptic medication. What teaching should be included?
  3. During the initial home visit, the client experiences a generalized seizure. What action should the nurse take?

You have been working as a nurse in the adult oncology unit for the past year

/in /by

You have been working as a nurse in the adult oncology unit for the past year. You have developed a close relationship with many of your patients, but Mr. Newcomb has a special place in your heart. He has been diagnosed with stage 4 pancreatic cancer and has undergone aggressive chemotherapy. Each day his wife has come to the unit to be with her husband. They have been married for over 40 years and share a deep love.

Mr. and Mrs. Newcomb have made the decision to no longer continue with treatment and have decided that hospice care is needed. Over the past few days, you have watched Mr. Newcomb’s health decline, and you can tell from your experience that he does not have much time left to live. Mr. Newcomb has been very open about discussing his death, and you have had the opportunity to learn about his life and the legacy he will leave behind.

While you are completing your rounds, you stop in Mr. Newcomb’s room to see how he is doing. You ask, “Is there anything else I can do for you?” Mr. Newcomb has rarely asked for anything, but today he has one request. Mr. Newcomb states, “Before I die, I would like to see my mistress one more time. Mrs. Newcomb is always here. Do you think you could tell her that I will be busy for a few hours tomorrow so I can make arrangements to see my mistress one more time?”

Reflect on the following questions before you begin working on this task:

•   What would you do in this scenario?

•   How can your knowledge of ethical principles be utilized to determine your response to Mr. Newcomb?

•   How would this affect you as a nurse and direct provider of care for Mr. Newcomb?

A.  Summarize how the principles of beneficence, non-maleficence, autonomy, and justice apply to the scenario by doing the following:

1.  Describe how you would respond to Mr. Newcomb’s request.

2.  Evaluate how you applied the principles of beneficence, non-maleficence, autonomy, and justice to the scenario.

3.  Examine how personal beliefs and values influenced your response to the scenario.

4.  Describe three strategies to promote self-care.

 Research an article that relates to client needs for quality safe patient-centered care.

/in /by

Research an article that relates to client needs for quality safe patient-centered care.  Choose a peer-reviewed article that addresses one of the following topics: -Safe/effective environment, management of care, safety and infection control, health promotion and maintenance, reduce risk potential, healthcare policy, provider of care, and/or patient-centered care.

Cystic fibrosis (CF)

/in /by

Cystic Fibrosis

Cystic fibrosis (CF) is a prevalent autosomal disease caused by autosomal passive alleles. Alles are different kinds of genes located at the same locus on the chromosome (McCance and Huether, 2019). Cystic fibrosis is a life-limiting autosomal recessive disease that affects around 30,000 people in the U.S. and 70,000 around the world (Peters, 2014). It is the most commonly known deadly disease in white children, occurs at about 1 in every 2500 births, and about 1 in every 25 whites carries a duplicate of the allele that can cause cystic fibrosis (McCance and Huether, 2019). In various organ systems, most commonly gastrointestinal, pneumonic and genitourinary, this hereditary problem causes the collection or accumulation of thick gooey discharges. The affected individuals usually battle recurrent respiratory infections, pancreatic insufficiency, and malnutrition. The transpiration or sweat glands are also affected.

Pathophysiology

Cystic fibrosis is caused by a change in the quality of the cystic fibrosis transmembrane conductance controller (CFTR) (Brown, White, and Tobin, 2017). The movement of chloride and sodium particles across epithelial cell layers or membranes is regulated by the CFTR generated by this gene. The cystic fibrosis gene encodes a protein product that forms chloride channels in the membranes of specific epithelial cells, as per McCance and Huether (2019). CFTR transports proteins through membranes and works with the epithelial sodium channels simultaneously to maintain the balance of salt, fluid and PH in different epithelial membranes. Impairment in the transport of chloride ions causes a salt imbalance that leads to anomalous, thick and dehydrated discharges of mucus or body fluid. Approximately 1,900 CFTR mutations have been recognized as indicated by Peters (2014). F508del, with heterozygotes and homozygotes making up 87 percent and 47 percent of patients with cystic fibrosis, is the most commonly known mutation. According to McCance and Huether (2019), associations (marriage between related individuals or people) is a factor in the creation of offspring with recessive diseases or sickness, such as cystic fibrosis. This is on the basis that related individuals or persons are bound to have similar alleles that cause recessive disease.

The patient showed the side effects of colic, an inability to gain weight despite having a good appetite, a salty taste, a chest clog, and pneumonia, as indicated in the case study. These introductions are due to a defect in the transport of chloride ions and a salt imbalance that causes abnormally thick mucus or body fluid secretions in the various secretive glands. They cause colic, distension, malabsorption, inability to thrive, and meconium ileus in newborn children to the point where secretions accumulate in the digestive tract (Brown, White, and Tobin, 2017). It can hinder the pancreas, leading to a lack of healthy sustenance. With mucus-inducing cough, wheezing, dyspnea, chest clog, and pneumonia, the lungs may be hindered. An undescended testicle, congenital bilateral absence of vas deferens and infertility in women are part of the genitourinary presentation.

Genetic Factor

Genes are the essential hereditary units within a cell nucleus known as chromosomes. There are 46 chromosomes in each person, 23 taken from each parent. In CF, each parent carries one anomaly CF gene and one normal CF gene, but due to the fact that the normal CF gene dominates the abnormal CF gene, the disease does not appear. In order to have CF, the child must acquire two abnormal CF genes, one from each parent. Since it is a non-sex-connected chromosome, CF can also occur in both males and females. Parents of children with autosomal recessive diseases, for example, CF is a heterozygous carrier of the genes of the disease, so there is a risk of 25 per cent of disease or disease in other children. Before considering having children, at-risk parents should seek hereditary advice. In the case of an increasing number of autosomal recessive hereditary or genetic diseases, parents may also benefit from Carrier detection tests.

Diagnosis and Treatment

The diagnosis of CF is made by means of a screening test for infants or newborns. A regular sweat test is performed to give a full diagnosis of CF if the test is positive for CF. The management of CF depends on the severity and progression of the disease. These include breathing, immunization, symptomatic therapy, non-intrusive therapy, physical therapy, exercise, and medication therapy (Brown, White, and Tobin, 2017). Other measures of physiotherapy, such as chest percussion and breathing, are often carried out with the ultimate aim of expanding and draining secretions from the lungs. In some extreme cases, lung transplantation may be considered (Mikesell, 2019). Dietary supplementation by prescription, diet and vitamins improves nutrition. In most cases, numerous antimicrobials and enzyme replacements are consistently used in the treatment of CF patients.

Conclusion

Cystic fibrosis is an inherited multisystem disease that affects the function of CFTR, resulting in chronic pulmonary disease, gastrointestinal interference, and the blocking of exocrine organs or glands. In Caucasians, CF predominates over other ethnic groups, approximately 1 in 3500 in North America and Europe, and new cases are analyzed annually (McCance & Huether, 2019). Diagnosis depends on the clinical indication and laboratory findings of the sweat test. It is important to maintain a follow-up appointment with the healthcare provider and management team due to the nature and complications of the disease.

References

Brown, S. D., White, R., & Tobin, P. (2017). Keep them breathing: Cystic fibrosis pathophysiology diagnosis and treatment. Journal of The American Academy of Physician Assistants, 30(5): 23-28. Retrieved from https://dx.doi.org.ezp.waldenulibrary.org/10.1097/01.JAA0000515540.36581.92Links to an external site.

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Mikesell, H. F. M. (2019). Cystic fibrosis and genetics. Salem Press Encyclopedia of Health.

Retrieved December 2, 2020 from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=ers&AN=94416438&site=eds-live&scope=site

Peters, S. (2014). Cystic fibrosis: A review of pathophysiology and current treatment recommendations. The Journal of the South Dakota State Medical Association, 67(4): 148-51, 153. Retrieved from https://web-a-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/detail?vid=5&sid=81561ef6-823c-4415-9f10-d7568752e3f9%40sessionmgr4008&bdata=JnNpdGU9ZWhvc3QtbGI2ZSZzY29Wzt1zaXRILinks to an external site.

Written Assignment Hypothermia and Hyperthermia

/in /by

Written Assignment Hypothermia and Hyperthermia

 

 

 

Complete all lesson content and assigned readings. Make sure you are focusing on:

1. Differences between hypothermia and hyperthermia

1. Patient impacts from hypothermia and hyperthermia

1. Patient education for clients and families to avoid extreme temperature variations

Instructions:

1. Answer the questions listed below using complete sentences.

1. Use correct grammar, spelling and APA format.

1. Support your answers using credible sources such as textbooks, course materials, and evidence-based articles ( 1 Point)

Resources:

How do I know if a source is credible?

How do I find evidence-based practice articles? Or nursing best practices?

 

1. What are the differences between and patient impacts of hypothermia and hyperthermia? ( 2 Points)

 

 

 

1. What education should be provided to patients and families to avoid the extreme temperature variations? ( 2 Points)

Case: Adolescent white male without health insurance seeking medical care for STI

/in /by

Case: Adolescent white male without health insurance seeking medical care for STI

 

· How would your communication and interview techniques for building a health history differ with each patient?

· How might you target your questions for building a health history based on the patient’s social determinants of health?

· What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?

· Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.

· Select  one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the  Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.

· Develop  at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

 

 

 

 

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

 

 

Apa and at least 3 resources must be scholar resources

Today I will be discussing a summary of a patient encounter who is a 28 year old Middle Eastern female presenting to the clinic for prenatal care, and how my encounter progressed and what assessment techniques I used.

/in /by

Response 1

Today I will be discussing a summary of a patient encounter who is a 28 year old Middle Eastern female presenting to the clinic for prenatal care, and how my encounter progressed and what assessment techniques I used. To begin I want to emphasize that I am a strong believer that every patient is unique in their own way. For example, there is a major difference in building history with a patient who has had multiple previous pregnancies, compared to a soon to be mother with her first pregnancy. My patient is a soon to be mother who is worried and concerned about her child’s wellbeing and what she can do to decrease the probability of the child having complications. It is fundamentally important to practice active listening with all your patients, but I believe that it is essential to closely collect data with first time mothers to prevent prenatal complications, gestational complications, maternal complications and post-partum complications. As I listened to my patients needs, I noticed that I had previously heard these needs and concerns and correlated the patient’s cultural and traditional background to my previous patients. Thereafter I adopted an approach to the encounter more suitable for the culture itself. According to Subki & Agabawi et.al (2021), Middle Eastern women have a family structure that is distinctive to the culture itself that sets standards to the type of care that is expected. These standards include comfortability, and empowerment of the patient-provider encounter. Taking this into consideration, the closest model I found to my approach is the Health Action Process Approach Model also known as HAPA. The HAPA model has phases to its approach. The first phase is the motivation phase “that leads to a behavioral goal intention/motivation, followed by the (b) volitional phase that leads to the actual health behavior” (p. 5). I used this model because the model best fits the patient’s cultural expectations, and covers both the patients and the provider’s goal as mentioned above. I proceeded to carefully collect health history data including basic demographic information, general medical history medications and allergies, mental health history, substance use, family health history, social history, occupation and finances, safety and personal habits. These are all determinants and social determinants that can alter ones care.

After gathering all medical data pertinent to the patients visit, I proceeded with the Antenatal Risk Questionnaire. According to Ayoub & Shaheen et.al (2020), Middle Eastern women are twice as more likely to have antenatal and postpartum depression than any other race. I chose ANRQ because this questionnaire gathers sensitive indirect information that could provide data for the patient’s current needs such as the one she in for today, and, could provide data that can be viable for the future. The questionnaire is composed of 12 items, and assesses 7 psychosocial risk domains. According to Subki & Agabawi et.al (2021) these domains include emotional support, “past history of depressed mood or mental illness and treatment received, perceived level of support available after birth of the baby, partner emotional support, life stresses in the past 12 months, personality (anxious or perfectionistic traits) and history of abuse (emotional, physical and sexual)” (p.4). I had slightly reworded the questionnaire so it does not sound intrusive to the patient’s cultures expectations or her husband.

Five targeted questions asked

· Do you feel that you have support from your husband and or family members when the child is born?

· Have you had a time in your life that you felt worried about something for 2 weeks or more?

· Do you currently have any stressors in your life and how would you define them?

· How do you and your partner solve any given obstacle?

· Do you or your partner have any ongoing concerns?

 

Response 2

As an advanced practice registered nurse it is important to take into consideration all factors that can influence your patient’s health. Factors include economic conditions, environment, education status, and social conditions that can influence health. By assessing social determinants of health you are able to better treat and diagnose your patients. Pt. M.M. is a 32-year-old female patient who presents to the clinic because she had a positive at-home pregnancy test. Pt. last menstrual cycle was December 19, 2022. Ultrasound was conducted and a fetal heart rate of 161 BPM is present. Pt. is about 10 weeks pregnant, and her due date is set for September 25, 2023. Pt. states she is worried about her pregnancy because she drinks alcohol about five times per week, smokes one pack of cigarettes a day, and smokes marijuana on a daily. For example, if the patient does not have proper access to education or health care, this factor can influence both her and her baby’s health outcomes.

It is important for this patient to be educated on abstinence from alcohol, tobacco, and illicit drug use. Pregnancy smoking can cause birth defects, preterm birth, and infant sleep-related deaths (Healthy People of 2030, (2023). As an advanced practice registered nurse it is your duty to listen to your patient and screen your patients properly for alcohol/tobacco/drug use in order to refer them out to treatment if needed. To communicate properly with your patient it is important to develop a relationship with the patient because the first meeting sets the tone for a successful partnership between you and the patient. It is also important to establish a positive patient relationship consisting of courtesy, comfort, connection, and confirmation (Ball et al., 2018). One questionnaire I would use is the CAGE questionnaire which was developed in 1984 by Dr. John Ewing. The CAGE questionnaire is a proper screening tool for substance dependence in my opinion because it is short and does not require too many questions; therefore, it will not irritate the patient. The CAGE questions are scores of 0 for a “no” and 1 for a “yes”. If your patient’s score is two or more, it is considered clinically significant (Basu et al, 2016).

Five targeted questions:

· Have you ever felt the need to cut down on your drinking or marijuana use?

· Has anyone gotten annoyed or complained about the amount you drink or use marijuana?

· Do you ever feel guilty about your alcohol and marijuana usage?

· Have you ever felt the need to have a drink or smoke marijuana first thing in the morning to steady your nerves?

· Are you able to afford stable/safe housing and food?

I would offer my patient the American Pregnancy Helpline number just in case she finds herself unable to quit drinking alcohol and smoking. The American Pregnancy Helpline is able to provide complimentary and confidential information and support for women who are pregnant and using substances. They are also able to provide women with proper resources regarding what they are suffering with. The helpline is able to connect women to treatments (American Pregnancy Association, 2022).