Tag Archive for: nursing

American Diabetes Association.

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For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.

Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/

To Prepare
  • Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
  • Select one type of diabetes to focus on for this Discussion.
  • Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
  • Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments.

Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

MENTAL STATUS EXAM

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BACKGROUND INFORMATION

The client is a 70 year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to your office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse.

 

SUBJECTIVE

During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.

 

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. You administer the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression).

RESOURCES

§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.

For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders ( Selected above) You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.

To Prepare

· Review this week’s interactive media pieces and select one to focus on for this Discussion.

· Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

·

Post a brief explanation of the psychological disorder presented( depression) and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected ( as below) Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

Decision steps taken:

Decision point 1

Begin Zoloft 25mg orally daily. ( pt came back in not feeling better and c/o erectile dysfunction)

Decision point 2

Decrease dose of Zoloft ( pt still feels better but still same complain)

Decision point 3

d/c zoloft and start on paxil ( SSRIs should be first line of treatment while MOAIs last line of treatment for depression( from research, say why this decision will be best for this patient with three references)

scholarly activities

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Throughout the RN to BSN program, students are required to participate in scholarly activities outside of clinical practice or professional practice. Examples of scholarly activities include attending conferences, seminars, journal club, grand rounds, morbidity and mortality meetings, interdisciplinary committees, quality improvement committees and any other opportunities available at your site, within your community or nationally.

You are required to post one scholarly activity while you are in the BSN program, which should be documented by the end of this course. In addition to this submission, you are required to be involved and contribute to interdisciplinary initiatives on a regular basis.

Submit, as the assignment, a summary report of the scholarly activity, including who, what, where, when and any relevant take-home points. Include the appropriate program competencies associated with the scholarly activity as well as future professional goals related to this activity. You may use the “Scholarly Activity Summary” template to help guide this assignment.

food infection

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Answer Clinical Application Questions 1-3 for Chapter 15 on page 450. Answers should be submitted in a word document with any associated references used.

1) On July 8, a woman was given an antibiotic for presumptive sinusitis. However, her condition worsened, and she was unable to eat for 4 days because of severe pain and tightness for the jaw. On July 12, she was admitted to a hospital with severe facial spasms. She reported that on July 5, she had incurred a puncture wound at the base of her big toe; she cleaned the wound but did not seek medical attention. What caused her symptoms? Was her condition due to an infection or an intoxication? Can she transmit this condition to another person?

2) Explain whether each of the following examples is a food infection or intoxication. What is the probable etiological agent in each case?

a) Eighty-two people who ate shrimp in Louisiana developed diarrhea, nausea, headache, and fever from 4 hours to 2 days after eating

b) Two people in Vermont who ate barracuda caught in florida developed malaise, nausea, blurred vision, breathing difficulty, and numbness 3 to 6 hours after eating.

3) Cancer patients undergoing chemotherapy are normally more susceptible to infections. However, a patient receiving an anti tumor drug that inhibited cell division was resistant to salmonella. Provide a possible mechanism for the resistance.

interprofessional collaboration

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Respond

 

Patient care delivery model is the method used to deliver care to patient and it depends on multiple factors such as financial, staffing capability, patient population, organizational mission and philosophy (Motacki & Burke, 2017). The health care delivery system stipulates how care is delivered, coordinated, and the skill sets required. The basic elements of any health care delivery rely on its clinical decision making, work allocation, communication, management, coordination and accountability (Motacki et al., 2017). In my current employer, the nursing care delivery model used is the functional structure. Service and department are arranged based on expertise. Each department functions independently. I would definitely apply the functional structure model at SLMC by incorporating interprofessional collaboration.  As long as there is interprofessional collaboration and effective communication with care coordination among providers I believe any health care delivery model will work.

At SLMC great emphasis is placed on optimizing the quality of life of all those served beyond traditional medical needs rather the whole person.  Not much is mentioned at SLMC about interprofessional collaboration- however at my current employment, interdepartmental consult is placed to other services to address individual needs.  On the units every morning we have the interdisciplinary grand rounds that includes the intensivist, the clinical pharmacist, the dietician, social worker and the in care of the patient.  The patients do not get to participate however, they normally have a family meeting to address needs of patient and their families.  The focus is placed on the individuals and their families and we have been encouraged to do hand-off communication at the bedside so patient can be part of the discussion.  I believe this model support the person-centered nursing framework by McCormack and MCCance (2017).   According to McCormack and MCCance (2017) person centered practice (PCN) is a consensus approach among all healthcare providers to foster a healthful relationship with patients and their family by respecting their values and beliefs.  PCN placed great importance on empowering the individual with education and knowledge to assist with making informed decisions regarding their healthcare needs Bechtold & Fredericks (2014).

Patient-centered care and treating patients as individuals are hallmarks of excellent care by registered nurses (Radwin, Cabral, Seibert, Stolzmann, Meterko, Evans, Barker et al., 2019).  The PCN Framework has four constructs where the provider is providing are has to be aware of self, competent, has great interpersonal skills, and being committed to the job. The Care environment that support sharing decision making through a supportive organizational structure such as shared governance to allow the staff at the frontline to impact care. The person- which values and beliefs are respected and care is provided on a mutual respect- be available to assist with physical needs. The patient satisfaction of the care provided is the expected outcomes where a therapeutic environment is created, pt involve in his/her care, overall, feeling of well-being (McCormack et al., 2017)

I strongly support the use of the person -centered nursing framework because this framework addresses all dimensions of caring which are the four constructs. It depict the quality nurses must demonstrate such as commitment to the profession,  beliefs and values clarification,  a sense of self have great interpersonal skills and professionally competent, combine with an organizational structure that supports share decision making, healthful work environment that address individual physical needs, and promote a therapeutic approach to effectively provide holistic care. The patient perception of quality of care determines his or her satisfaction.  As I previously mentioned, the healthcare professional core values as prerequisites to deliver holistic care approach that acknowledge the needs of the patient and empower the patient with education that would aid in decision making process. As well as working collaboratively with the interprofessional team at all level to engage the patient and family to improve care outcome and staff satisfaction.  Patient -centered care is not limited to the patient, but it also accounts families, and caregivers who are involved.  It provides distinct information about health-care effectiveness, comprising improvement of patient experiences and outcomes and health-care provider satisfaction, while decreasing health-care services utilization and cost (Santana, Manalili, Jolley, Zelinky, Quan, & Lu, 2018).

Bechtold, A., & Fredericks, S. (2014). Key concepts in patient-centered care. American Nurse Today, 9(7), 35. Retrieved from https://search-ebscohost-com.chamberlainuniversity (Links to an external site.). .oclc.org/login.aspx?direct=true&db=edo&AN=97097993&site=eds-live&scope=site

McCormark, B.  & McCance, T. (2017). Person-centered practice in nursing and health care. Theory and and practice (2nd ed.) Oxford: Wiley Blackwell.

Motacki, K., & Burke, K. (2017). Nursing Delegation and Management of Patient Care – E-Book (Vol. 2nd edition). St. Louis, Missouri: Mosby. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=nlebk&AN=1214091&site=eds-live&scope=site (Links to an external site.)

Radwin, L. E., Cabral, H. J., Seibert, M. N., Stolzmann, K., Meterko, M., Evans, L. & Barker et al.,(2019). Patient-centered care in primary care scale: Pilot development and psychometric assessment. Journal Of Nursing Care Quality, 34(1), 34–39. https://doi-org.chamberlainuniversity (Links to an external site.). idm.oclc.org/10.1097/ NCQ.0000000000000341

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person‐centered care: A conceptual framework. Health Expectations, 21(2), 429–440. doi:10.1111/hex.12640

Accountable Care Organizations

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Read the scenario that you will use for the Individual Projects in each week of the course. The Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health care delivery. Many changes have transpired to improve patient safety along with the implementation of additional quality metrics, and these changes impact reimbursement rates.

Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee structure of Medicare and Medicaid reimbursement for health care services. Other legislation including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015 (MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use of data to improve quality and delivery of patient care.

Scenario

Mr. Magone, CEO of Healing Hands Hospital, has asked you to join the “Future of Healing Hands” Task Force. Your first assignment is to work with the Hospital Chief Financial Officer, Mr. Johnson, and provide a summary of the current regulations regarding Medicare reimbursement including how MACRA will impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with physician practices.
For this assignment, write a 2-page report, not including the title page and reference page, on how the new CMS initiatives and regulations will impact the organization’s revenue structure. The HCM Learning Center page for this class has excellent resources for more information within the Unit 1 tab. This is Section 1 of your report to the Task Force. This first section should be titled “Impact of CMS Regulations and Reimbursement Models”. In your report include:

  • How does CMS impact the reimbursement model for Healing Hands Hospital and other health care organizations? If CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other insurance providers change their policies on reimbursement?
  • The CMS website on Innovation Models provides examples of healthcare payment and service delivery models designed to increase quality of care while reducing costs.
    • Choose one example of ongoing or planned models for Accountable Care Organizations or Episode-Based Payment Initiatives and explain how participation in the models would be beneficial to Healing Hands Hospital.

Be sure to include at least two reference sources and cite them using APA formatting.

Searching Databases

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Discussion: Searching Databases

When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.

The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.

In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.

To Prepare:

  • Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
  • Review the Resources for guidance and develop a PICO(T) question of interest to you for further study.
By Day 3 of Week 4

Post your PICO(T) question, the search terms used, and the names of at least two databases used for your PICO(T) question. Then, describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.

lymphocytic leukemia

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Please make a reply to this discussion post from another student. Please place a reference APA style.

 

Chapter 28

You are meeting with a newly diagnosed 8-year-old acute lymphocytic leukemia (ALL) patient and his family to answer their questions about his illness and plan for treatment. They had sought medical treatment because the boy had experienced unusual fatigue, repeated infections, and unexplained bruising over the past few months.

a.            The patient and his family want to know why he has problems with bruising and infections when their understanding is that leukemia is a problem with too many white blood cells. How would you answer their question using lay language?

b.            The parents are very afraid of the chemotherapy regimen that is being planned, stating that their 40-year-old cousin died of ALL despite receiving powerful chemotherapy drugs that

Acute lymphoblastic leukemia (ALL) is a cancer of the lymphocytes, which are white blood cells that are in charge of the immune system. It is the most common type of cancer in children.
In the (ALL), the lymphoblasts provide the bone marrow and crowd out other normal cells, repressing the generation of red blood cells, several other types of white blood cells. If the bone marrow is not working correctly, the child may encounter anemia, simple bruising, bleeding, or infection.

Anemia is the result of reduced red blood cells. Anemia symptoms include tiredness, irritation, drowsiness, colorlessness, shortness of breath, and a rapid heartbeat.
When lesions occur it is difficult for blood to clot, so bleeding and bruises may happen more easily since there is a low flow of platelets. Additionally, an infection may happen often if the blood lack of normal white blood cells.
Lymphoblasts may also extend to other organs, including the skin, liver, spleen, the spinal fluid, and a girl’s ovaries, and a boy’s testicles

The purpose of chemotherapy in patients with acute lymphocytic leukemia is to achieve remission. As a result, leukemia cells are no longer seen in bone marrow samples, the normal marrow cells respond, and the blood counts become normal.  92% of children begin within a month of induction treatment to then start remission. Patients are required to stay in the hospital for treatment and daily doctor’s check. Complications can be very severe to be life-threatening, but improvements in health care, have made the threat less probable.

References

Treatment of Children With Acute Lymphocytic Leukemia (ALL). (n.d.). Retrieved from https://www.cancer.org/cancer/leukemia-in-children/treating/children-with-all.html

Pathak, N. (2017, September 8). Acute Lymphoblastic Leukemia (ALL): Survival, Treatments, and More. Retrieved from https://www.webmd.com/cancer/lymphoma/acute-lymphoblastic-leukemia#1.

NEUTROPENIC SEPSIS

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NEUTROPENIC SEPSIS ( PATIENT’S POST CHEMO)

A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.

Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

PICOT format is a helpful approach for summarizing research questions that explore the effect of an intervention.

  • (P) – Population refers to the problem and the population that is effected.
  • (I) – Intervention refers to will be provided to solve or improve the problem
  • (C) – Comparison identifies what you plan on using as a reference to compare with your  intervention
  •  (O) – Outcome represents what result you plan on measuring to examine the effectiveness of your intervention
  •  (T) – Time describes the duration for your data collection.

Make sure to address the following on the PICOT statement:

  1. Evidence-Based Solution
  2. Nursing Intervention
  3. Patient Care
  4. Health Care Agency
  5. 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 Turnitin. Please refer to the directions in the Student Success Center.

30.0 %Identification of Clinical Problem/Issue

30.0 %Clinical Problem/Issue, Including Description, Evidence-Based Solution, Nursing Intervention, Patient Care, Health Care Agency, and Nursing Practice

10.0 %PICOT Statement Focused on Resolution, Improvement, Application, and Intervention

10.0 %PICOT Statement Including Population, Intervention, Comparison, Outcomes, and Time

WE CAN USE SAME REFERENCES

Butcher, L. (2016). Stepping up against SEPSIS. H&HN: Hospitals & Health Networks, 90(1), 38-42.

Clarke, R., Bird, S., Kakuchi, I., Littlewood, T., & Hamel Parsons, V. (2015). The signs, symptoms and help-seeking experiences of neutropenic sepsis patients before they reach hospital: a qualitative study. Supportive Care in Cancer, 23(9), 2687-2694. doi:10.1007/s00520-015-2631-y

Ford, A., & Marshall, E. (2014). Neutropenic sepsis: a potentially life-threatening complication of chemotherapy. Clinical Medicine (London, England), 14(5), 538-542. doi:10.7861/clinmedicine.14-5-538

Knight, T., Ahn, S., Rice, T. W., & Cooksley, T. (2017). Acute Oncology Care: A narrative review of the acute management of neutropenic sepsis and immune-related toxicities of checkpoint inhibitors. European Journal of Internal Medicine, 4559-65. doi: 10.1016/j.ejim.2017.09.025

Raz, B. (2017). Neutropenic sepsis. Nursing Standard (Royal College of Nursing (Great Britain): 1987), 31(48), 64-65. doi:10.7748/ns.31.48.64. s47

Vossen, M. G., Milacek, C., & Thalhammer, F. (2018). Empirical antimicrobial treatment in haemato-/oncological patients with neutropenic sepsis. ESMO Open, 3(3), e000348. doi:10.1136/esmoopen-2018-000348

Wells, T., Thomas, C., Watt, D., Fountain, V., Tomlinson, M., & Hilman, S. (2015). Improvements in the management of neutropenic sepsis: lessons learned from a district general hospital. Clinical Medicine (London, England), 15(6), 526-530. doi:10.7861/clinmedicine.15-6-526

psychological and spiritual issues

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Module 09 Written Assignment – The Effects of AgingScoring Rubric:CriteriaPointsDescribe what your job is as a nurse to help these individuals with their challenges. Your answers to each of the following prompts should be at least 2-3 paragraphs in length and should be contained within a single Word document.Remaining independentMaintaining self-esteemFinding outlets for energies and interestsDeveloping a happy lifestyle with financial meansContinuing positive relationships with othersMeeting all basic human needsConfronting morality

It becomes very challenging on an individual as the aging process begins. Although many individuals age comfortably and remain active throughout the life span, others may experience the effects of medical conditions, cognitive disorders, psychological and spiritual issues. As health care workers it is important to know what to expect and how to help individuals to take steps to counterbalance the effects of aging to maintain as much independence as possible. The following are all issues that the aging adult may deal with. Describe what your job is as a nurse to help these individuals with their challenges. Your answers to each of the following prompts should be at least 2-3 paragraphs in length and should be contained within a single Word document.Remaining independentMaintaining self-esteemFinding outlets for energies and interestsDeveloping a happy lifestyle with financial meansContinuing positive relationships with othersMeeting all basic human needsConfronting moralitySubmit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.