Review the following concepts so you can provide a logical discussion on sampling: parameters or attributes of the population representativeness of the defined population appropriateness of the sampling plan to the research design appropriateness and justification of the sample size evidence that the rights of human participants (subjects) have been protected  Now develop your own sampling strategy based upon your PICOT question by responding to the questions below.

Make sure you support your answers with the literature. Provide both in-text citations and a reference list. A State your PICOT. Define your target population and proposed sample.

B Discuss your sampling approach in terms of its nature, use, advantages, and disadvantages.

C Indicate the inclusion and exclusion criteria. Exclusion criteria must be other than “Participants are excluded if they do not meet inclusion criteria.”

What else could exclude participants from your research study? D Identify the sample size and discuss how the number of participants was determined. E Discuss potential threats to internal and external validity as a source of sampling bias.

F What is your Cosmic Question  (This is a question you ask your peers to respond to based on the chapter discussed in class this week: Sampling Strategy).

Remember, the aim of the cosmic question you propose should enable others to critique your sampling strategy

A 19-year-old female college student presents to the emergency department complaining of chest tightness and dyspnea. She was cutting and trimming the lawn when these symptoms developed. Rhinorrhea and tearing began soon after she went outside and preceded the chest discomfort. Going inside did not relieve her symptoms. During the physical examination, she said, “I have had asthma since childhood, and my mother and brother also have asthma.” Her respiratory rate was 30 breaths per minute, and she exhibited the use of accessory muscles for respiration. Breath sounds were decreased, except for expiratory wheezes. Heart sounds were distant with tachycardia but regular.

Identify appropriate laboratory tests. Indicate what therapies might be initiated. What worsening signs and symptoms may manifest?

 

 

 

 

 

CASE STUDY II

Mr. S. is a retired 69-year-old county attorney who was on a buying trip with his wife

looking for old, classic cars in the high, mountainous country of Colorado when he

became extremely short of breath, much more than usual. His alarmed wife took him

to a multispecialty medical clinic for evaluation.

Upon admission, Mr. S. was restless and dyspneic. His history revealed a habit

of smoking two packs of cigarettes a day for 45 years (90 pack years). During the past

few years, Mr. S. noticed a cough each morning on arising. Recently, while working in

his flower garden, he had to stop at times to catch his breath. He stated, “Even while

I’m watching television, it is sometimes hard to breathe.”

On examination, the anteroposterior diameter of his chest was enlarged, and upon

percussion, his chest exhibited a hyperresonant sound. A chest radiograph was

taken, and pulmonary function tests were done. The chest radiograph revealed a

flat, low diaphragm with lung hyperinflation, but clear fields. Pulmonary function tests

showed decreased tidal volume and vital capacity, increased total lung capacity, and

prolonged forced expiratory volume.

 

Which pulmonary disease is exhibited by Mr. S.’s symptoms? Justify your answer.

A nurse assessing a client with anxiety disorder identifies which of the following physiologic symptom(s) of anxiety? ( Select all that apply) 1-Irritability2- Blurred vision 3-Dilated pupils 4- Hypervigilance 5-Crying 6-Diaphoresis

Definitions of the quality of medical care are no longer left to clinicians who decide for themselves what technical performance constitutes “good care.” What are the other dimensions of quality care and why are they important? What has changed since the days when “doctor knows best?”

-Quality in medical care may be defined as achieving the greatest benefit at the lowest risk. How have the priorities of our health care system and the allocation of resources addressed this goal?
-Contrast the definitions of implicit and explicit criteria in assessing health care quality. How is each type of criterion useful in the quality assessment?

Please use scholarly articles within 5 years. Thank you.

A case study on chest tube complication, A 30-year-old woman with a history of cystic fibrosis was admitted to the hospital for management of spontaneous left pneumothorax (collapse of her lung). She required urgent thoracostomy (chest tube) placement in the emergency department.

The chest tube was connected to wall suction in order to promote re-expansion of her lung.

Over the next 2 days, the patient improved, and repeat imaging showed re-expansion of her lung. The consulting pulmonary team felt that the chest tube might be able to be removed, so they requested that the tube be disconnected from suction and clamped. The plan was to obtain a chest radiograph 1 hour after clamping the tube, and if the pneumothorax had not recurred, the tube would be removed.

About 45 minutes after the tube was clamped, the patient complained of acute, sharp pain radiating to her left arm. The nurse gave the patient pain medication.

She noted that the radiograph had not yet been done but assumed that it would be done soon. Unfortunately, the radiograph was not done, and the nurse became busy with another acutely deteriorating patient.

Approximately 2 hours later (3 hours after the tube was clamped), the nurse found the patient unresponsive, in cardiac arrest with a rhythm of pulseless electrical activity.

A code blue was called. The code team recognized that the arrest could have been due to a tension pneumothorax, reconnected the chest tube to suction, and eventually performed needle decompression.

Despite these measures, the patient did not recover spontaneous circulation for more than 30 minutes and sustained severe anoxic brain injury as a result. The patient required tracheostomy and feeding tube placement, and she was eventually transferred to a long-term care facility with a poor neurologic prognosis.

 

 

The hospital conducted a root cause analysis (RCA). The RCA committee found that there was considerable variation around chest tube removal practices between services.

For example, the trauma surgery service did not routinely perform a clamping trial before chest tube removal. Although other services did perform such a trial, there was variation in when the radiograph was performed after clamping the tube.

The committee noted that this variation led to confusion among bedside nurses about how to monitor patients and communicate with physicians immediately after chest tube removal.

As a result, the committee felt the complication might still have occurred even if the radio