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Peripheral Vascular Disease

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Peripheral Vascular Disease

Case Studies

A 52-year-old man complained of pain and cramping in his right calf caused by walking two blocks. The pain was relieved with cessation of activity. The pain had been increasing in frequency and intensity. Physical examination findings were essentially normal except for decreased hair on the right leg. The patient’s popliteal, dorsalis pedis, and posterior tibial pulses were markedly decreased compared with those of his left leg.

Studies

Results

Routine laboratory work

Within normal limits (WNL)

Doppler ultrasound systolic pressures

Femoral: 130 mm Hg; popliteal: 90 mm Hg; posterior tibial: 88 mm Hg; dorsalis pedis: 88 mm Hg (normal: same as brachial systolic blood pressure)

Arterial plethysmography

Decreased amplitude of distal femoral, popliteal, dorsalis pedis, and posterior tibial pulse waves

Femoral arteriography of right leg

Obstruction of the femoral artery at the midthigh level

Arterial duplex scan

Apparent arterial obstruction in the superficial femoral artery

Diagnostic Analysis

With the clinical picture of classic intermittent claudication, the noninvasive Doppler and plethysmographic arterial vascular study merely documented the presence and location of the arterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography to document the location of the vascular occlusion. The patient underwent a bypass from the proximal femoral artery to the popliteal artery. After surgery he was asymptomatic.

Critical Thinking Questions

1. What was the cause of this patient’s pain and cramping?

2. Why was there decreased hair on the patient’s right leg?

3. What would be the strategic physical assessments after surgery to determine the adequacy of the patient’s circulation?

4. What would be the treatment of intermittent Claudication for non-occlusion?

Please attach at least 2 updated bibliographic references of less than 5 years

personal philosophy of practice

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Being able to articulate your personal worldview can help you formulate a personal philosophy of practice and enhance your influence on patients and the industry. In this assignment, you will have an opportunity to reflect on your current and future practice, and the ways worldview and nursing theory influence that practice.

Draft a 1,000-1,250 word paper in which you:

  1. Describe your personal worldview, including the religious, spiritual, and cultural elements that you think most influence your personal philosophy of practice and attitude towards patient care.
  2. Choose a specific nursing theory that is most in line with your personal philosophy of practice and approach to patient care and discuss the similarities. Explain how the nursing theory reinforces your approach to care.
  3. Include in your explanation a specific example of a past or current practice and how your worldview and the nursing theory could assist you in resolving this issue.
  4. Finally, explain how your worldview and the nursing theory will assist you in further developing your future practice.

Address Questions 1 through 4

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

multispecialty health care organization

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Assignment Details

Imagine that you are the CEO of a large, metropolitan, multispecialty health care organization located in an urban city within the United States. The health care organization is for-profit and privately held. The demographics of the surrounding area include military personnel, educators, government employees, professionals, factory workers, and laborers. With the recent and proposed changes in health care regulations and the uncertainty surrounding federal law (e.g., the Affordable Care Act), the organization must cut costs and reduce the number of full-time personnel. The board has asked you to create a bulleted Executive Summary of the key positions that must be retained within the organization and the positions that can be eliminated. Provide your opinion about how these personnel changes could impact quality and patient satisfaction.

Create a high-level 500–750-word Executive Summary for the board that provides a brief description of the health care organization, a list of applicable laws that must be considered if staff is to be reduced, and a list of both the positions that must be retained and those that may be eliminated.

Be sure to include the following:

  • A brief description of the health care organization
  • A list of applicable laws or regulations that must be considered
  • Recommendations regarding which positions may be eliminated and which cannot be eliminated
  • Opinion about how these personnel changes could impact quality and patient satisfaction
  • At least 2 outside scholarly sources, exclusive of your textbook
    • Your textbook may be used as an additional source.
  • Always provide a Title page and References page—and these are not counted in your total assignment page count.

Effective communication

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Effective communication is a staple of our healthcare culture.  Working with patients, peers, and interprofessional teams requires that nurses manage information and evidence toward influencing safe and positive patient outcomes.

Please address the following:

Describe caring attributes of the culture where you currently practice. Which attributes stand out as having significant influence on patients, nurses, and other healthcare professionals?

How do you see effective communication relating to patient outcomes in this setting? What is the evidence for this?

the philosopher’s brief

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could you write an response essay of roughly 250-500 words after reading the article I attached  , by explain and write as much as details do you have , but please DO NOT copy , paste , or piligrasim  ..

 

 

Read “the philosopher’s brief” on page 661 of the Bioethics text. What is the central argument and how is the claim made? Do you agree or disagree and why or why not? Use specific examples, textual support, and solid argumentation in your response essay of roughly 250-500 words.

 

 

after you finish the response please answer these questions by small essay , please write your opinion without copy or paste or  piligrasim

Health care delivery

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Health care delivery and the organizations that provide it, manage it, and reimburse for it are growing at an explosive rate. As part of this trend, the growth in the allied health job sector is expected to grow significantly, with job growth projections in the 40% plus range for the period 2012-2022 (according to the U.S. Bureau of Labor Statistics, 2012).

Expansive growth is a response to current and predicted need for services, and while encouraging, sustained, and rapid growth will inevitably impact safety, risk management, and quality provision on scales not yet seen by health care organizations.

In an essay of 1,250-1,500 words, provide your assessment, with recommendations, of how the United States, as a country, can best manage quality assurance in the health care workplace going into the future. Questions to consider include:

  1. How best can the United States, as a country, manage this growth in the allied health sector? Provide examples.
  2. What steps might the United States take, from the global down to organizational level, to maintain high standards to provide outstanding care-based services?
  3. What steps might the United States take, from the global down to organizational level, to provide exceptional employment opportunities in in-demand allied health fields?

In addition to your readings and resources from the the AHRQ National Quality Measures Clearinghouse (http://www.qualitymeasures.ahrq.gov), and the National Quality Forum (http://www.qualityforum.org) can provide you with excellent data to develop and support your analysis.

You are required to use and cite a minimum of four qualified resources from the readings,  or cited sources in order to complete this assignment succe

effective leader

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Do you believe you have the traits to be an effective leader? Perhaps you are already in a supervisory role, but as has been discussed previously, appointment does not guarantee leadership skills.

How can you evaluate your own leadership skills and behaviors? You can start by analyzing your performance in specific areas of leadership. In this Discussion, you will complete Gallup’s StrengthsFinder assessment. This assessment will identify your personal strengths, which have been shown to improve motivation, engagement, and academic self-conference. Through this assessment, you will discover your top five themes—which you can reflect upon and use to leverage your talents for optimal success and examine how the results relate to your leadership traits.

To Prepare:

To take the Assessment, visit http://walden.gallup.com. Using the Guidance Document Resource(s) for the Strengths Finder assessment, follow the instructions for setting up an account. If the link does not work, please copy and paste the link into your web browser.

Please Note: This Assessment will take roughly 30 minutes to complete.

  • Once you have completed your assessment, you will receive your “Top 5 Signature Themes of Talent” on your screen.
  • Click the Download button below Signature Theme Report, and then print and save the report. We also encourage you to select the Apply tab to review action items.

NOTE: Please keep your report. You will need your results for future courses. Technical Issues with Gallup:
If you have technical issues after registering, please contact the Gallup Education Support group by phone at +1.866-346-4408. Support is available 24 hours/day from 6:00 p.m. Sunday U.S. Central Time through 5:00 p.m. Friday U.S. Central Time.

  • Reflect on the results of your Assessment, and consider how the results relate to your leadership traits.

By Day 3 of Week 5

Post a brief description of your results from the StrengthsFinder assessment. Then, briefly describe two core values, two strengths, and two characteristics that you would like to strengthen based on the results of your StrengthsFinder assessment. Be specific.

Please find the attached result from strengh finder

community activism

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Describe the key concepts underlying community activism and give examples of how each of these concepts applies to a specific context. Examine how advanced practice nurses can engage in community activism to limit further negative health impacts from Big Tobacco in their respective health communities.

Attached below is an additional resource, an article, that details various ways by which nursing professionals can engage in community activism.

Patient Advocacy and in the Community and Legislative Arena: http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Advocacy-in-Community-and-Legislative-Arena.html?css=print

All discussion posts must be minimum 250 words, word document, double space. References must be cited in APA(6th) format, and must include minimum of 2 scholarly resources published within the past 5-7 years. A rule of thumb for all DQ responses is the 3-3 rule; 3 paragraphs minimum, 3 sentences per paragraph minimum.

Comparing Frameworks for Analyzing Organizations

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Discussion: Comparing Frameworks for Analyzing Organizations

 

Avedis Donabedian’s work generated a pivotal means of assessing organizational performance relative to structure, process, and outcomes. However, it is clearly not sufficient to view health care quality merely in terms of outcomes—the structures and processes that facilitate these outcomes are equally as important.

In this Discussion, you consider multiple frameworks that can be used to analyze an organization. As you proceed, consider how these frameworks allow you to examine the interplay of interdependent and related parts and processes that comprise the systems within an organization, as well as the arrangements or structures that connect these parts.

 

To prepare:

 

Investigate and reflect on the systems and structures of an organization with which you are familiar. Consider the following:

What is the reporting structure?

Who holds formal and informal authority?

How many layers of management are there between the frontline and the highest office-holders of the organization?

How are interdisciplinary teams organized?

How is communication facilitated?

How well integrated is decision making among clinical personnel and administrative professionals?

How are particular service lines organized?

Which departments, groups, and/or individuals within the organization are responsible for monitoring matters related to performance, such as quality and finances?

Select two of the following frameworks:

Learning organizations, presented in the Elkin, Haina, and Cone article

Complex adaptive systems (CAS), presented in the Nesse, Kutcher, Wood, and Rummans article

Clinical microsystems, presented in the Sabino, Friel, Deitrick, and Sales-Lopez article

Good to great, presented in the Geller article

The 5 Ps, presented in the ASHP Foundation article

Review the Learning Resources for each of the frameworks that you selected. Also conduct additional research to strengthen your understanding of how to use each framework to assess an organization.

Compare the two frameworks. How could each framework be used to identify opportunities to improve performance? In particular, how would you use each of these frameworks to analyze the organization that you have selected?

 

Post an analysis of the systems and structures of the organization you selected, sharing specific examples. Explain insights that you gained by comparing the two frameworks, and how each can be used to assess an organization, identify a need for improvement, and, ultimately, enhance the performance of an organization.

 

Read a selection of your colleagues’ responses.

 

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Compare the organizational structure of your colleague’s selected organization to your own.

Ask a clarifying question.

Select an attribute of the identified organizational structure and ask your colleague to elaborate on how this attribute is evidenced in their organization.

 

Required Readings

Hickey, J. V., & Brosnan, C. A. (2017). Evaluation  of health care quality in for DNPs (2nd  ed.). New York, NY: Springer Publishing Company.

Chapter 1, “Evaluation and DNPs: The Mandate for Evaluation” (pp. 3-36)

Chapter 3, “Conceptual Models for Evaluation in Advanced Nursing Practice” (pp. 61-86)

Chapter 6, “Evaluating Organizations and Systems” (pp. 127-142)

Chapter 1 defines microsystem, mesosystem, and macrosystem and notes that evaluation can focus on one of these levels or all three. Chapter 5 examines the evaluation of organizations and systems.

Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. M. (2013). Integrating quality and strategy in health care organizations, Burlington, MA: Jones & Bartlett Publishers.

Chapter 2, “Understanding the Healthcare Organization” (pp. 31–43)

Although this chapter focuses on hospitals, the authors provide information about strategic planning and organizational structure that is applicable in many health care settings. The authors examine financial and quality issues as key aspects of performance measurement.

Elkin, G., Zhang, H., & Cone, M. (2011). The acceptance of Senge’s learning organisation model among managers in China: An interview study. International Journal of Management, 28(4), 354–364.

Retrieved from the Walden Library databases.

 

This article outlines the five disciplines that Senge argued could be found in a learning organization. The authors also discuss the worldview that is inherent in business organizations in China and explain how this relates to Senge’s theory.

Geller, E. S. (2006). From good to great in safety: What does it take to be world class? Professional Safety, 51(6), 35–40.

Retrieved from the Walden Library databases.

 

Geller reviews and applies Collin’s foundational Good to Great theory from its focus on financial success to safety.

Nesse, R. E., Kutcher, G., Wood, D., & Rummans, T. (2010). Framing change for high-value healthcare systems. Journal for Healthcare Quality, 32(1), 23–28.

Retrieved from the Walden Library databases.

 

This article explores how to implement change in complex adaptive systems (CAS) such as health care. The authors purport that an understanding of the principles of change management in CAS is critical for success.

Sabino, J. N., Friel, T., Deitrick, L. M., & Salas-Lopez, D. (2009). Striving for cultural competence in an HIV program: The transformative impact of a microsystem in a larger health network. Health & Social Work, 34(4), 309–313.

Retrieved from the Walden Library databases.

 

The authors discuss cultural competence as part of a patient-centered perspective on health care delivery. They examine an approach to creating innovation that originates at the unit (microsystem) level and can be diffused to the larger health care environment (macrosystem).

ASHP Foundation. (n.d.). Assessing your microsystem with the 5 Ps. Retrieved February 5, 2012, from http://www.ashpfoundation.org/lean/CMS9.html

 

This article discusses 5 Ps—purpose, patients, professionals, processes, and patterns—that you can analyze to deepen your understanding of a microsystem.

Document: Course Project Overview (PDF)

Required Media

Laureate Education (Producer). (2013f). Organizational structures. Retrieved from https://class.waldenu.edu

 

Note:  The approximate length of this media piece is 3 minutes.

 

Dr. Carol Huston discusses the influence of organizational structure on the delivery of quality care.

Case Study

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 Unit 2 Assignment—Case Study 1

As part of his internship, Trey is working night intake at a psychiatric hospital in a medium-sized college town. It’s been pretty quiet all evening until a little after 1 a.m. when he hears shouting in the outer hallway.
Trey looks at Lisa, his fellow student intern, who says, “What’s going on out there?”
A moment later the doors burst open, and a young man, who looks about 18 years old, is escorted in to the intake desk. He is agitated and has tears on his face, but he is not showing signs of violence or aggression, beyond the brief shouting he did out in the hallway.
He plunks himself down in the chair across from the intake desk and buries his face in his hands, rocking slightly and moaning. He has a slight body odor and is perspiring heavily.
“He’s all yours,” Lisa whispers.
Trey ignores her and moves quickly to the intake desk. Lisa runs off to find the supervising nurse, who has gone on break.
“Hey there,” Trey says calmly, bending over to look into the patient’s eyes. “I’m Trey. What’s up?”
He is almost surprised when the patient stops rocking, sits up, and lowers his hands. “Hey,” he says quietly. “I’m Matt, and this is hell, dude.”
“Not quite,” Trey smiles. “I’m here to help. Can you tell me what’s happened?”
“I’m going all to pieces,” Matt says, “little screws and bolts and debris flying off everywhere.”
Trey says nothing; he just waits.
“I had kind of a breakdown in my dorm,” Matt says. “I threw my laptop out the window.”
“Ooh, that’s rough. Bad night, huh?”
“Bad week, bad month, bad year, bad bad life. Bad bad bad bad bad bad bad bad BA-A-A-AD.”
“What happened?”
“Where you wanna start?”
In fits and starts, Matt conveys small clues that hint at his story.
Matt has always been a “nerd,” he says, according to his older brothers. As a child, he often withdrew from playgroups at school to play on his own. In isolation, he has always managed to perform well academically, but in group work or group assignments, he has tended to resort to outbursts and a refusal to participate. He says he has always been awkward in social situations and has always found it hard to carry on “a good, rewarding conversation.”
“And I’m freakin’ clumsy. Klutzy. A klutz,” he says, looking everywhere but at Trey. “I’m the opposite of an athlete, the opposite of my brothers.”
Although his speech is frequently eccentric, Matt manages to convey a very brief picture of how, because of his withdrawal, negative thoughts, and social awkwardness, people tend to leave him on his own, both at large extended family gatherings or social functions in his family’s community and place of worship.
In his senior year of high school, Matt’s grades and SAT scores gained him entrance to a leading Midwest university-despite his disruptive problems.
Matt had been looking forward to going away to school, hoping that part of his problems “fitting in” had to do with his family’s “obscenely proper prominence” in the community, and his older brothers’ “super-dude images, which,” he says, “I will never live up to.”
“At the same time,” he says during intake, “I was also pretty nervous, pretty stressed, pretty freaked out, pretty freaky.”
In his first week of college, Matt found orientation week “disorienting,” he jokes with a slight smile. “Orientation disoriented me. It dissed me. I got dissed. There were people everywhere, like climbing-the-walls-and-on-top-of-you everywhere.”
Except when Trey first initiated a conversation, Matt, for the most part, has worked to avoid eye contact and continually bounces his left leg nervously. He is gripping the arms of his chair and looks as if he’s about to fly right out of it.
“My roommate is a jock,” he says. “Jocular jock. Oh, Jocularity, wouldn’t you know they’d put me with a jocular-not-so-very-jocular-jock. They plan that stuff, you know. Just to keep me from escaping, from making a fresh start. Guy’s a jerk, and now, here I am.” He grins and expands his arms, gesturing the psychiatric ward around him.
“And now here I am, just 8 weeks into my first semester away from home, and I’ve just been admitted for totally breaking down, shooting laptop missiles from the second freakin’ floor. They win.”

  1. If Matt is truly suspected of having newly diagnosed or recent-onset schizophrenia, should Trey be letting the conversation focus so much on Matt’s childhood? Where might intake or assessment be best focused?
  2. Based on this initial phase of Matt’s intake interview alone, what symptoms are already suggested in his behaviour that would be significant in terms of potential psychosis or schizophrenia?

 

3. Case Study   Rubric For NM 230

 

Organization

40%

All   questions answered with information organized in logical sequence (20 points)

All   questions answered with information generally organized in logical sequence (15 points)

All   questions answered and information intermittently organized

(10 points)

All   questions answered but information disorganized

(5 points)

All   questions not addressed

(0 points)

 

Analysis and Evaluation

40%

Presents   an insightful and thorough analysis of the issue with scholarly support

(20 points)

Presents a thorough analysis of issue with   scholarly support

(15 points)

Presents   an incomplete analysis of the issue by failure to address one aspect OR failure   to provide scholarly support

(10 points)

Presents   an incomplete analysis of the issue by failure to address multiple aspects and failure to provide scholarly support

(5 points)

Presents   a superficial analysis of issue; No scholarly support

(0 points)

 

Writing Mechanics

10%

Demonstrates   clarity, conciseness, and correctness; Minimal to no spelling or APA errors

(10 points)

Majority   of information is clear with some questions left to reader interpretation;   Minimal spelling or APA errors

(8 points)

Sentence   structure proper but paragraph is disorganized; Major spelling/grammar or   APA errors

(6 points)

Poorly   organized and does not follow proper sentence structure;  Major spelling/grammar or APA errors

(4 points)

Unfocused and rambling; Major spelling/grammar or APA   errors

(2 points)