Disturbance in maternal metabolism

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Patient Case Question 3. Which of the following explanations below is accurate and appropriate? a. Episodes of morning sickness can create a disturbance in maternal metabolism that may interfere with embryonic development. b. Drugs used to treat morning sickness can cause a variety of birth defects. c. These physical characteristics are highly suggestive of some type of chromosome abnormality. d. These phenotypic aberrations are pathognomonic (i.e.. diagnostic) for Down syndrome

Discuss the purpose of strategic planning in a health care environment

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Discuss the purpose of strategic planning in a health care environment. Explain what factors affect future planning in an organization and what tools can be used for future planning.

What ways of knowing have you used in your personal life?

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What ways of knowing have you used in your personal life, How did these ways of knowing guide your
personal actions? 3. What ways of knowing have you used in clinical practice? 4. How did these ways of
knowing guide your professional nursing actions?

Addressing issues related to information systems

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Part of the job of a Nurse informaticist working in a hospital setting is to serve as a member of a team addressing issues related to information systems and their effect on nursing workflow.   This work often includes root cause analysis, which is a process of identifying root causes for a problem, and then prioritizing them to allow for an organized means of correcting the problem through improvements in policy and procedure.

The Ishikawa (fishbone or cause & effect) diagram is a graphic structural tool used to facilitate this analysis by exploring the many primaries, secondary, and tertiary causes that contribute to a certain effect or outcome. It helps team members to explore and understand how the many causes can contribute to an identified outcome and thus identify areas for improvement. For benefit of this assignment, the secondary causes will be the root causes and we will not explore the tertiary causes which drive them.

Primary causes are the identified action or influence resulting in the undesired outcome and are grouped naturally into categories such as People, Processes, Environment, & Equipment that are used in this assignment.  Secondary causes are the actions or influences that contribute to the primary cause, driving it to produce the undesired outcome.

The diagram displays the relationship of the identified causes to the outcome and to each other.  It looks like the bones of a fish, with the head being the place to put the undesired outcome.  Each vertical branch off the central horizontal spine is associated with a category and has horizontal branches from it that hold the primary causes.  Each primary cause has a secondary cause attached below it.

In this assignment, you are given a scenario that has been adapted with a few revisions from a nursing research study.

  1. View the Cause & Effect Instructional diagram provided to see the form and how it is to be filled out
  2. Download and save the Cause & Effect diagram template to use for this assignment
  3. Read the Case Study below to help you determine primary and secondary causes for the workflow issue
  4. Edit the template diagram to include the causes by clicking on the appropriate boxes and adding your text
  5. Causes for all headings should be taken directly from the scenario provided
  6. Review the Rubric for grading criteria
  7. Submit the completed diagram to the assignment link

 

Workflow Analysis Scenario Nurses working in a Labor and Delivery Unit have been experiencing an increased need for translation services.  Currently, they have access to a service paid for by the hospital that utilizes the phone in the labour room.  Most nurses find phone use cumbersome and invasive during labour.

It is awkward as it doesn’t facilitate visual communication and doesn’t apply to deaf patients.  Nurses frequently rely on family members present in the room, which can result in miscommunication and faulty understanding.

The unit is usually staffed with 62 nurses to cover two 12-hour shifts.  The patient population is diverse with at least 10% of patients speaking no English and an additional 15% where English is not the first language.  There are also occasional deaf patients who use sign language for communication.  This patient diversity translates to an average of 10 nurses per shift requiring some form of communication assistance. The hospital has purchased two tablets to facilitate additional communication access.

Each tablet has its own password protection.  The tablets are capable of making audio and video calls via the internet to a translation service that includes sign language and over 500 different languages and dialects.  The tablets are kept by the L&D Nursing Staff Educator in an office on another unit.

She is responsible for tracking the tablets using a system where nurses log the devices in and out when they are taken to the L&D unit. After using the tablets for 60 days, the staff, including the nurse educator, was asked to complete a survey regarding the use of the tablets and any pros and cons they noted. After interpreting the survey results, the following issues were noted:

  • Tablets not located on the unit
  • Not enough tablets available
  • Nurses’ failure to check out tablets
  • Passwords difficult to remember
  • Different passwords for each tablet
  • Nurses misplace tablet chargers
  • Limited internet service in some patient rooms
  • Long wait times for translator service due to increased demand and patient diversity
  • Nurses using tablets for other purposes
  • Short battery life of tablets
  • Lack of available charging stations
  • Frequent software updates interrupt service

Different stages of healing

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Family violence is a heartbreaking and far too common problem that we as nurses must contend with in our practice. Unfortunately, those who have suffered or witnessed abuse are more likely to repeat violence later in their lives (McKinney et al., 2018, p. 37). Signs that we as healthcare workers can be aware of that would alert us to the potential child or intimate partner violence include patients with bruises at different stages of healing (Falkner, 2018), bruises of odd shapes of recognizable objects like wooden spoons or paddles, children or adults that avoid eye contact and care partners that answer questions for the patient before the patient is allowed to answer for themselves.

Those care partners, who may also be the perpetrators of violence, may also give stories themselves or urge the patients to tell stories that do not match the injuries being treated.

I do not currently work in a healthcare setting but in the state of California, where I intend to practice, nurses are mandated reporters of suspected or observed child and elder abuse or neglect. The reporting of such observation or suspicion needs to be made immediately by phone to local law enforcement with a follow-up written report within 2 working days (BRN, 2010).

 

Reply to the above post briefly

Describe the most challenging negotiation in which you were involved

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Describe the most challenging negotiation in which you were involved.  What did you do?  What were the results for you?  What were the results for the other party?

Different types of headaches from migrain

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Please revised the information below. Mainly ruling out headaches and fatigue. More information added will be helpful. Overall, the patient is a healthy 21 years old female who comes into the office with a complaint of having a headache and feeling fatigued. According to Bates, there are different types of headaches from migraine, to tension, or cluster headaches.

It’s important to assess other factors in order to diagnose the patient. For example, cluster headaches can come with watery eyes and pain can occur around the orbital area. Another diagnostic test such as an x-ray can be done to rule out sinusitis (Cash, 2011). Furthermore, tension headaches can be a feeling of pressure around the whole head.

And for some patients, nausea and vomiting come with migraine. In this case, the patient does have nausea and vomiting with a unilateral headache for about 2 weeks. Also, a head CT and MRI can be performed if the patient starts to have double vision, pupil changes, balance disturbances, or even confusion (Cash, 2011).

The patient is also being evaluated for feeling fatigue, which can be from the pain, or possible dehydration. But it is important to rule out thyroid disease and any blood disorder that can fatigued.

Healthcare disparities

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Healthcare disparities exist across the board; in every city and every state, there are groups of individuals who are more likely to suffer from one or another form of detriment to their health. In my local area, that being Dallas – Fort Worth, I was able to track what I might be more likely to see and what my community might be more likely to face.

In the medical field, it is well known that heart disease and strokes are two major killers for an aging population. According to my state’s research, my area is 20% more likely to have an individual die of cardiovascular complications (DFWHC, 2022).

This is astounding given that while genetics do play a role, cardiovascular care is mostly controlled through proper diet and exercise. The other major disparity that I see my community facing is that of an economic one. When compared to the national population my community is 8% less likely to have insurance coverage.

This is actually talked about in Community as Partner. Racially, black individuals are the least likely to have insurance, as much as 18% less than white individuals. Given that black individuals are already at a higher risk for cardiovascular complications, going without insurance only makes them less likely to treat any complications that might have.

While this won’t directly harm someone like a poor diet, they will be less likely to seek early or proactive medical care, thus causing further or even irreversable harm.

On the plus side, my community also has the benefit of being above the rest of the nation on several key points. My community is less likely to have disabled or behavioral health crisis’ go untreated. Both of these are 10% higher than comparred to rest of the nation (DFWHC, 2022). We are also less likely to experience criminal activity or violance when compared to the rest of the US.

For me, I believe I understand why Advanced Nursing Practices will aid in better serving my community. Instead of a nurse treating a patients symptoms, we do our best to treat the route cause or disease that is present. Lets say that a patient comes in with shortness of breath, in the ER I would treat them with albuterol and oxygenation. As an Advanced Practicing Nurse I would not only treat them, but seek to undertstand their healthcare climate

What are they lacking that makes them more likely to be sick? Is this a black women who lacks healthcare? Is she starting to develop some form of CHF from poor diet and exercsie? If she is able to get early and frequent enough treatment, can she live a longer and healthier life? What can I do to make this happen?

In the event I am able to figure out the route cause and a way to treat it. I would advocate and voice what needs to be done in order to prevent further decline. While I am only a floor nurse right now, this class will allow me the skills to advance to make the kind of decisions that will affect my community.

 

Match the mechanical ventilation to the correct term

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Match the mechanical ventilation to the correct term. Pressure-limited ventilation. Volume-limited ventilation. Synchronized Intermittent Mandatory Ventilation (SIMV)

4. Pressure Support Ventilation (PSV)

5. Continuous Positive Airway Pressure (CPAP)
[ Choose – Select 1 ]

A. Provides support to a preset pressure level, above the PEEP level, for every patient-triggered breath. Used for those patients without sufficient inspiratory capacity.

B. Mode provides air pressure on a continuous basis to keep the airways continuously open in patients who are able to breathe spontaneously. Used as a weaning mode.

C. Ventilator delivers a breath to a preset pressure target at a preset respiratory rate.

D. Ventilator delivers a breath to a preset volume target at a preset respiratory rate.

F. Mode provides an inverse inspiratory to expiratory ratio (I:O ratio) to improve oxygenation in patients with acute respiratory distress syndrome.

G. Mode is used to assist patients who have some, but not sufficient, breathing effort.

Medical history of diabetes mellitus on insulin, hypertension

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Pamela Knight is a 69-year-old female with a past medical history of diabetes mellitus on insulin, hypertension, COPD, reformed tobacco user, and hyperlipidemia, who presents to urgent care today for an evaluation of productive cough, weakness, fatigue, and decrease in appetite that has been present for the past 2 to 3 days. She states that she has been feeling well until she started coughing up yellowish-green sputum.

She occasionally has shortness of breath and has been using her rescue inhaler more frequently than normal. She went to work this morning at the library and decided to come in for evaluation after the end of her shift.

Vital signs: Temperature: 99.6, HR 96, RR: 22, O2: 93%, BP: 139/72

 

You are the provider entering the room for examination.

What is your next step?

What other information do you need?

What 3 differential diagnoses would be a part of your work up?

How would you treat this patient as she walks out of your clinic today?