Tag: Clinical-Nursing

Catheter Associated Urinary Tract Infections Essay

Following an operation, Catheter urinary may be inserted, for a short time, into the patient’s bladder to assist in emptying the bladder. Nevertheless, certain compelling medical circumstances may dictate long-term insertion of the Catheter Urinary to continue draining the bladder. These ways applied in Catheter Urinary maintenance are what turns to be referred to as ‘health care policies’. Lately, cases of Catheter Urinary overuse have been on the rise, despite the fact that the Indwelling Urinary Catheter (IUC), as it is also referred to, is designed for the purposes of effecting healing and diagnosis of the patient. The failure of executing a timely termination of IUC usage is chiefly attributed to the inability of the patient to move, nurses’ workload that hinders prioritization, urinary incontinence as well as limited knowledge regarding IUC risks. This has many at times, resulted in development of other Urinary Tract Infections which are commonly known as Catheter Associated Urinary Tract Infections (CAUTI).

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From literature, a considerable amount of evidence on the CAUTIs prevention is made available with main best recommendations for practice as follows: various coatings, including silver alloy, prevention of unnecessary insertions, and perineal hygiene is highly recommended for patients.

Focus plan for the nursing care in regards to UTI, is aimed at increasing knowledge on knowledge of prevention, compilations’ absence, regimen treatment and reducing both pain and discomfort. This will involve acute pain, hyperthermia, infection, deficient knowledge, uneasy sleep pattern and compromised urinary elimination Catheter Associated Urinary Tract Infections Essay.

Change Model Overview

The ACE star model of knowledge transformation facilitates quick and easy comprehension of the nature, sequences and knowledge characteristics applied in various elements of Evidence-Based Practice (EBP). Where knowledge transformation implies adapting findings of the research to influence health care upshots in a manner anchored in evidence oriented care Catheter Associated Urinary Tract Infections Essay. It portrays different stages that knowledge is transformed through to the stage where it is integrated into practice. The model generally has five broad phases namely, discovery research, evidence summary, translation to guidelines, integration into practice and lastly process and outcome evaluation by design.

With the EBP at the core of this model, nurses are encouraged to adopt this model as a guide to facilitate change. EBP is rapidly gaining momentum in the nursing practice. EBP emphasizes on more practice-related research, modifications in student education and handier working interactions between researchers and clinicians. Simply put, the application of evidence in defining best practices instead of supporting the current practices ensures nursing care remains updated with the modern advances in technology as well as ensuring nursing capitalizes on new knowledge improvements Catheter Associated Urinary Tract Infections Essay.

Define the Scope of the EBP

Cases of Catheter Urinary over use have been on the rise, despite the fact that the Indwelling Urinary Catheter (IUC), as it is also referred to, is designed for the purposes of effecting healing and diagnosis of the patient. The failure of executing timely termination of IUC usage has resulted into many IUC risks such as CAUTIs Catheter Associated Urinary Tract Infections Essay.

Based on the first stage of the ACE star model that encompasses the discovery research, a single study to investigate policies guiding replacement of long term IUC will be conducted among adult patients (Stevens, 2004). Catheter Associated Urinary Tract Infections Essay From the randomized control trials involving 107 participants conducted in three separate healthcare locations namely Israel’s geriatric center, Hong Kong nursing service for the army and the nursing home administration for the USA veterans as recorded in the Cochrane Collaboration, the following comparison pre-stated data was found. Different catheter replacement time intervals were evaluated by Priefer and colleagues (n= 17); different antibiotic prophylaxis replacement times were evaluated by Firestein and colleagues (n= 70); and different cleaning solution types were compared by Cheung and colleagues.

Generally, adoption of use or non- use of policy in the prevention of CAUTIs has a significant impact on the quality improvement in the care adults with IUC receive.

Stakeholders

           
The research will involve the following; the Infection Prevention specialists, Urology Specialists, Ward Managers/ Matrons and The entire Healthcare Staff Catheter Associated Urinary Tract Infections Essay.

Determine Responsibility of Team Members

The research members will perform their tasks respectively as follows; Urologists will offer competent training on current care as well as removal and    insertion. The Infection prevention specialists will have roles ranging from auditing and inspecting use of catheter, CAUTI and dwell time. Ward Managers/ Matrons will be tasked with ensuring proper evidence-based training is given to all healthcare personnel dealing with catheter insertion, current care giving and removal. The responsibility of entire Healthcare Staff will be to set out learning as well as development needs besides taking accountability for the delegated tasks to non-registered member of staff.

                

Evidence

A thorough search for evidence in this proposal yielded Clinical Practice Guides, EBP guidelines, and Quality improvement data besides the Evidence summary Catheter Associated Urinary Tract Infections Essay. Very small methodological errors existed in all the three trials. Thus, new trials are required to so that they can answer research questions precisely.

Summarize the Evidence

The following three are some few evidence-based interventions discovered in the summary evidence that could become handy in the carrying out the project in future as suggested by (Faikh M G, et al., 2014) .

Various coatings, including silver alloy, and constituent materials of catheters have been undertaken through numerous changes to boost comfort and prevent infection. In the Journal of Clinical Nursing, a review was conducted systematically and showed that silver alloy utilization in IUC reduced CAUITs. Most indwelling catheter kits were designed by hospitals with silver alloy coating as the main components (Lederer J W. Jarvis W R. Thomas L, et al., 2014).

Prevention of unnecessary insertions of IUC as the practice was found by (Anema, C., Schalich, C., Skewis, L., et al, 2014), to be taking place in emergency departments without orders of the physician. Life-threatening complications such as urethral strictures, hematuria, urosepsis, and urethritis and bladder perforations occurred even after a short duration of use.

Perineal hygiene is highly recommended for patients with indwelling catheters because the direct exposure they have towards microorganisms makes them highly vulnerable to CAUTIs. This can be achieved through daily cleaning of insertion points with water and soap during bathing or showering (Barsuk JH, Cohen ER, Pots S, et al., 2014) Catheter Associated Urinary Tract Infections Essay.

Develop Recommendations for Change Based on Evidence

It is recommended that the nursing healthcare personnel handling IUC cases to effect quality improvement that is based on evidence as well as ensure there is knowledge transformation in the practice Catheter Associated Urinary Tract Infections Essay. Care is supposed to be redesigned to ensure it becomes safe, effective and efficient. Nurses are expected to launch initiatives like training and curricular modifications, development of models and theories, participate in new fields of scientific research and develop a network of research nationally to promote improvement.

Translation

Action Plan

The plan to implement this project will involve working systematically through steps of infrastructural preparation, project stakeholders’ coordination and eventually monitoring the implementation outcome. Catheter Associated Urinary Tract Infections Essay The outcome evaluation plan will entail engaging stakeholders, program description, evaluation design focus, justification of conclusions and using and sharing lessons learned among the nursing staffs.

Process, Outcomes Evaluation and Reporting

The anticipated outcomes of this research are to encourage the use of evidence-based healthcare practice policies and procedures that will result into the overall improvement in the prevention of Catheter Associated Urinary Tract Infections. Patient satisfaction is also expected to rise as in correspondence to the quality care they receive. The outcome of this research will be communicated through written reports such as fact sheets, newsletters, annual reports, empirical publications and abstract and briefing. Reports prepared visually or orally will also become handy when it comes to communication of outcomes to stakeholders.

Identify Next Steps

There is relatively low morbidity and mortality resulting from CAUTIs as compared to other Healthcare Associated Infections. But occurrence of urinary catheters still high and could turn in the long run to be infectious or fatal Catheter Associated Urinary Tract Infections Essay. Therefore, the use of Urinary Catheter Protocol (UCP) is necessary though there is need to determine barriers hindering implementation of UCP so as to minimize catheter use and eventually eliminate CAUTIs.

To ensure implementation plans of CAUTIs prevention remain permanent, the healthcare personnel should be encouraged to embrace the change and apply it in their care plan. The staff resisting change should be reported to relevant departments for further education on the same.

Disseminate Findings

The research findings will be communicated internally through use of newsletters, meetings, and town hall. Externally, communication of the findings will entail use of posters, publications and conferences bringing together other personnel in the nursing profession.

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Conclusion

The exercise of simple nursing care in nursing and patient advocacy can, in the long run, lead to constructive change in patient results. There is need to revise policy as well as procedures within the institutional and the present-day evidence-based research. This can assist in developing an instrument that will help nurses adhere to proper insertion and maintenance of catheters. The nursing personnel will be required to undergo continuous education and training on appropriate maintenance of IUC and Chlorohexidine Gluconate (CHG) bathing to bring about efficient change in this project. Catheter Associated Urinary Tract Infections Essay. The ACE star model for knowledge transformation will be incorporated to help implement, reinforce, and preserve changes of this project. All ACE star model processes as mentioned in the foregoing such as summary evidence, translation into practice guidelines and practice integration as well as process outcome evaluation will be applied. When this project will be successfully completed, the results will not just be limited to prevention of CAUTIs, other areas like duration of stay, fall, and cost will reduce as well as delirium will decline too (Frampton G. K.,Harris P., Cooper K., et al, 2014)

References

Anema, C., Schalich, C., Skewis, L., et al. (2014). Best evidence of suprapubic catheter and exchange.
The Nursing Voice
, 6.

Barsuk JH, Cohen ER, Pots S, et al. (2014). Dissemination of a simulation-based mastery learning intervention reduces central line-associated bloodstream infections.
BMJ Qual Saf.
, 47-52.

Beattie M. and Taylor J. (2011). Silver alloy vs. uncoated catheters: A systematic review of literature.
Journal Clinical Nursing
, 20(15-16) Catheter Associated Urinary Tract Infections Essay.

Faikh M G, et al. (2014).
Avoiding potentialharm by improving appropriateness of urinary catheter use in 18 emergency departments.
, 761-8.e1.

Frampton G. K.,Harris P., Cooper K., et al. (2014). Educational interventions for preventing vascular catheter bloodstream infections in critical care evidence map, systematic review and economic evaluation.
Health Technological Assessment.
, 1-365.

Godfrey H, Fraczyk L. (2004). Preventing and managing catheter-associated urinary tract infections.
British Journal Community Nursing
, 205-212.

Gokula et al. (2007). Emergency room staff education and use of urinary catheter indication sheet improves use of Foley catheters.
American Journal Infection Control.
, 589-593.

Lederer J W. Jarvis W R. Thomas L, et al. (2014). Multicenter Cohort Study to Assess the Impact os a Silver-Alloy and Hydrogel Coated Urinary Catheter on Symptomatic Catheter Associated Urinary Tract Infections.
Wound Ostomy Continence Nursing
.

Stevens, K. R. (2004).
ACE Star Model of EBP: Knowledge Transformation.
Retrieved from Academic Center for Evidence-Based Practice: http://www.acestar.uthscsa.edu.com

Wilson M, Wilde M, Webb L, et al. (2009). Nursing intervention to reduce the risk of catheter-associated urinary tract infection.
Wound Ostomy Continence
, 137-154 Catheter Associated Urinary Tract Infections Essay.

Super sized kids Sample Article Critique Essay

Journal Article Critiques

Instructions:

These critiques should be between 1.5 and 2 pages, double-spaced, in Times New Roman (12 point) font, and with 1” margins on all sides. Please include and APA style cover page, page numbers and headers/sub headers, in text citations, and works cited page.

Summary: The summary should be between 1 and 2 paragraphs. This should briefly explain the authors’ purpose(s), method, and results (main findings in your own words. No numbers.) Keep the summary informative, but concise (less than a page).

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Critique: You should critique the articles based on the following criteria. Be sure to completely and concisely address each point. Remember this should be a critical assessment or the study (objective). DO NOT INCLUDE YOUR OPINION. Paraphrase , no direct quotes Super sized kids Sample Article Critique Essay.

1. Purpose/Research Question: Determine the authors’ purpose of the research and state it in your own words. Comment on how clearly this was presented in the article.

2. Method: Comment on how appropriate the method used was for addressing the purpose. State if the method was employed effectively.

3. Evidence of Support: Examine the method and results of the article and determine if they helped the authors effectively address the purpose presented. Also discuss the strengths and weaknesses of the evidence and the study as a whole. Super sized kids Sample Article Critique Essay.

4. Real World Application: After reading the discussion section summarize any real world implications the authors suggest. Also give your own suggestions for the real world application of the study and its’ findings.

5. Recommendations: Determine who might benefit from the article, what the benefit may be, and the importance of the benefit. Here you may summarize your subjective judgments of the work and suggestions on how to improve or extend the work Super sized kids Sample Article Critique Essay.

Super-Sized Kids

Morbid obesity is a serious condition that exists in many populations. Patel (2005) explains that close to 60% of the American population is overweight, with a majority of them being children. In fact, close to 5.3 million youngsters in the U.S are obese,  accounting for 30% of all the American children (Patel, 2005). Morbid obese children display a BMI measurement that is higher than 30. The higher the BMI figure, the most likely the child would contract ailments related to obesity. The author sought to elaborate the main causes of morbid obesity amongst children. He employed a quantitative analysis method to scrutinize several case studies on American families.  He established that morbid obesity was mainly caused by family neglect, unhealthy eating habits, and lack of enough physical exercising. A combination of these factors ultimately leads to accumulation of body fat. The researcher recommended the need for education amongst families on controlling diet through government-initiated programs, and engaging children in more physical exercises. Super sized kids Sample Article Critique Essay.

Purpose of Research

Patel (2005) purposed to determine the causes of morbid obesity amongst children. The author presented his views about morbid children in children concisely, by offering valid evidence, specifically amongst kids in the U.S. He explains the eating trends amongst the population, noting an increase of sugar intake from 24 ounces to 48 ounces for the past 15 years amongst American families. The author succeeds in formulating the basis of his question by stating that genetic patterns in families play a crucial role in a child’s weight. Super sized kids Sample Article Critique Essay.

Method

The researcher analyzed a number of case studies of families whose children experienced complications related to morbid obesity in the U.S. The studies covered a variety of families across the country, notably the state of Iowa, Indiana, California, New Mexico, Pennsylvania and Texas. Since the cases under study were from different states, the research attained diversity. The author eradicated any chances of errors that would arise from bias on one region. The study results would therefore display the true picture of obesity in children living in the country. This way, the researcher was guaranteed of accurate results Super sized kids Sample Article Critique Essay.

Evidence of Support

The researcher derived that many cases of child obesity were as a result of family negligence, which led to sedentary behavior and unhealthy eating. Specifically, one household in California experienced the death of their child due to inattention.  The mother gave consent for the child to abandon school, so as to give her maximum care. However, the child resorted to watching television and uncontrolled eating. Besides, the mother was also obese, therefore, could not offer adequate care Super sized kids Sample Article Critique Essay. The child was later found dead in the sitting room.  The evidence was relevant enough to ascertain that neglect is the main cause of child obesity in the U.S. However, the indication failed to reveal whether there were other family members responsible for care, since the mother was also obese, a factor that could hinder provision of maximum care.

Real World Application

The article is educative, since it highlights the plights faced by families with histories of obesity.  The author suggests that it is vital for the society to ensure the safety and wellness of families suffering from health related problems, especially obesity. Since obesity may be acquired through genetics, teachers in the community can identify overweight families through observing children in schools. Super sized kids Sample Article Critique Essay This way, they can incorporate strategies that ensure proper practices in the child and the family in general. In the long run, the family benefits in engaging in proper practices that guarantee healthier lives.

Recommendations

The article is beneficial to families that have histories with obesity. It helps them understand the prevalence of obesity and therefore, engage in practices that ensure better health. Besides, obese children can gain extensively from this research, and refrain from unhealthier practices like poor eating habits and sedentary behaviors. This way, the community is guaranteed of a healthy and competent young generation.  Additionally, government officials can learn on the causes of morbid obesity in children. Since it may be difficult to reach all families to educate on interventions, federal officials can collaborate with learning institutions to implement   strategies that deter behaviors promoting obesity. For instance, they can enact feeding packages that exclude fatty foods and enforce mandatory physical education programs to ensure all children are active. This way, the government is guaranteed of a healthy population.

Reference

Patel, D. (2005). Super‐sized kids.
Family Court Review
,
43
(1), 164-177.

doi:10.1111/j.1744-1617.2005.00015.x Super sized kids Sample Article Critique Essay.

Cognitive behavioral therapy vs emotional behavioral therapy sample essay

Cognitive Behavioral Theory (CBT) Versus Rational Emotive Behavioral Theory (REBT)

While cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) have many similarities, they are distinctly different therapeutic approaches. When assessing clients and selecting one of these therapies, you must recognize the importance of not only selecting the one that is best for the client, but also the approach that most aligns to your own skill set. For this Assignment, as you examine the similarities and differences between CBT and REBT, consider which therapeutic approach you might use with your clients.

Rational Emotive Behavioral Theory (REBT) Learning Objectives

Students will:

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Compare cognitive behavioral therapy and rational emotive behavioral therapy

Recommend cognitive behavioral therapies for clients Cognitive behavioral therapy vs emotional behavioral therapy sample essay.

To prepare:

Review the media in this week’s Learning Resources.

Reflect on the various forms of cognitive behavioral therapy.

The Assignment

In a 1- to 2-page Cognitive Behavioral Theory (CBT) Versus Rational Emotive Behavioral Theory (REBT) paper, address the following:

Briefly describe how cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) are similar.

Explain at least three differences between CBT and Rational Emotive Behavioral Theory (REBT). Include how these differences might impact your practice as a mental health counselor.

Explain which version of cognitive behavioral therapy you might use with clients and why. Support your approach with evidence-based literature. Cognitive behavioral therapy vs emotional behavioral therapy sample essay.

Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

The Cognitive Behavioral Theory (CBT) Versus Rational Emotive Behavioral Theory (REBT) Assignment

In a 1- to 2-page Cognitive Behavioral Theory (CBT) Versus Rational Emotive Behavioral Theory (REBT) paper, address the following:

Briefly describe how cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) are similar. Cognitive behavioral therapy vs emotional behavioral therapy sample essay.

Explain at least three differences between CBT and REBT. Include how these differences might impact your practice as a mental health counselor.

Explain which version of cognitive behavioral therapy you might use with clients and why. Support your approach with evidence-based literature. (Please use APA formanting Introduction, summary References, ) Cognitive Behavioral Theory (CBT) Versus Rational Emotive Behavioral Theory (REBT).

Psychologists employ an array of methods when handling clients with mental disabilities. The methodologies used vary according to the problem under study. Besides, psychiatrists ensure that they incorporate strategies that aim at both healing the patient and ensuring the longevity of their mental stability.  Among the many approaches available, psychologists use cognitive behavioral therapy (CBT) and rational emotive behavior therapy when handling clients with mental instabilities. Cognitive behavioral therapy vs emotional behavioral therapy sample essay.

CBT and REBT

Cognitive behavioral therapy (CBT) entails one -on-one interaction with clients. Psychiatrists analyze patients’ views and advise them to change their way of thinking in order to achieve stable mental states (Fairburn et al., 2015). Besides, rational emotive behavioral therapy (REBT) entails convincing clients to identify, evaluate, dispute and act against his/her beliefs which bring about disturbances (David, D. (2015). CBT and REBT are useful approaches with similar and dissimilar provisions.

Similarities

CBT and REBT are similar in that they require the client to identify the cause of their problems and situations. Patients need to ascertain the root of their depressions and work towards correcting the situations Cognitive behavioral therapy vs emotional behavioral therapy sample essay. Loerinc et al. (2015) state the two theories are instruction-based, since psychologists advise the clients on refraining from certain behaviors or models of thinking.  The approaches are time-limited and directive, as the psychiatrists advise on strategies that would guarantee outcomes if implemented effectively.

Differences

CBT approaches are mind-oriented, since they only direct the client to modify their thinking criterion on a limited basis. REBT aims at identifying the root cause that leads to decision making, and advises on an in depth critical evaluation of situations before deriving a decision (Şoflău, & David, 2017). It teaches individuals on effective assertiveness and the ability to solve problems.  Besides, Tulbure et al. (2015) state that the CBT approach aims at bolstering a client’s mental stability by reinforcing their positive qualities. The REBT approach teaches clients on accepting difficult situations and developing newer behaviors to ensure mental stability.

Opinion

In my opinion, I would employ the REBT approach, since it aims at identifying the root cause of discomfort and mental problems in a client. This way, one can recommend on insightful thinking before making a decision. In the long run, the client is guaranteed of a table mental state. Cognitive behavioral therapy vs emotional behavioral therapy sample essay.

References

David, D. (2015). Rational emotive behavior therapy (REBT).
The Encyclopedia of Clinical Psychology
.

doi: 10.1002/9781118625392.wbecp077

Fairburn, C. G., Bailey-Straebler, S., Basden, S., Doll, H. A., Jones, R., Murphy, R., … Cooper, Z. (2015). A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders.
Behaviour research and therapy
,
70
, 64-71.

https://doi.org/10.1016/j.brat.2015.04.010

Loerinc, A. G., Meuret, A. E., Twohig, M. P., Rosenfield, D., Bluett, E. J., & Craske, M. G. (2015). Response rates for CBT for anxiety disorders: Need for standardized criteria.
Clinical psychology review
,
42
, 72-82 Cognitive behavioral therapy vs emotional behavioral therapy sample essay.

https://doi.org/10.1016/j.cpr.2015.08.004

Şoflău, R., & David, D. O. (2017). A Meta-analytical approach of the relationships between the irrationality of beliefs and the functionality of automatic thoughts.
Cognitive Therapy and Research
,
41
(2), 178-192.

Retrieved from https://link.springer.com/article/10.1007/s10608-016-9812-y

Tulbure, B. T., Szentagotai, A., David, O., Ștefan, S., Månsson, K. N., David, D., & Andersson, G. (2015). Internet-delivered cognitive-behavioral therapy for social anxiety disorder in Romania: A randomized controlled trial.
PLoS One
,
10
(5), e0123997.

https://doi.org/10.1371/journal.pone.0123997 Cognitive behavioral therapy vs emotional behavioral therapy sample essay

Complete Health History Sample Essay

Write-up complete health history on a selected person of your choice, citations in the diagnoses section and the treatment plan section.

Use the history components of the SOAP note to guide you.

I’d like the hypothetical person to be a 32-year-old male, no past medical history, only complaint constipation.

Complete Medical History

Patient’s ID:
Mr. A

Physical and History conducted by:
Dr. P

Physical and History conducted on:
March 10, 2018

Chief Complaint:
“I am okay most days, except that I have regular constipation that is very irritating and for which I have to take laxatives.”

Past Medical History:
No past medical history.

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HPI:
32-year-old male. He has been treating his constipation using over the counter laxatives without a prescription. His follow up in the clinic has been occasioned by the on and off constipation that is not solved by over the counter laxatives Complete Health History Sample Essay.

Review of Systems:

General: No night sweats or fever.

Skin: Normal baldness pattern due to aging with no changes to the skin.

Head: No history of seizures, dizziness, trauma, headaches, or trauma.

Eyes: No field or vision changes, or glaucoma diagnosis.

Ears: No vertigo or tinnitus.

Nose: No running nose, facture history or epistaxis.

Mouth and Throat: No pain or sores.

Neck: No pain, goiter or masses.

Respiratory: No hemoptysis, sputum, wheezing, or cough.

Gatrointenstinal: No black stools, diarrhea, vomiting or nausea. Persistent constipation that occurs at least once weekly for which he takes over the counter laxatives. The constipation is accompanied by abdominal pain. Complete Health History Sample Essay.

Genitourinary: No urination urgency or frequency, or dysuria.

Neurologic: No paresthesia, tingling or numbness.

Musculoskeletal: Occasional abdominal pain but no joint or muscle pain.

Hematologic: No history of transfusion, anemia or bleeding disorder.

Emotional: N history of abnormal adjustments, depression, or psychiatric problems.

Family History:

Father 82, Obesity, Hypertension

Mother 76, Rheumatoid arthritis

Sister 42, History of breast cancer

Physical Examination:

General Appearance:
Oriented and alert 32-year-old male in no acute distress.

Vital Signs:
BP 127/77 HR 70 RR 15 Weight 174lbs Height 6’1/4” Temp not measured

Skin:
No abnormal lesions or moles noted.

Neck:
No masses.

Cardiovascular:
Regular rhythm and rate, no gallops, rubs or murmurs.

Lungs:
No crackles or wheezes.

Abdominal:
Abdominal pain, soft and no striations, scars or distensions. No pulsatile masses. Liver and spleen are not palpable. Complete Health History Sample Essay Murphy’s sign is negative with no guarding or reflex tenderness.

Rectal:
Negative hemoccult.

Problem list:
Persistent constipation.

Differential diagnosis:

Constipation, abdominal obstruction

Discussion:

Mr. A reports constipation with all other signs being normal.  As such, there is a need to recommend medication for constipation.

In addition, intestinal obstruction should be considered. That is because it can add to the persistent constipation to cause the abdominal pain (Tham, Collins & Soetikno, 2016).

Diagnostic plan:
Abdominal tests to check for obstructions that could cause the constipation.

Therapeutic plan:

Complete Health History Sample Essay The constipation should be treated by prescribing docusate sodium BID (a laxative).

Patient Education:
Mr. A should be educated on the need for proper diets, rich in fiber, and exercise.

 

References

Tham, T., Collins, J. & Soetikno, R. (2016).
Gastrointestinal Emergencies
(3
rd
ed.). Hoboken, NJ: John Wiley & Sons Complete Health History Sample Essay.

For this Application: Planned Change in a Department or Unit Assignment, you propose a change at the department or unit level and develop a plan for guiding the change effort.

To prepare:

Review Chapter 8 in the course text. Focus on Kurt Lewin’s change theory, and contrast it with other classic change models and strategies.

Reflect on problems, inefficiencies, and critical issues within a specific department, unit, or area in your organization or one with which you are familiar. Select one issue as a focal point for this assignment, and consider a change that could be made to address the issue Application: Planned Change in a Department or Unit.

Think about how the change would align with the organization’s mission, vision, and values as well as relevant professional standards.

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Using one of the change models or strategies discussed in Chapter 8, begin formulating a plan for implementing the change within the department/unit. Outline the steps that you and/or others should follow to facilitate the change effort. Align these steps to the change model or strategy you selected.

Determine who should be involved in initiating and managing the change. Consider the skills and characteristics that are necessary to facilitate this change effort.

Write a 3 page paper page count does not include title and reference page that addresses the following:

Identify a problem, inefficiency, or issue within a specific department/unit.

Describe a specific, realistic change that could be made to address the issue.

Summarize how the change would align with the organization’s mission, vision, and values as well as relevant professional standards. Application: Planned Change in a Department or Unit.

Identify a change model or strategy to guide your planning for implementing the change. Provide a rationale for your selection.

Outline the steps that you and/or others would follow to facilitate the change. Align these steps to your selected change model or strategy.

Explain who would be involved in initiating and managing this change. Describe the skills and characteristics that would be necessary to facilitate the change effort Application: Planned Change in a Department or Unit.

E-Health ethical considerations Reflection Paper Essay example

Apply what you have learned (this course is nursing informatics). Reflect on all you have learned from this class (HIPAA, EMR, meaningful use, etc.). Given the future of E-Health, with the prospect of Digital patient engagement and empowerment. In your opinion, what are some of the ethical considerations.

The advancement of technology has necessitated the transformation of healthcare to a digital platform where it is commonly referred to as E-Health (Electronic Health). This is designed to enhance provision of health care in general E-Health ethical considerations Reflection Paper Essay example. However, it has been established that there are medical risks that could harm patients that are associated with this transformation. This has necessitated laying down of numerous ethical considerations that are supposed to guide the healthcare practice to minimize the possibility of having the potential medical harm associated with E-health occur.

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For example, when recommending digital technology, care providers are supposed to consider technical skills and knowledge of the digital economy of the patient. This will enable them give necessary assistance to those who may not be well versed in digital matters e.g. the poor and uneducated fellows, whom if directed to use the technology without guidance can end up causing themselves harm health wise (Armontrout J, et al., 2016) E-Health ethical considerations Reflection Paper Essay example.

It is also important for physicians to recommend a small number of websites with quality medical information by basing on the assumption that all patients use the digital technology occasionally to diagnose and perhaps start medication of certain health conditions. This will help minimize having patients getting lost into the internet websites maze while seeking relevant medical assistance when some of these websites provide poor quality information on health that can result in medical harm to patients E-Health ethical considerations Reflection Paper Essay example.

General practitioners and healthcare administrators should have basic knowledge in digital technology used in routine healthcare such as EMR (Electronic Medical Records). This basic knowledge will enable them analyze potential negative consequences associated with of tracking data of individual patients whom they directed to use technology.

To sum up, much as the advent of E-health comes with positive impacts on healthcare such as enhancing the sector and raising cost-efficiencies through use of monitoring devices and digital apps, and application of analytics to manage large and diverse sources of data, there are inherent medical issues that require properly outlined ethical considerations such as the ones discussed above to minimize their occurrence.

References

Armontrout J, Torous J, Fisher M, Drogin E, Gutheil T. (2016).
Mobile mental health: navigating new rules and regulations for digital tools. E-Health ethical considerations Reflection Paper Essay example.

Write a paper (2,000-2,500 words) in which you apply the concepts of   epidemiology and nursing research to a communicable disease. Refer to   “Communicable Disease Chain,” “Chain of   Infection,” and the CDC website for assistance when completing   this Epidemiologic Essay assignment.

Communicable Disease Selection

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Choose one communicable disease from the options below.

Chickenpox

Tuberculosis

Influenza

Mononucleosis

Hepatitis B

HIV

Ebola

Measles

Polio

Influenza

Epidemiology Paper Requirements

Address the following:

Describe the chosen communicable disease, including causes,     symptoms, mode of transmission, complications, treatment, and the     demographic of interest (mortality, morbidity, incidence, and     prevalence). Is this a reportable disease? If so, provide details     about reporting time, whom to report to, etc. Epidemiologic Essay.

Describe the     social determinants of health and explain how those factors     contribute to the development of this disease.

Discuss the     epidemiologic triangle as it relates to the communicable disease you     have selected. Include the host factors, agent factors (presence or     absence), and environmental factors. Are there any special     considerations or notifications for the community, schools, or     general population?

Explain the role of the community     health nurse (case finding, reporting, data collection, data     analysis, and follow-up) and why demographic data are necessary to     the health of the community.

Identify at least one national     agency or organization that addresses the communicable disease     chosen and describe how the organizations contribute to resolving or     reducing the impact of disease.

Discuss a global     implication of the disease. How is this addressed in other countries     or cultures? Is this disease endemic to a particular area? Provide an example Epidemiologic Essay.

A minimum of three peer-reviewed or professional references is required.

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 Epidemiologic Essay assignment to become familiar with the

Electronic Medical Record (EMR) Application Essay Paper

EMR-Abraxas Medical Systems (iConnect network)

This scholarly paper is to be presented using the format set forth in the Manual of the American Psychological Association 6th edition. The list of references includes all reference sources used to support your paper. Citation required where appropriate.

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Analysis must include: How does the EHR provide solutions / capabilities / for:

1. Legal, Privacy, Confidentiality and Organizational components

2. Reporting capabilities – operational and analytical

3. Describe how the EHR may help or hinder your duties as a nurse? What can you do to improve your organization/team/staff approach to the EHR in the future?

4. An abstract for your scholarly paper is required Electronic Medical Record (EMR) Application Essay Paper.

Attached is a copy of the rubric criteria. Only the highlighted sections on this rubric need to be completed for this Electronic Medical Record (EMR) Application Essay paper.

Do a literature search from at least (2) nursing/healthcare journal articles. Analyze the key issues in the articles and support your position.

 

Electronic Health Record Application Paper Criteria:

Percentage

1. Purpose of the Electronic Medical Record application

10%

2. Analysis

How does the EHR provide solutions / capabilities / for:

40% total from 8 sections below

§ 
Performance measures, Core Measures, Quality Measures CMS reporting

5%

§ 
Legal, Privacy, Confidentiality and Organizational components

5%

§ 
HIMSS EMR Adoption Model Score – Stage 0-7

5%

§ 
ARRA, HITECH, and Meaningful Use

5%

§ 
Reporting capabilities – operational and analytical

5%

§ 
Options for mobile platforms (smartphones, iPad, portable devices)

5%

§ 
Patient Education before, during, and after clinical encounter Electronic Medical Record (EMR) Application Essay Paper

5%

§ 
How would nurse informaticist support the Change Management of implementing or modifying EMR? (Super User, Subject Matter Expert, etc.)

5%

3. Impact on nursing practice, administration, education and research as applicable

20%

4. Describe how the EHR may help or hinder your duties as a nurse? What can you do to improve your organization/team/staff approach to the EHR in the future?

10%

5. Current literature research supporting all aspects of paper. At least (2) References from nursing/healthcare journal articles

10 %

6. APA Format:

Title page – header in APA format, student name, affiliation, title of paper, course & date.

Body of paper – headings (one or two levels), references cited correctly in text, quotes are appropriate in amount & length, paragraph structure, spelling, grammar, punctuation is appropriate. Avoid jargon, slang, and conversational tone. Clear, concise, organized.

Reference page – Citations according to 6th edition, all citations on the reference page are found in the Electronic Medical Record (EMR) Application Essay Paper

Overall format – Margins are 1 inch, new times roman, 12 pitch font, double spaced

Note: Papers may/will be submitted to Turnitin to check for plagiarism.

10%

Total

100%

Abraxas Medical Systems Electronic Medical Record (EMR) Application Paper

Abstract

Following many decades of development, Electronic Medical Records (EMRs) are currently exerting an essential effect on health care practices than it was previously. Although the primary reasons for instigating EMRs concentrates on refining medical care system as a whole, one must consider the effect and the application of increased EMR to patient-physician encounter and the medical system as a whole. In this paper, the writer analyzes how Electronic Health Record provides solutions and capabilities for privacy, legal and confidentiality components of a healthcare organization as well as the operational and analytical reporting capabilities. The paper describes how Electronic Health Record helps or hinders the nurse’s duties and what I can do as a nurse to improve the organizational approach to EMR in the future Electronic Medical Record (EMR) Application Essay Paper.

EMR-Abraxas Medical Systems (iConnect network)

According to Blechman, Electronic Health Record (EHR) is a real-time patient-centered digital record of patients’ data which makes the information available securely and instantly to users who are authorized (2015). EHR can streamline and automate workflow, allow access to evidence-based tools essential in the decision-making process about the care of the patient and stores medical records of a patient with their laboratory test results. Abraxas Medical Solutions Inc. has specialized in developing and marketing software solutions for healthcare institutions to enhance efficient charting and clinical workflow functionalities of the stated institutions above.

How Abraxas EHR software provides solutions and capabilities to legal, privacy, confidentiality and organizational components.

The Electronic Health Record software stores the patient’s data electronically which can only be retrieved by authorized users hence improving privacy and confidentiality of the patient’s information. A paper-based medical record lacked security where the access was controlled by locks, doors, tedious sign-out procedures for authorized persons and use of identification cards to access the information. Such measures do not provide sufficient privacy and confidentiality of the patient’s information Electronic Medical Record (EMR) Application Essay Paper. Due to such a doubt, EHR has been designed to restrict the number of users to have access to the data. The EHR provides legal capabilities through its ability to allow the patient routinely review their electronic medical records which contain clinical documentation concerning their diagnosis.

According to Hanauer (2015), the data which is shared as an outcome of a medical affiliation is often deliberated as private hence such information must be secured. The patient’s information ought to be unrestricted to third parties merely by the consensus of the patient or the regulation permitting a nurse to do so. EHR allows a two-tier approach to authentication, enhancing biometric identifier scans to permit the access to the patient’s medical records hence improving the privacy and confidentiality of patient’s information. In Electronic Health Record systems, user access to patient’s confidential report is based on pre-established and role-based privileges Electronic Medical Record (EMR) Application Essay Paper.

How EHR improves operational and analytical reporting capabilities

When healthcare institutions have access to accurate and complete records, patients will obtain efficient and improved health care. Electronic Health Records can advance the aptitude to detect ailments, prevent or reduce medical faults and improve the reporting capabilities for operations and analysis. According to research by Blechman, ninety-two percent of healthcare institutions who use EHR system make patient’s record readily available at any point of care hence efficient operational reporting (2015) Electronic Medical Record (EMR) Application Essay Paper. Also, the health care providers reported that EHR permits clinicians to deliver enhanced patient’s care and also enjoys clinical benefits in their analytical reporting capability. EHR always alerts a clinician in the event of an emergency such as patient’s lethal allergy which makes the emergency supervisor modify care correctly even when the patient is cataleptic thus improving operations.

Hanauer (2015) mentions that EHR system aids in diagnosis through making health institutions to have reliable access to the complete health information of the patient. Such comprehensive picture makes the health professionals diagnose the patient’s problem soonest due to the ready availability of data. Similarly, EHR keeps the record of the medication for the patient. Consequently, the system spontaneously checks for hitches every time a new prescription is issued hence signals the nurse thus improving operational capabilities Electronic Medical Record (EMR) Application Essay Paper. Furthermore, EHR instantly and systematically identifies and corrects any operational errors thereby improving the operational and analytical abilities. Such problems are difficult to adjust on a paper-based setting since it may take a lot of time.

How EHR can help or hinder my duties as a nurse and what I can do to improve my organization’s approach in future

Personally, EHR speeds up my process to offer medication, getting reports and communicate efficiently with other facilities. On the contrary, EHR affects how I do my work through slowing down and also speeding up the process of charting and investigating the records of the patient. Occasionally the computers may be down which eventually slows down the chatting process. It is sometimes frustrating when the network goes down unexpectedly especially when I don’t know what to do.

I will do the following to improve my organizational approach to EHR in future. I will ask our management to advocate for enhanced and regular surveillance and monitoring of the system to allow for efficiency and reduce errors and technicalities which may occur as a result of operation slowing down. I will also propose support team who will regularly check the system and computer functionality to prevent EHR from slowing down Electronic Medical Record (EMR) Application Essay Paper.

References

Blechman, E. (2015). “Electronic health records.” U.S. Patent Application No. 14/588,304.

Hanauer, D. A., Mei, Q., Law, J., Khanna, R., & Zheng, K. (2015). Supporting information retrieval from electronic health records: A report of University of Michigan’s nine-year experience in developing and using the Electronic Medical Record Search Engine (EMERSE). 
Journal of biomedical informatics
, 
55
, 290-300 Electronic Medical Record (EMR) Application Essay Paper.

Nursing Clinical Packet Patient Assessment and Care Plan

Instructions to student:

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1)            Bring one copy of this packet with you to clinical each week.

2)            Your instructor will inform you of the number of packets and the dates each packet is due.  They may have you complete only portions of or all of the packet.

3)            Read the rubric! Each packet is Pass/Fail. You must meet the requirements listed to receive a Pass.  Your instructor may ask you to resubmit packets that are incomplete or incorrect.

4)            If your instructor asks you to submit the packet electronically, then please record your answers in bold or in a colored or lower case font.  This helps us identify your answers more quickly. Nursing Clinical Packet Patient Assessment and Care Plan.

 

PATIENT ASSESSMENT FORM

STUDENT NAME:

DATE:

                                                                                                 

CLIENT INITIALS:

ROOM #

DOB:

AGE

GENDER:

ADMISSION DATE:

CODE STATUS:

ALLERGIES:

MARITAL STATUS:

OCCUPATION (FORMER):

MEDICAL DX:

CHIEF COMPLAINT:

PAST HISTORY (SURGERY/PROCEDURES) WITH DATES

ORDERS

RATIONALE (Why is this ordered for this client???)

EXAMPLE:

  DIET

2 g Sodium diet with nectar thick liquids only

Sodium is restricted due to edema in the bilateral lower extremities and nectar thick liquids due to dysphagia from a past stroke.

DIET

ACTIVITY

I/O

VS

BGM

FOLEY

NG

PEG/PEJ TUBE

WOUND CARE

RESPIRATORY TREATMENT

Nursing Clinical Packet Patient Assessment and Care Plan

TRACHEOSTOMY

SUCTIONING

CHEST TUBE

SPECIAL EQUIPMENT

LAB ORDERS

OTHER

REHAB SERVICES

ACTIVITY OR TREATMENT PLAN & SCHEDULE

RATIONALE

PHYSICAL THERAPY

SPEECH THERAPY

OCCUPATIONAL THERAPY

 

 

      / 5 pts

 

IVs

IV FLUID AND RATE:

SITE LOCATION AND CONDITION:

LAST DRESSING CHANGE:

LAST TUBING CHANGE:

GAUGE:

REASON FOR IV ACCESS:

 

DIAGNOSTIC TESTS: 

DATE

RESULTS

REASON FOR TESTING AND IMPLICATIONS FOR NURSING CARE

 

LAB TEST

DATE

RESULTS

NORMS REFERENCE RANGES

IMPLICATIONS FOR NURSING CARE (WHAT S&S I SHOULD BE AWARE OF AND WHAT YOU CAN DO TO HELP IMPROVE AN ABNORMAL RESULT?)

 

GROWTH and DEVELOPMENT:  (
see pages 378-379 Taylor, Lillis and White) or (Erikson’s Stages of Development)

CLIENT’S DEVELOPMENTAL STAGE ACCORDING TO HAVIGHUSRT

TASKS OF THIS STAGE:

 

 

 

ASSESSMENT OF CLIENT’S SUCESSFUL ACHIEVEMENT OF TASKS

 

 

 

 

      / 5 pts

 

MEDICATIONS

If your client has more than 12 medications, select the 12 medications that are most important, most frequently given or those that pertain to the client’s most significant medical problems.  See the example below. Nursing Clinical Packet Patient Assessment and Care Plan.

 

Brand Name and Generic Name

Normal Dosage Ranges

Contraindications

Coreg (carvedilol)

 

3.125 mg – 50 mg BID

Asthma, heart block

Pharmacotherapeutic Class

Dosage, Route & Frequency

Adverse Reactions

β-adrenergic blocker

 

6.25 mg p.o. BID

Bradycardia, CHF, thrombocytopenia, hyperglycemia, bronchospasm

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

He has a history of hypertension but has been taking Coreg for 2 years to control his hypertension

 

BP’s for past 3 days have been 128/78, 132/72, 138/80

 

How is this medication impacting your client??B/P readings, lab results, pain management, etc……..

Do not discontinue abruptly or before surgery

Caution with Upper airway dysfunction Nursing Clinical Packet Patient Assessment and Care Plan

Rise slowly to minimize orthostatic hypotension, check B/P and heart rate prior to administration

Take before meals

 

 

#1 Brand Name and Generic Name

Normal Dosage Ranges

Contraindications

 

 

Pharmacotherapeutic Class

Dosage, Route & Frequency

Adverse Reactions

 

 

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

 

 

 

 

#2 Brand Name and Generic Name

Normal Dosage Ranges

Contraindications

 

 

#3 Pharmacotherapeutic Class

Dosage, Route and Frequency

Adverse Reactions

 

 

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

 

 

 

#4 Brand Name and Generic Name

Normal Dosage Ranges

Contraindications

 

 

Pharmacotherapeutic Class

Dosage, Route and Frequency

Adverse Reactions

 

 

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

 

 

 

#5 Brand Name and Generic Name

Normal Dosage Ranges

Contraindications

 

 

Pharmacotherapeutic Class

Dosage, Route and Frequency

Adverse Reactions

 

 

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

 

 

 

# 6 Brand Name and Generic Name

Normal Dosage Ranges

Contraindications

 

 

Pharmacotherapeutic Class

Dosage, Route and Frequency

Adverse Reactions

 

 

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

 

 

 

#7 Brand Name and Generic Name

Normal Dosage Ranges

Contraindications

 

 

Pharmacotherapeutic Class

Dosage, Route and Frequency

Adverse Reactions

 

 

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

 

 

 

#8 Brand Name and Generic Name

Normal Dosage Ranges

Contraindications

 

 

Pharmacotherapeutic Class

Dosage, Route and Frequency

Adverse Reactions

 

 

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

 

 

 

#9 Brand Name and Generic Name

Normal Dosage Ranges

Contraindications

 

 

Pharmacotherapeutic Class

Dosage, Route and Frequency

Adverse Reactions

 

 

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

 

 

 

#10 Brand Name and Generic Name

Normal Dosage Ranges

Contraindications

 

 

Pharmacotherapeutic Class

Dosage, Route and Frequency

Adverse Reactions

 

 

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

 

 

 

#11 Brand Name and Generic Name

Normal Dosage Ranges

Contraindications

 

 

Pharmacotherapeutic Class

Dosage, Route and Frequency

Adverse Reactions

 

 

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

 

 

 

#12 Brand Name and Generic Name

Normal Dosage Ranges

Contraindications

 

 

Pharmacotherapeutic Class

Dosage, Route and Frequency

Adverse Reactions

 

 

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

 

 

 

 

      / 20 pts

 

 

 

 

 

NURSES NOTES FOR CLINICAL

For this clinical, we are having you write out your assessment findings in the form of a narrative nurse’s note.  We have provided some samples of assessments. We have also provided a worksheet that you may use to take into a patient’s room to take notes during your assessment. Record your vital signs and type your physical assessment findings. This form will expand to fit your typing.  A sample of charting for a long term care resident follows below.

TEMP:

APICAL HR:

RESP:

BP:

HT:

WT:

 

DATE / TIME

(TYPE HERE)

 

 

Sample Narrative Note
— Head to Toe format

 

Temp: 98.6

Apical HR: 72

Resp: 16

BP  128/62

Ht: 5’10”

Wt:  145

 

12/22/2010         1400

Resident in semi-fowlers position in bed.  Pressure reduction mattress in place.  Alert and oriented x 3. Appropriate mood and affect. Well groomed.  Recent and remote memory intact. Facial symmetry noted. Pupils are equal, reactive to light and accommodation.  Oral mucosa moist, pink.  Frequent oral care rendered with sponge toothette and toothbrush. Dentition intact.  Hearing intact. Oropharynx clear without erythema or exudate. No chewing or swallowing difficulties. 75% of general diet taken at breakfast. Skin pink, warm, dry, free of lesions with elastic turgor.  Hair and nails unremarkable.  Carotid and radial pulses present and equal. Motor and sensory functions grossly intact. No weakness or paralysis.  Upper extremities equal strength bilaterally, full ROM w/ capillary refill < 3 sec. Fine resting tremor in the left hand” No involuntary movement or abnormal posture.   Lungs clear bilaterally to auscultation. Tracheostomy dressing clean, dry, and intact. Connected to ventilator with settings: TV-550, Fio2-40%, Rate 10, and PEEP-5cm. Sao2-92%. Suctioned for moderate amount of white, thin secretion. Apical pulse regular (rate) and rhythm. Double lumen picc line note to left antecubital space. Tegaderm dressing is clean, dry, and intact. Last dressing change on 11/28/16. Chlorhexadine caps intact to all lumens.  Bowel sounds active x 4.  Abdomen soft, non-distended, non-tender. Last bowel movement this morning, passed a large, soft- formed brown stool and a moderate amount of clear yellow urine. Bilateral lower extremities, no tenderness, swelling or joint deformities noted.  Denies numbness or tingling to extremities. Toe nails thick and yellowed w/ capillary refill < 3 sec.  No peripheral edema noted, pedal pulses palpable and equal bilaterally.   PHYSICAL ASSESSMENT WORKSHEET ( Use this sheet for jotting down your assessment findings.) ROUTINE FINDINGS PATIENT VARIATIONS/ABNORMALS COGNITION/NEUROLOGICAL (SAMPLE)   Alert and oriented x3, recent and remote memory intact. Denies any numbness or tingling to extremities” (SAMPLE) “Fine resting tremor of left hand    SKIN       SENSORY Wound measurements and complete description if available at the very least Document dressing including the type of dressing and description of condition! BREASTS – DEFERRED. RESPIRATORY – (Include ventilator settings as indicated in narrative note)     CARDIOVASCULAR Include any vascular access device, IV lines, AV fistulas, perma -cath lines, etc.     ABDOMEN – . Include any enteral feedings here and route   BOWEL CONTINENCE?    LAST BM?  BOWEL PLAN? MUSCULOSKELETAL –       GENITOURINARY – URINARY CONTINENCE?  TOILETING PLAN?     PELVIC – DEFERRED.   RECTAL – DEFERRED.         / 10 pts   NURSING CARE PLAN Begin your NCP by listing ALL your clients individual problems (at least 10) and then identify an appropriate nursing diagnosis that you can think of that would apply to your client.  Determine which 3 problems/nursing diagnoses are of greatest priority and then add a #1, #2, and #3 to indicate which of the two have highest priority Nursing Clinical Packet Patient Assessment and Care Plan.  Risks would not be priority 1, 2, or 3!!!!! Expectation is to have at least 10 nursing diagnosis listed! #    List the Client problem An appropriate Nursing Diagnosis stem (REFER TO YOUR NURSING DIAGNOSIS LIST) Related to part of the statement  (This is individual to your client) As evidenced by part of the statement (This is individual to your client) REMEMEBR THIS IS NOT USED IN A “Risk For” diagnosis 1 SAMPLE: Reports severe pain in the right hip. “Acute Pain” “related to” fractured right hip “as evidenced by” verbal report of pain rated at an 8 on a scale of 0 –to 10. 2 SAMPLE: Complete bed rest “Risk for Impaired skin integrity” “related to “ immobility NONE it is a “Risk for” diagnosis so there is no evidence statement From the list above your faculty member will give you direction regarding how many and which diagnoses they want you to develop for either a Nursing Care Plan and/or a Concept Map. Nursing Clinical Packet Patient Assessment and Care Plan.   SAMPLE NCP NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED BY STATEMENT:  Acute Pain related to right hip fracture as evidenced by a verbal report of pain rated 8 on a scale of 0 -10.    ASSESSMENT (Data that directly pertains to the above nursing diagnosis) OUTCOME STATEMENT (Patient centered, realistic, specific, measurable, target time) INTERVENTIONS (Individualized, specific, frequency) Minimum of 4-5 interventions per plan SCIENTIFIC RATIONALE (Supporting statement from text or other source, cite source)   EVALUATION OF OUTCOME (Met, partially met, unmet, unknown by target time) SUBJECTIVE DATA:  “My right hip hurts me so much every time I move.  I am so afraid to start physical therapy” SHORT TERM:  Client will report pain level rated at a 3 or lower 30 minutes after pain medication taken 1. Educate the client on the importance of pain relief to enhance her rehabilitation efforts and include education on various types of methods to relieve pain.     2. Encourage client to express any questions or concerns she may have regarding pain management methods to alleviate anxiety and fears.       3.  Educate the client on her responsibility to honestly report pain when it occurs as well as reporting if the current pain management is effective or ineffective for providing her pain relief   4. Provide for alternative/complementary measures of pain relief, such as, reduce lighting and noise, soothing music, pet therapy, massage, and hot/cold packs according to client preferences. 1. “There are many ways to manage pain.  In addition to pharmacologic and non-pharmacologic measures, simple nursing interventions can alter patients’ pain experience and speed their recovery.” Taylor, Lillis and White pg. 1168.   2.   “Common fears include a loss of control and embarrassment by being unable to deal with pain maturely… The patient may view the need of for medication as a sign of weakness or may fear addiction or loss of effectiveness at a later date.” Taylor, Lillis and White pg. 1169.     3. “As a patient advocate, ensure that a strong emphasis on the need for aggressive, individualized strategies that can minimize or eliminate acute pain and improve patient outcomes.  Preventing pain is easier then treating it once after it occurs.”  Taylor, Lillis and White pg. 1178.   4. Alternative/complementary measures will provide an added benefit of distraction from pain experience and augment analgesic effect. Cold/hot therapy can provide constriction and or dilation which will reduce pain inflammation in each specific circumstance Daniels. Pg 378 Short Term Goal: Met; pain was rated at a 2 on a scale of 0 to 10 after administration of Vicodin.           Long Term Goal.  In progress OBJECTIVE DATA: Alert and oriented 70 year old widowed female.  Lives in an apartment independently. 2 daughter live nearby and visit often. History of a fall while out shopping 1 ½ weeks ago.  Right hip surgically repaired 7 days ago.  Surgical dressing to right hip is clean, dry and intact. Circulation, motion and sensation intact to right lower extremity. Afebrile; BP 124/80; R-18 AP 84 and regular. 5 foot 7 inches weighs 142 pounds. No hearing deficits; wears eye glasses Medical history positive for osteoarthritis and osteoporosis Non weight bearing to right leg and to use a walker for ambulation To start physical therapy for gait and strength training BID times 7 days and occupational therapy to develop upper body strength once daily times 7 days Reports pain level is at 8 on a scale of 0 to 10. Has Vicodin 5mg/325 mg po 2 tabs every 4 hours prn for severe pain Ibuprofen 400 mg every 6 hours prn for moderate pain. LONG TERM:  Client will report pain level of 2 or less using ibuprofen with alternative pain control methods by discharge. Nursing Clinical Packet Patient Assessment and Care Plan Short term outcome:  An outcome that can be accomplished by the end of the student clinical day. Interventions:  Each nursing intervention must come from a reliable nursing reference or source.  Please note:  do not use nursing care planning book exclusively.  Not more than one intervention can come from a source outside your textbooks. Rationales:  Cite a reliable source for each intervention (name of text, author, page number, internet site and date retrieved (reliable sites: .gov or .edu. or .org) Nursing Clinical Packet Patient Assessment and Care Plan. NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED BY STATEMENT:   ASSESSMENT (Data that directly pertains to the above nursing diagnosis) OUTCOME STATEMENT (Patient centered, realistic, specific, measurable, target time) INTERVENTIONS (Individualized, specific, frequency) SCIENTIFIC RATIONALE (Supporting statement from text or other source, cite source)   EVALUATION OF OUTCOME (Met, partially met, unmet, unknown by target time) SUBJECTIVE DATA: SHORT TERM: OBJECTIVE DATA: LONG TERM: Short term outcome:  An outcome that can be accomplished by the end of the student clinical day. Interventions:  Each nursing intervention must come from a reliable nursing reference or source.  Please note:  do not use nursing care planning book exclusively.  Not more than one intervention can come from a source outside your textbooks. Rationales:  Cite a reliable source for each intervention (name of text, author, page number, internet site and date retrieved (reliable sites: .gov or .edu. or .org) Nursing Clinical Packet Patient Assessment and Care Plan.         /30   NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED BY STATEMENT:   ASSESSMENT (Data that directly pertains to the above nursing diagnosis) OUTCOME STATEMENT (Patient centered, realistic, specific, measurable, target time) INTERVENTIONS (Individualized, specific, frequency) SCIENTIFIC RATIONALE (Supporting statement from text or other source, cite source)   EVALUATION OF OUTCOME (Met, partially met, unmet, unknown by target time) SUBJECTIVE DATA: SHORT TERM: OBJECTIVE DATA: LONG TERM: Short term outcome:  An outcome that can be accomplished by the end of the student clinical day. Interventions:  Each nursing intervention must come from a reliable nursing reference or source.  .  Please note:  do not use nursing care planning book exclusively.  Not more than one intervention can come from a source outside your textbooks. Rationales:  Cite a reliable source for each intervention (name of text, author, page number, internet site and date retrieved (reliable sites: .gov or .edu. or .org) Nursing Clinical Packet Patient Assessment and Care Plan.         /30     NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED BY STATEMENT:   ASSESSMENT (Data that directly pertains to the above nursing diagnosis) OUTCOME STATEMENT (Patient centered, realistic, specific, measurable, target time) INTERVENTIONS (Individualized, specific, frequency) SCIENTIFIC RATIONALE (Supporting statement from text or other source, cite source)   EVALUATION OF OUTCOME (Met, partially met, unmet, unknown by target time) SUBJECTIVE DATA: SHORT TERM: OBJECTIVE DATA: LONG TERM: Short term outcome:  An outcome that can be accomplished by the end of the student clinical day. Interventions:  Each nursing intervention must come from a reliable nursing reference or source.  .  Please note:  do not use nursing care planning book exclusively.  Not more than one intervention can come from a source outside your textbooks. Rationales:  Cite a reliable source for each intervention (name of text, author, page number, internet site and date retrieved (reliable sites: .gov or .edu. or .org)         /30   3   Key Problem:   Impaired urinary elimination Data: Intake=3800  Output=3200 Polyuria 3+ glucose in urine AEB:  Polydipsia and polyuria Outcomes: Pt. will have urine output of 1000 – 2000 ml/24 hours. Interventions: Monitor I & O q shift. Monitor BGM a.c. and h.s. Monitor kidney function tests Administer antihyperglycemics as ordered. Key Problem:   Knowledge deficit Data:   Pt verbalizes confusion about diagnosis, new meds, diet, exercise routine AEB:  Verbal statements and questions. Nursing Clinical Packet Patient Assessment and Care Plan. Outcomes: Pt will verbalize understanding of ADA diet and administer insulin using appropriate technique by discharge. Interventions: Assess level of knowledge regarding diabetes/ treatment and client’s preferred learning style. Provide information q shift according to teaching plan recorded in EMR and document pt’s response. Reassess level of knowledge daily. Provide written information. Provide educational resources available in the community. 4 Medical Problems (Pathophysiology)/Surgical Procedures: Newly diagnosed diabetic         Key Assessments: S/S of hyper and hypoglycemia, good intake, I/O, glucose level, vitals   Tests: FBS, hemoglobin A1C “I don’t know how this fits” Recent widow Kids live out of state ? support system   1 Key Problem : Acute anxiety Data : Restless, verbally states she is anxious. AEB: Pt states “I don’t know what I will do with diabetes, this is too much.” Outcomes: Pt. will verbalize under-standing of resources available by discharge. Interventions: Provide pt. with an opportunity each shift to verbalize anxiety by asking open ended questions. Demonstrate progressive relaxation exercises and have pt. return demonstrate. Nursing Clinical Packet Patient Assessment and Care Plan. Provide pt. with a list of community resources for newly diagnosed diabetics. Identify client’s perception of anxiety Utilize empathy.   2 Past Medical History:   Hypertension x 20 years; appendectomy at age 9. Risk Factors: Mother had Type 2 diabetes; hypertension; Native American descent; sedentary lifestyle; 290 pounds, age 52 Key Problem: Imbalanced nutrition, more than Data: BMI: 35.0–39.9; Ht: 5”9; Wt: 290 lbs AEB: Anthropometric measurements. Outcomes: Client will verbalize a realistic weight loss goal and three strategies to reach it prior to discharge. Nursing Clinical Packet Patient Assessment and Care Plan. Interventions: Assess client’s knowledge of nutrition and its relationship to diabetes. Arrange for dietary consultation. Reinforce teaching  by dietician. Encourage physical activity as a weight loss strategy. Provide pt with community resources that can assist her with weight loss goal.   “I DON’T KNOW HOW THIS FITS” PAST MEDICAL HISTORY     RISK FACTORS MEDICAL PROBLEMS (PATHOPHYSIOLOGY)/SURGICAL PROCEDURES:   KEY ASSESSMENTS: Key Assessments: Tests: KEY PROBLEM: DATA: AEB: OUTCOMES: INTERVENTIONS: KEY PROBLEM: DATA: AEB: OUTCOMES: INTERVENTIONS:           /60pts KEY PROBLEM: DATA: AEB: OUTCOMES: INTERVENTIONS: KEY PROBLEM: DATA: AEB: OUTCOMES: INTERVENTIONS: RUBRIC for Grading Packets Student Name: Clinical Date: Site:   Section Grading Criteria Satisfactory  Or  Unsatisfactory Comments, Kudos, Things to Improve for Next Time 10 points Patient Demographics, Diagnoses, Surgeries, Orders, Rehab, IV, Imaging and Lab Page 1 fully  and correctly completed                                                   5 pts Page 2 fully and correctly completed                                                    5 pts   _/5___ _/5___   20 points Medications     Medication Trade Name                                                                          2 pts Medication Generic Name                                                                      2 pts Pharmacological Classification                                                               2 pts Normal Dosage Range                                                                              2 pts Dose ordered                                                                                             2 pts Route and Frequency                                                                               2 pts Contraindications                                                                                      2 pts Adverse Effects/Reactions                                                                       2 pts Nursing Considerations & Teaching                                                       2 pts (Legible or typed)                                                                                      2 pts    / 2    / 2    / 2    / 2    / 2    / 2    / 2    / 2    / 2    / 2   _/20__ 10 points Narrative Notes Head-to-Toe Assessment Narrative note is in Head to Toe order Head-to-toe assessment documented   Abnormal results noted     10 pts     ___/10_ 60 points  (either a Concept Map or a Patient Care Plan) Concept Map Correct Medical Diagnosis                                                                       15 pts Pathophysiology                                                                                        15 pts Key Assessments                                                                                       15 pts At least 3 problems identified                                                                15 pts   ____/60   OR 60 points (either a Concept Map or a Patient Care Plan) Patient Care Plan   3 nursing diagnoses Related to”  “As evidenced by”                           18 pts 2 Outcomes specific, measurable, timed                                               8 pts 4-5 Interventions are logical, appropriate                                             15 pts 4-5 Scientific Rationales supporting each intervention                       15 pts                                          2 Evaluations                                                                                               4 pts   ____/60 Nursing Clinical Packet Patient Assessment and Care Plan

Feasibility of Your Design Proposal and Importance of Communication

This week’s graded discussion topic relates to the following Course Outcome (CO).

CO3 Communicates effectively with patient populations and other healthcare providers in managing the healthcare of individuals, families, aggregates, and communities. (PO 3)

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Now that you have identified your capstone change project, it is time to look at its feasibility.

What tangible and intangible resources will be needed to implement your project?

What improved outcomes do you anticipate will occur that could indicate the project produced a successful return on investment (ROI) of these resources?

How will you communicate your plan for change with key decision makers so that they will support the allocation of the resources you are seeking? Feasibility of Your Design Proposal and Importance of Communication.

Design Proposal Feasibility and Communication

Question 1: What tangible and intangible resources will be needed to implement your project?

The research will require both tangible and intangible resources during the implementation stage. The tangible resources include all visible inputs that can be directly measured to include funding and personnel. For instance, funding is necessary to pay for the software that would be used in data analysis Feasibility of Your Design Proposal and Importance of Communication. The intangible resources include incorporeal project contents that include the raw medical data showing how each variable performed in the project (Pasian, 2015). Including the two resource types will allow the project to proceed.

Question 2: What improved outcomes do you anticipate will occur that could indicate the project produced a successful return on investment (ROI) of these resources?

A successful ROI for the resources will be achieved if data on the research variables can be accurately collected and in the right quantities. This is important because it will allow for the link between variable to be determined, particularly in showing whether including antibiotic prophylaxis reduces the risk of infection. In essence, a successful ROI must have all the project steps followed as documented in the methodology section. This would allow for the results to be trusted, since they can be verified. If any single step is left out or not followed as indicated, then the conclusion will be erroneous thereby resulting in an unsuccessful ROI of the resources (Kloppenborg, 2015) Feasibility of Your Design Proposal and Importance of Communication.

Question 3: How will you communicate your plan for change with key decision makers so that they will support the allocation of the resources you are seeking?

The results will be communicated through two strategies to support the allocation of resources. Firstly, tangible data from reliable resources will be collected and presented to key decision makers as part of the project proposal to inform them of the project merits thereby garnering their support since the project would be a logical step Feasibility of Your Design Proposal and Importance of Communication. Secondly, information to support the project will be published in independent peer-reviewed publications where they will be scrutinized. The successful publication will be an indication that the information supporting the project has be verified to show that allocating resources towards the project is justified (Kloppenborg, 2015).

References

Kloppenborg, T. (2015).
Contemporary Project Management
(3
rd
ed.). Stamford, CT: Cengage Learning.

Pasian, B. (2015).
Designs, Methods and Practices for Research of Project Management
. Surrey: Gower Publishing Limited Feasibility of Your Design Proposal and Importance of Communication.