History of hypertension, past MRSA infection, and a recently implanted pacemaker. petechiae in the conjunctivae and splinter hemorrhages in his nail beds.

OBJECTIVE DATA

Petechiae in the conjunctivae and splinter hemorrhages in his nail beds.

blood pressure is 138/64, heart rate 80, respiratory rate 18, and temperature 99.5^oF (37.5^oC).

A Heart murmur is noted

Blood culture results are positive for Staphylococcus aureus

Echocardiogram demonstrates vegetations on his mitral valve.

Discussion Questions.

1. What risk factors for IE does E.F. have? and what other risk factors would you assess E.F. for?
2. What clinical manifestations of IE does E.F. present with? and what other clinical manifestation of IE would you assess for him.
3. What diagnostic studies would you expect the admitting health care provider to order for E.F?
4. What medical treatment would you expect the healthcare provider to order for E.F?
5. Identify appropriate nursing diagnoses and goals for E.F.
6. What important patient and caregiver teaching should you provide E.F. and his family?
7. E.F. mentions to you that he has a scheduled upcoming dental surgery. What important information would you provide to him based on his diagnosis of IE?

Research news and other sources of information about healthcare trends in the United States. Describe one trend and at least 3 implications the trend could have for financial planning within a healthcare organization, such as a hospital or clinic.

include why the trend could have these implications. Support with research and cited statements

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 radiograph had been performed.

All labor and delivery team members must be able to recognize the signs of a prolapsed cord and initiate appropriate emergency interventions to relieve pressure on the cord until emergency delivery, usually, a cesarean delivery, can be accomplished.

Prolonged cord compression (occlusion of blood flow to and from the fetus for longer than 5 minutes) leads to fetal hypoxia, usually resulting in central nervous system (CNS) damage or fetal death.

List 6 steps you would take to relieve pressure on the umbilical cord.

Please include the following steps

1. Perform hand hygiene before patient contact.
2. Introduce yourself to the mother and support person.
3. Verify the correct patient using two identifiers
4. Assess the presentation, position, and station of the fetus.
5. Determine if factors that increase the risk of a prolapsed umbilical cord are present.
6. Ensure that adult and neonatal resuscitation equipment is readily available.
7. Ensure that supplies and equipment are available and prepare for an emergency cesarean delivery.
8. Perform hand hygiene and don gloves

10.

From the International Council of Nurses (ICN) Code of Ethics for Nurses, Element1 is ‘Nurses and People’.  In addition to the information given in the scenario, you are also aware that recovery staffs in the healthcare facility regularly administer narcotic analgesia as part of their pain management protocol.

Provide two (2) examples of how EN Baxter can apply Element 1 in this scenario. In your response, include reference to Mr Smythe’s cultural beliefs about analgesia.