Predisposing factors for the development of deep vein thrombosis

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Therefore, to prepare for the simulation, you are required to complete the pre-briefing questions below and submit them to the faculty facilitating the simulation before the start of the pre-briefing. If you do not complete the pre-briefing questions below and submit them to the faculty facilitating the simulation before the start of the pre-briefing, you will not be permitted to participate in the simulation.

Pre-Briefing Questions for NR304 Annie LaDuke 1. Based on the nursing process, describe the following information regarding a client diagnosed with deep vein thrombophlebitis. a. Components of a peripheral vascular assessment b. Predisposing factors for the development of deep vein thrombosis c. Diagnostic test and lab values associated with deep vein thrombophlebitis: venous doppler, D-dimer, INR, PT, PTT, Hematocrit, Hemoglobin, Platelets d. Establish a priority nursing diagnosis for the client 2. Formulate questions that would be included in a pain assessment for a client with deep vein thrombophlebitis. 3. Identify 3 non-pharmacological measures that can be used for pain relief in care for a client with deep vein thrombophlebitis 4. Identify cultural domains included when performing a culture assessment.

Identify the grand theory that guides nursing

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Identify the grand theory that guides nursing in your current place of employment, and describe one to two (1 to 2) things done on your unit to reflect that theoretical framework, including the rationale. Support your Initial Post with examples, if warranted, and at least two (2) scholarly references (i.e., journal articles, books) that were NOT assigned for this module.

Discuss the social determinant of health

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1. How would you address the parents of a 6-month-old who declines any vaccinations for their child?

2. Discuss the social determinant of health that you feel impacts parents the most against immunizing their child. Discuss the vaccines available for Covid vaccination and the appropriate dosages and frequency. Please discuss any side effects that have been mentioned, according to CDC  guidelines

External allied health

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GROUP CLIENT SERVICE DELIVERY PLAN State your client’s feedback below on: Needs (state 2 needs) Interests (state 2 interests) Rights (state here what rights should there be a client) for these rights and interests to be met for the 1. 2 . 2. List below in the table; services to support each of your client’s interests and needs in the table above Service to Support Your Clients Interests (add web link)

1. Service to Support Your Client’s Interests (add web link) 1. 2 . 2. What is the expected outcome your client wishes from these services to address their two interests and two needs: Outcomes desired for both interests listed Outcomes desired for both needs listed 1. 1 2. 2. Your client has provided feedback; discuss below what type of feedback occurred for the client Feedback from the client on the interests (Improvements, feedback or Feedback from client on the interests (Improvements, feedback or complaints) complaints) " Based on the client’s feedback of the service and the feedback of the services we can determine if the service was successful or not and make adjustments if required * External allied health staff that visit to provide services for the client can also be considered for this assessment task.

 

Leininger’s cultural care

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How can we employ Leininger’s cultural care: diversity and universality theory to provide individualized nursing care during the Covid-19 pandemic? Support your Initial Post with examples, if warranted, and at least two (2) scholarly references

Greenish discoloration

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A client delivered a baby boy at 41.3 weeks gestation. The newborn weighed 3040 grams and was very alert during the initial assessment. His skin is dry and cracking with little vernix or lanugo. His fingernails are long with greenish discoloration. He is 23 inches long with little subcutaneous fat.

Case Study 1 Questions

  • What is the most likely medical diagnosis for this infant?
  • What characteristics support this diagnosis?
  • What complications are anticipated for this infant?
  • What would be the appropriate nursing interventions to prevent these complications?
  • What are the expected outcomes when providing nursing care to the newborn?
  •  How does an infant with postmaturity syndrome differ from an infant who is large for gestational age (LGA) or who is an infant of a diabetic mother (IDM)?

The public’s perception of nursing

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Describe how the nursing profession is viewed by the general public. Discuss factors that influence the public’s perception of nursing. Describe ways to educate the general public on the professional nurse’s role and scope of nursing within a changing health care system.

Primary Medical Diagnosis and another medical diagnosis

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Nursing Care Plan for Nursing Year 1

 

REHAB FACILITY (information)

Patient Name: Mrs. X

Age: 92

Code Status: DNR

Marital Status: Widowed

Medical Condition: Right Hip #

Meals: Regular Diet

Fluid Consistency: Regular Fluids

Eye opening: spontaneously

Best Verbal response: oriented

Best motor response: obey

 

  • Take meds whole with apple sauce
  • Adjust oxygen saturation flow to maintain saturation 90-95%

 

92 yo woman transferred from HRH for right periprosthetic hip #.

→ She had previous hip #, dementia with dn PD, and fell unwitnessed, on Dec 28, 2022, while walking to the bathroom with her walker. Found to have a right hip # and an abrasion to the scalp. Underwent ORIF for right periprosthetic hip #.

 

27/02/23 → Nutrition:

  1. Intake Appetite: Intake has been fluctuating → consuming 50-100% of most meals, receiving supplemental vitamin D, diet tech involved with menu selection
  2. Chewing/swallowing: recent FEES – tolerating regular diet well
  3. Bowel management: last charted BM+today, receiving scheduled lactulose & senna to assist with regularity
  4. Skin Integrity: Skin is reported as being intact. Braden = 15

 

28/02/23 → Physiological

Received sitting up in a chair

  • 1 person assist
  • Toileted x 1, cont x 1
  • Took 15mls lactulose instead of 30 MLS
  • Assisted to bed at 2230 at her request

 

27/02/23 →Client progress: Continue to progress in therapy. Assist x1 with direct pivot transfer from bed to wheelchair. OT program initiated. PBP did this am; SBP elevated, asymptomatic of BP, and with position changes
03/03/23 → Participated in PT yesterday: “Ambulation: 60 m with 1min standing break + 2min sitting break at halfway point. Steady gait” Seen up in a wheelchair, comfortable
Speech and Language

SLP Focus: FEES Study

  • Fibreoptic Endoscopic Evaluation of Swallowing was completed
  • Equipment used: Olympus CV-170, flexible nasolaryngoscopy
  • The procedure was well tolerated and no clear penetration /aspiration

Questions
1. What is the Primary Medical Diagnosis and another medical diagnosis

2. what kind of communication strategies should use, what is significant about the client’s condition, how can we provide care by one person or do we need help, how does our care connect with CNO standards of practice, how do we interact with the interprofessional team, eg. UCP?)

 

NURSING PROCESS STEPS (CLINICAL JUDGEMENT MODEL)

Assessment (Recognizing and Analyzing Cues)

a. Identify data found on Kardex/Client care summary relevant to the care.

b. Identify further data needed before providing client care.

 

Diagnosis (Prioritizing Hypotheses)

a. Generate Nursing Diagnoses relevant to client (remember to consider physiological and psychosocial needs).

 

Planning (Generating Solutions)

a. Identify goals or desired outcomes for the client, related to the nursing diagnosis identified above. This should describe the client response that we expect to achieve as a result of interventions (Goals should be SMART [specific, measurable, attainable, relevant, times] goals).

b. Describe with the rationale the activities, including nursing interventions, required to provide care. List the activities in the order that we will complete them.

 

Implementation (Taking Action)

a. Identify specific equipment items that we would need to prepare to take to the bedside to provide the care we have planned above.

b. What would be any other communication strategies to be used during the implementation of care for this client?

c. what safety factors do we need to consider while providing care for this client? (For client and For Nurse)

d. Identify and give a rationale for the infection control practices that we would use while implementing this care?

e. While providing this care, what other assessments would you make?

 

Evaluation (Evaluating Outcomes)

a. For the goal/desired outcome identified above, describe how we will evaluate our intervention. (Evaluation should reflect the goal/outcome related to the nursing diagnosis)

 

Documentation

a. Provide a progress note or consider significant data to be documented.      

 

ISBAR

a. Consider how to communicate significant information with the interdisciplinary team. (eg. shift change, conference, physician, OT/PT etc.)

The treatment of coronary bifurcations

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A factor to consider in the treatment of coronary bifurcations is the risk of the patient developing stent thrombosis and how large the side branch vessel is compared to the main vessel and if this side branch occlusion is going is significant enough to cause symptoms. As a result of an increased risk of stent thrombosis after bifurcation lesion stenting, intensive (e.g., aspirin and ticagrelor or aspirin and prasugrel) or prolonged ( greater than 12 months) dual antiplatelet therapy may be considered, especially for two-stent bifurcation PCI techniques. When stenting is used, a major question is whether both the main vessel and the side vessel should be stented. Such double stenting is appealing because it produces attractive postprocedural angiographic results.  However, there have been concerns with long-term major adverse cardiac events and, in particular stent thrombosis with adjacent stents. The strategy of provisional side branch stenting is widely accepted for suitable bifurcation lesions and is accompanied by low rates of stent thrombosis. However, it is not applicable to all patients. Stent thrombosis has been associated with high rates of morbidity and mortality rates, often leading to events of cardiac death or nonfatal myocardial infarction4. Stent thrombosis is typically an acute process resulting in acute coronary syndrome (ACS). There are various risk factors that have been associated with stent thrombosis, including a history of diabetes mellitus, ACS, and reduced left ventricular ejection fraction (LVEF). All of these risk factors should be taken into account before stenting a bifurcation lesion, especially if the side branch vessel supplies a small amount of myocardium that is unlikely to cause symptoms if it becomes occluded. The size of the side branch vessel should be a major factor to consider before stenting both the side branch and the main vessel. Patients should be educated following PCI with a DES placement of the risks associated with stent thrombosis in the postoperative period, especially if a bifurcation lesion was treated4. Stent thrombosis, when it occurs acutely, can be fatal if not treated right away.

The treatment of coronary bifurcations

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A factor to consider in the treatment of coronary bifurcations is the risk of the patient developing stent thrombosis and how large the side branch vessel is compared to the main vessel and if this side branch occlusion is going is significant enough to cause symptoms. As a result of an increased risk of stent thrombosis after bifurcation lesion stenting, intensive (e.g., aspirin and ticagrelor or aspirin and prasugrel) or prolonged ( greater than 12 months) dual antiplatelet therapy may be considered, especially for two-stent bifurcation PCI techniques. When stenting is used, a major question is whether both the main vessel and the side vessel should be stented. Such double stenting is appealing because it produces attractive postprocedural angiographic results.  However, there have been concerns with long-term major adverse cardiac events and, in particular stent thrombosis with adjacent stents.

The strategy of provisional side branch stenting is widely accepted for suitable bifurcation lesions and is accompanied by low rates of stent thrombosis. However, it is not applicable to all patients. Stent thrombosis has been associated with high rates of morbidity and mortality rates, often leading to events of cardiac death or nonfatal myocardial infarction4. Stent thrombosis is typically an acute process resulting in acute coronary syndrome (ACS). There are various risk factors that have been associated with stent thrombosis, including a history of diabetes mellitus, ACS, and reduced left ventricular ejection fraction (LVEF). All of these risk factors should be taken into account before stenting a bifurcation lesion, especially if the side branch vessel supplies a small amount of myocardium that is unlikely to cause symptoms if it becomes occluded. The size of the side branch vessel should be a major factor to consider before stenting both the side branch and the main vessel. Patients should be educated following PCI with a DES placement of the risks associated with stent thrombosis in the postoperative period, especially if a bifurcation lesion was treated4. Stent thrombosis, when it occurs acutely, can be fatal if not treated right away.