Chronic back pain

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John Smith is a 64-year-old male. His past medical history includes BPH, HTN, chronic back pain, COPD, seasonal allergies, Erectile dysfunction, and intermittent UTI’s. Mr. Smith has completed school through 8thgrade but then ultimately became a laborer until his retirement.

His wife accompanies him to meetings with doctors to assist and learn about the medications as well.

Mr. Smith is very independent however and does not want to rely on his wife.

Each student will make educational pamphlet on one of the prototype medications from the semester that applies to the scenario and client above.

They must use the appropriate health literacy level for a patient/family member. The pamphlet must include:

  • expected action
  • therapeutic uses
  • side effects/adverse effects
  • medication/food interactions
  • any specific details pertinent to that medication

Surgical removal of the stomach

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Tamika Perry, a patient of Dr. Kowalski, had a gastrectomy (surgical removal of the stomach). A nasogastric (NG) tube is in place to drain all fluids. It is connected to suction and irrigated at times. An intrave- nous (IV) solution is providing liquid intake.

Oral intake is limited to sips of ginger ale or water and ice cubes. a. NG tube was irrigated with normal saline (NS) as follows: 7 AM 10 mL . 9 PM 25 mL with 10 mL withdrawn 11 AM 10 mL 1 AM 10 mL 4 PM 10 mL 4 AM 20 mL with 5 mL withdrawn

b. IV was absorbed as follows: 12 Noon 400 mL 10 PM 200 mL 2 PM 150 mL 3 AM 400 mL 8 PM 500 mL 6 AM 200 mL c. Urine output was as follows: 9 AM 400 mL 9 PM 550 mL 1 PM 250 mL 1 AM 400 mL 5 PM 375 mL 5 AM 200 mL d.

The patient had greenish liquid stool as follows: 11 AM 300 mL 5 PM 200 mL 3 AM 750 mL e. The NG tube suction jar was emptied on each shift. Measurements were as follows: 2 PM 780 mL greenish liquid 10 PM 550 mL golden-brown liquid 6 AM 625 ml golden-brown liquid

Shortness of breath and wheezing

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Dependent, and 3. A client reports shortness of breath and wheezing and is technical skills given a nebulizer
treatment with a bronchodilator. What evaluation recorded by the nurse indicates a positive ther data and
outcome of the treatment? ogno has decreased wheezing with no shortna

History of hypertension, past MRSA infection

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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 99.5oF (37.5oC).

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?

What is buspirone? How does buspirone differ from benzodiazepines?

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What is buspirone? How does buspirone differ from benzodiazepines?

3.     Is buspirone appropriate for the treatment of dental anxiety?

4.     What are the adverse effects associated with buspirone?

5.     Would there be a problem if a dentist had to prescribe a sedating medication for or use one during treatment while taking buspirone?

6.     Would a benzodiazepine be the better choice? How can i deal with the issues surrounding sedation and driving?

7.     What is zolpidem?

8.     What are some of the concerns regarding zolpidem therapy? How have these concerns been addressed by the manufacturer?

Sources of information about Healthcare trends

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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 researches and cited statements.

A spontaneous Left pneumothorax

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A 30-year-old woman with a history of cystic fibrosis was admitted to the hospital for management of a 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 radiograp

Identify if EN Baxter was working within her scope of practice during this scenario. Explain how you came to this conclusion, based on her actions.

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Identify if EN Baxter was working within her scope of practice during this scenario. Explain how you came to this conclusion, based on her actions.

Remember the scope of practice for an Enrolled Nurse includes:

·       Implementing planned nursing care to achieve identified outcomes

·       Recognising and reporting changes in the health and functional status of individuals/ groups to the registered nurse

·       Ensuring communication, reporting and documentation are timely and accurate

·       Organising work load to facilitate planned nursing care for groups and individuals

Explain how methods of translation and approaches for the management of implementation of the guideline might improve the success for implementing the guideline in an organization

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Explain how methods of translation and approaches for the management of implementation of the guideline might improve the success for implementing the guideline in an organization.

 

B.  provide information that will deepen understanding of the concepts of methods for translation and approaches for the management of the implementation of the guideline

Discuss a healthcare safety concern using the SBAR (situation, background, assessment, recommendation) format by doing the following:

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Discuss a healthcare safety concern using the SBAR (situation, background, assessment, recommendation) format by doing the following:

 

1.  Describe a healthcare-related situation prompting a patient safety concern (S).

I have chosen the problem of CAUTIs or Catheter-Acquired Urinary Tract Infections, specifically, those patients who develop CAUTIs from the use of indwelling catheters in the acute care setting.

2.  Analyze background information about the concern by doing the following (B):

a.  Describe the data that support or would support the need for change.

This study showed the intervention strategy and CAUTI bundle can greatly decrease the IUC use rate and CAUTI rates, as well as improve quality and safety regimens in a large ICU while being able to create a durable cultural change regarding the use of IUC in hospital staff (Gupta, 2017). The importance of in-and-out catheterization and bladder scanning instead of IUC was also shown to prove a large role in the decrease of UTIs (Gupta, 2017).

b.  Explain how one or more national patient safety standards apply to this situation.

 

3.   Discuss the impact of the safety concern on the patient(s), staff, and organization (A).

The use of indwelling catheters unnecessarily exposes patients to CAUTIs, which can cause other problems associated with the UTI such as longer hospital stays and frequent use of antibiotics which can, in turn, lead to antibiotic resistance.

The use of indwelling catheters should be carefully monitored, used only when necessary and no longer than needed.

a.   Explain how the safety concern affects value for the patient(s) and the organization.

 

4.   Recommend an evidence-based practice change that addresses the safety concern (R).

I believe the best intervention to decrease the rates of CAUTIs is the reinforcement of education or better training on the appropriate usage, cleaning techniques, and removal guidelines for indwelling catheters.

a.   Discuss how this recommendation aligns with the principles of a high-reliability organization.

 

b.   Describe two potential barriers to the recommended practice change.

I think there are several barriers that could be encountered such as the new practice not being followed by staff who are resistant to change or feel that it is easier to deal with multiple patients if they have an IUC.

There is also the issue of incontinent patients that can develop skin integrity issues which is why many patients have an IUC.

c.   Identify two potential interventions to minimize the barriers from part A4b to the recommended practice change.

For incontinent patients more frequent trips to the bathroom or use of a bedpan, diaper or chucks could be helpful in not using an IUC. For staff that is resistant to change, ask them why they feel the new guidelines are not achievable and if they have any ideas that they feel could be implemented that would be helpful to the issue.

d.   Discuss the significance of shared decision-making in implementing this recommendation.

I believe it would be important to involve the nurses that work at the bedside and make sure they understand how important it is to implement the new changes along with getting their input on how the changes are positive or negative as well as the unit leaders or managers that will be enforcing the new changes and providing training on how to insert, use and care for IUCs following the new guidelines.

The physicians that work on the unit should be included in the teaching exercises and informed on why this change needs to be implemented and their opinions considered since they are the ones who prescribe the IUCs.

e.   Describe an outcome measure that could be used to evaluate the results of the recommendation.

The outcome that would measure my recommended change would be a decreased number of cases of hospital-acquired CAUTIs in an acute care unit over 3 months compared to the 3 months before the changes were implemented.

f.    Discuss how the care delivery model in this organization would be impacted by this change.