National Patient Safety Goals website concerning Hospital

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Review the Millie Larsen case update within this assignment, read the questions, and consult your resources–particularly the texts and National Patient Safety Goals website concerning Hospital Chapter, Goal 7, NPSG.07.01.01 and NSPG.07.03.01. Brainstorm ideas and formulate your responses. Use the Braden Scale form to score her skin risk; access the Braden Scale form through the link below.

 

Several weeks have passed since the clinic visit, and Millie is now re-admitted to the hospital with a diagnosis of urinary tract infection and dehydration. Her presentation is atypical, and she is confused. Upon the admission assessment, the nurse notices that Millie has a wound on her sacrum and asks her if it is painful. Millie states that “it does hurt, so I have just been lying down more.” The nurse places a gauze dressing over the wound and continues with the assessment.

She is now being cared for on a medical-surgical unit and because she is confused, she has a bed alarm for her safety. Millie needs much encouragement to get out of bed and walk to the bathroom so has become more incontinent and requires frequent bed changes. She is receiving intravenous fluids and medications for the urinary tract infection. Millie appears weak and underweight as she is only eating about one-quarter of her meals. She refuses to drink the supplements that she is offered and sometimes refuses to take her medications.

A few days later, it is noted that the wound has worsened and now has purulent drainage with a foul odor which will require referral to a wound nurse for additional care. Wound cultures are positive for methicillin-resistant staphylococcus aureus (MRSA).

Before responding to the questions, review the following videos:

  1. Obtaining a Wound Culture by Swab (Links to an external site.)
  2. Removing and Applying Wet to Damp Dressings (Links to an external site.)
  3. Open-Pore Reticulated Polyurethane Foam Therapy (i.e., Vacuum-Assisted Closure [V.A.C.]) (Links to an external site.)

Respond to the Following Questions

 

 Oval wound on person with deep wound bed. Overall skin color is lightly pigmented.  Yellow fatty tissue noted in part of wound bed. Remainder of wound bed is red.

 

  1. View the picture to help you assess the wound. What are the “clinical findings” and how would you stage Millie’s wound?
  2. What would be included in the plan of care for treatment of Millie’s wound? Please include all aspects of a team-based approach that will be utilized in a successful treatment plan.
  3. What are three (3) nursing interventions that the nurse would incorporate into the plan of care? Give a rationale for each intervention.
  4. If the wound nurse orders a dressing change for this wound, what technique would be appropriate? (Medical asepsis, clean technique? Or surgical asepsis, sterile technique)? Describe the procedure and give a rationale for your choice.
  5. What are some of the risks that Millie demonstrates for forming a pressure injury? Using the Braden Scale  Download Braden Scale, how would you score Millie at this time?

 

 

Nasal cannula for oxygen saturation

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A term (41 weeks) female weighing 3100 g was born to a 30-year-old healthy gravida 2 para 1 mother by cesarean. Apgar scores were 9 and 9 at 1 and 5 minutes. The infant was initially well until day 3 of life, when she presented with tachypnea and increased work of breathing, including retractions and nasal flaring. The infant was transferred to the NICU. A complete sepsis workup was done and antibiotics were given as protocol. The infant was placed on a nasal cannula for oxygen saturation which ranged from 89-91%. Capillary blood gas was performed and revealed the following: pH 7.30, PaCO2 56 mm Hg, PaO2 45 mm Hg, HCO3 27 mEq/L, and BE 1. A chest radiograph showed mild hyperinflated lungs and mild perihilar interstitial markings. An echocardiogram was also ordered at this time, which showed an anatomically normal heart with no structural malformation. During the next 24 hours, the infant’s respiratory status worsened,
with progressive increases in work of breathing with increasing oxygen requirement. Continuous positive airway pressure was initiated by a nasal mask at 6 cm H2O and an FIO2 of 0.50. A follow-up chest radiograph was performed, which showed increasing haziness of both lung fields with air bronchograms. Capillary blood gases obtained 12 hours after nasal CPAP therapy revealed the following: pH 7.19, PaCO2 80 mm Hg, PO2 40 mm Hg, HCO3 29.5 mEQ/L, BE 1.8, and oxygen saturation 88%. Physical assessment revealed the following: temperature 37.1°C, heart rate 175 beats per minute, respiratory rate 90 breaths per minute, and blood pressure 70/40 mm Hg. The infant was
intubated and mechanically ventilated with an inspiratory pressure of 20 cm H2O, PEEP 6 cm H2O, set rate of 60 breaths per minute, and FIO2 of 0.80. Systemic examination was unremarkable except for respiratory distress. There was no clinical evidence of pulmonary hypertension. A complete sepsis workup was repeated. The white blood cell count was unremarkable. Chest radiograph following intubation
revealed a diffuse ground-glass appearance with air bronchograms. The endotracheal tube was 2 cm above the carina.

 

1. What therapeutic recommendation would you make based on the infant’s clinical presentation and chest radiograph?
2. Given this presentation, what diagnosis should be considered for this infant?
3. What information obtained by chest radiograph would indicate that this infant may benefit from
surfactant replacement
therapy?

 

Normal integrated prenatal screening

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You are called to the delivery room at 2:00 a.m. for a laboring gravida 1 para 0 mother at 28 weeks gestation. The mother had good antenatal care and had a normal integrated prenatal screening (IPS), normal 20-week ultrasound, and protective serology, including rubella immune, human immunodeficiency virus (HIV) negative, venereal disease research laboratory (VDRL) negative, and hepatitis negative. Group B Streptococcus (GBS) status is unknown as the woman had not yet had swabs done. Social history was negative for tobacco, alcohol, or recreational drug use during the pregnancy. She has gestational diabetes mellitus, which was reasonably controlled by diet and exercise
alone. You arrive to the delivery room moments before the baby is born and prepare equipment for a potential resuscitation, which includes oxygen, bag and mask, suction, towels to dry, and intubation equipment. At birth, the newborn cries spontaneously. She is placed on the warmer to be dried and stimulated; her heart rate is 120 beats per minute and her respiratory rate is 60 breaths per minute. The
infant grunts intermittently. At 4 minutes of age, the newborn has both subcostal and intercostal retractions, nasal flaring, and continuous grunting. Her respiratory rate is now 82 breaths per minute and her heart rate is 190 beats per minute. Oxygen saturation by pulse oximetry is 84% with blow-by oxygen. You begin providing CPAP at 6 cm H2O by mask with a t-piece resuscitator. A systolic murmur gr 2/6 is auscultated loudest at the left upper sternal border (LUSB). The infant is transferred to the NICU where she continues to receive nasal CPAP at 6 cm H2O and a FiO2 of 0.45. The chest X-ray shows a diffuse ground-glass appearance with air bronchograms. An arterial umbilical catheter (UAC) is inserted. Arterial blood gas reveals the following: pH 7.23, CO2 60, PaO2 40, HCO3 27, BE +1, and lactate 4.8.
Blood work shows white blood cell count 20.3, neutrophils 12.3, no left shift, hemoglobin 16.5, platelets 260.

 

1. What is the first line of therapy for this premature infant considering her presentation?
2. What are the chemical components that makeup surfactants?
3. How does surfactant work in the lung?

What are the major types of healthcare workforce planning?

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.What are the major types of healthcare workforce planning? Provide examples of situations where each strategy would be more appropriate than the others. Healthcare workforce planning is often done after a shortage in a particular profession is recognized. How could planning help avert those shortages? Counting healthcare professionals as part of healthcare workforce planning is not always straightforward. For a specific profession-nursing, dentistry, or medicine-describe how the prac-