Patent Intravenous (IV) line

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One issue within the nursing profession relates to the multiple attempts by nurses to insert a patent intravenous (IV) line. A specific example is a patient who had required a large-bore needle because they needed to receive a blood transfusion.

This patient had received a total of 6 sticks; All attempts were unsuccessful. The issue is the increased number of unsuccessful peripheral intravenous insertion attempts.

To address the issue, a Population, Intervention, Comparison, Outcomes, and Time (PICOT) question must be completed (Echevarria & Walker, 2015). In this specific scenario, we are focusing on elderly patients above 65 on a medical-surgical floor. This particular population tends to have fragile veins that quickly blow out.

An intervention can be using an ultrasound-guided machine to identify the location of veins. The comparison intervention will be using no device (Echevarria & Walker, 2015). The outcome is the number of needle sticks required for a successful patent IV site. Time would be the length of time at the hospital (Echevarria & Walker, 2015).

The PICOT question format would be as follows. In patients older than 65 on the medical-surgical unit, how does using an ultrasound-guided IV catheter compared to using no device affect the number of attempts to insert a peripheral IV site within the time frame at the hospital?

Addressing this problem via nursing research can improve patient outcomes. The research will inform nurses if using ultrasonography will decrease the number of unsuccessful sticks. Unsuccessful attempts at intravenous catheters can increase pain and delay treatment (Sengul & Acaroğlu, 2021).

One research study found that ultrasound-guided peripheral intravenous catheter (PIVC) had a short duration for the procedure, lowered pain during the process, and increased satisfaction.

However, the article further articulated that there was no significant difference between the number and rates of successful attempts between ultrasound-guided PIVC and traditional methods (Sengul & Acaroğlu, 2021).

It was also reported that all nurses working at the facility had at least five years of experience which may have affected the success rates of the interventions. In the end, it was recommended to use ultrasound to guide PIVC because it decreased the time of the procedure and had a high satisfaction rating (Sengul & Acaroğlu, 202

Improving Nursing research

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There is always room for improving Nursing research helps improve patient care and outcome. Falls are prevalent but 100% preventable in hospitals. These falls can lead to longer stays in the hospital or death. Over the years there have been innovations to improve patient safety to prevent falls such as hourly rounding, fall risk socks, signs, and wristbands, and bed and chair alarms.

With these safety items in place, falls still occur. At my hospital, we have had a 10% increase from last year in falls. Even though we have all these interventions in place for those who score high in fall risk, the number continues to go up. Utilizing PICOT and EBP, new initiatives can be put into place to make hospitals safe and prevent falls from occurring.

For example question is: does placing patients of the hospital in alarm belts prevent falls when compared to no alarm belts in a three-month period? “Fall detection is a widely researched topic” and ultimately is aimed at patient safety which is of the utmost importance for improving patient outcomes (Warrington et al., 2021, para. 6). “Globally, falls are the second leading cause of unintentional death injury” (Warrington et al., 2021, para. 1).

Wearable device technology, such as alarm belts, are effective and are low-cost to prevent falls (Warrington et al., 2021). Preventing falls can improve patient care safety and lower the statistic of being one of the leading causes of unintentional death.

A nursing practice problem in a diagnosis

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A nursing practice problem in a diagnosis, mainly dealing with how patients react or respond to underlying healthcare problems (NANDA International, n.d). These problems are usually identified when nurses are conducting their assessments concerning conditions patients are suffering from. A nursing problem is mainly concerned with patient needs, from when they seek medical attention to when they leave the hospital. Here, the nurse collects data about the patient, like their health history and the objective data. An example of such a problem is when a patient visits a hospital, and they are diagnosed with cancer. It will be necessary to conduct a physical examination on them to determine the pathophysiology of the disease.

On the other hand, a medical practice problem deals with research on the actual disease. A medical problem will often define the disease process (Nanda International, n.d). Issues like the disease’s epidemiology and how it affects the body can be researched in this area. For example, when a patient visits the hospital, they may be diagnosed with diabetes. Diabetes is the medical problem, whereas showing signs of fatigue, sweating, or increased temperatures shows the patient’s response to the condition, hence a nursing practice problem.

A PICOT question must always be based on the nursing practice problem because it focuses on the patient (Duke University, 2020). An excellent clinical problem should always look into the patient’s needs, as patient needs are at the core of the healthcare sector. This will make the research process much easier and more objective. Using the PICOT approach in defining medical problems gives room for a well-organized clinical question, with practical strategies to manipulate through the item.

Client presentation, willingness to work

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A brief assessment of the session. I.e. client presentation, willingness to work on the issue.  Only answer about assessments you are qualified to make. 

Tiffany and Jason have been married for 16 years. They have 2 children, Brendan, 7 and Michelle, 14 y/o. For the last few years, they both admit, to have been slowly drifting apart. Jason began spending more and more time at work. The situation worsened about a year ago when Tiffany found inappropriate text messages from his secretary on his phone.

When she confronted him about it he accused her of not trusting him and he stormed out of the house. Whenever Tiffany brought up the issue, it would end in a similar fashion. Jason neither confirmed nor denied anything and Tiffany assumed this meant he was indeed having an affair with his secretary.

She became bitter and withdrawn. Although Jason maintained that he still loved her, Jason became more distant too, partly due to his feelings of guilt and partly in reaction to Tiffany’s withdrawal.

Now the only time they interact with each other is in response to the children-and rather than being positive interaction, it is simply to apportion blame to each other for any of the children’s perceived short comings. An example of this occurred a month ago when Jason, Tiffany and Michelle were called into the school because of Michelle’s recent truancy.

As the Principal informed them of Michelle’s excessive absences, instead of discussing the issue with Michelle, Tiffany and Jason blamed each other for her behaviour. Eventually the Principal asked Michelle to leave the room and spoke to Jason and Tiffany in private, advising them that they seek counselling.

 

For their part Tiffany and Jason recognize they have been ignoring the children and their escalating marital problems are having detrimental effect on the well-being of their 2 children. They both believe their relationship has deteriorated beyond repair and are seriously considering getting a divorce. Tiffany has decided to come in for counselling, as Brendan is breaking into temper tantrums at the slightest of issues and the suspicion that Michelle may be taking drugs, although she denies this.

She wanted Jason to attend counselling as well, but he thinks that they don’t need counselling and Tiffany is being a bit paranoid again.  To add to the issues, Jason’s father died a week after the discussion with the principal. Jason is dealing with his grief by withdrawing from the family even more.

Brendan and Michelle are upset about the loss of their grandfather and spent more time close Tiffany as Jason is unresponsive to them. Tiffany is not sure she can cope with this added burden and the marriage break down.

 

Counselling: just imagine you are counselor and write according

  1. What did you want to achieve in this session and what skills or knowledge did you use to achieve these?
  2. What didn’t work so well in this session, and what will you do differently next time?
  3. How did you manage your own values so they do not impede effective work?
  4. What documents have been produced or could be produced as a result of this session and how will they be kept and accessed?

a. Purpose of Contact

What was the purpose of the session? I.e. ongoing monitoring of order, intake, assessment etc… 

 

b. Discussion

A brief summary of what occurred in the session, including a record of the clients own identified priorities and goals. Please answer the whole not in the third person, i.e.  the worker and keep to facts and what was observed. If you are going to say someone was angry, you have to say what you observed to make you think that. 

 

 

 

 

c. Assessment

A brief assessment of the session. I.e. clients presentation, willingness to work on issue.  Only answer about assessments you are qualified to make. 

 

 

 

 

d. Actions Require/Taken

What actions and follow up is required and by whom. 

 

Environments and Job responsibilities

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Part of what makes McClelland’s acquired needs theory so powerful is that the work environments and job responsibilities can — and in fact, should — be tailored to meet workers’ specific needs. Consider the three types of needs:  Need for achievement,  Need for power, and  Need for affiliation. Then answer the next questions:

1. Of achievement, power, or affiliation, which is the strongest need you have?

2. What type of position would be most likely to satisfy the need that you have identified as your strongest need?
3. Why would the position that you identified in #2 satisfy the need that you identified in #1?

Concerns about visiting hours policies

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The nurse manager has heard there have been some conflicts with the unit’s visiting hours policies. In order to address the concerns about visiting hours, which of the following is the most

important action by the nurse manager?

Leave the visiting hours unchanged.

Complete a survey of the visitors.

Change the visiting hours for 2 weeks.

Consult another nurse manage

The Baby Boomer generation

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A nurse is working with a generationally diverse team. The nurse is generation X and genuinely wants mentorship from a nurse from the Baby Boomer generation. What statement would

facilitate the conversation?

I notice that you like to have flexible scheduling. Would you show me how to do this?

 

It’s been really hard to keep up with the changes going on the unit. You seem to take it in

stride. What is your secret?

 

. I notice that you talk with a couple of nurses on the unit during your breaks. Would you

mind scheduling time with me to talk with you during breaks?

 

I notice that you are really organized and end your shifts on time. Would you give

me some tips?

Myocardial infarction Medication

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A client is being discharged after being admitted for myocardial infarction Medication. The physician wants the client to be monitored for vital signs while the client is doing the rehabilitation protocol.

What type of informatics system would be best for a reliable interface with client data?

A. Personal fitness tracker

B. Real-time health monitor system

C. Telehealth monitoring

D. Smart wearable body sensors

What is the dependent and Independent variable

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Please what is the dependent and independent variable in this statement? In residents 65 years and above, who are bed-bound at Pro Medical Skilled Nursing and Rehabilitation Center, Arlington, how does the application of natural cleansers and nutrient emollients as a preventative measure using foam dressings and scheduling a 2-hour turning time, compared to the application of lotion and aloe vesta without dressing and scheduling 2-hour turning time impact pressure ulcer development within a three-month period.

Care of clients with acquired hypothyroidism

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Compare and contrast the care of clients with acquired hypothyroidism (Hashimoto’s disease). Gretchen is an 11-year-old who is short in stature but overweight. Keisha is a 31-year-old woman with a TSH level of 12 who wishes to become pregnant. Loretta is a 67-year-old woman with long-standing hypothyroidism. She currently takes levothyroxine once a day. Please include assessments (including diagnostic testing), care measures (including medications), and teaching needed for each client.

For your response, formulate a response to a peer from the other group. Include any additional assessments, care measures, and teaching suggestions for your peer. Do not merely agree or disagree with your peer about the information given in the post. Be sure to include information related to age differences when planning care for clients with endocrine conditions.