A nurse is providing teaching about nutrition to a group of clients. The nurse should include that which of
the following foods contains the highest level of thiamine per serving? A. 1 hard-boiled egg B. 1 cup dried
pears C. 1 cup whole grain wheat flour D. 1 cup brussel sprouts

Identify pertinent positives & negatives. What additional information would you want to obtain? List 3 differential diagnosis. What is your plan for the priority diagnosis using clinical practice guidelines?

C.C. F/U Hospitalization for asthma

HPI: 11 y.o. F went on camping trip with girl scout troop a couple of weeks ago. During this trip she went hiking, camping and sat around the campfire during the evening. Initially, she noticed shortness of breath and wheezing in the evening around the campfire. Unfortunately, symptoms continued during the day where she was unable to catch her breath. Scout leader assisted her with the inhaler, ProAir.

The inhaler helped in the beginning, however as the trip continued, she had more attacks. It was decided to have her mother pick her up and take her to the hospital. On arrival to hospital they found her to be in acute respiratory distress. She was started on continuous nebulizer treatments, given steroids and azithromycin. She was doing better and 2 days later she was discharged home. She is following up in the office after hospitalization. Mother reports symptoms have been uncontrolled since leaving the hospital. Using inhaler two times a day. She denies chest tightness or SOB. Does still have a non-productive cough at times.

Allergies: Bactrim, Trimethoprim, Ceclor

Current Mediation: Pro Air 90mcg/spray MDI PRN bronchospasm. Mucinex 1-2 tab PO PRN bronchial secretions. Medrol dose pack. Azithromycin x 2 more days, 500 mg PO daily.

PMH/SH: Asthma, never required intubation. Hospitalized four times for it.

Social History: Pt and family deny tobacco, illicit drugs or alcohol use. Family History: Mother has hypertension and her father has DM. She is the only child and is unsure of the history of her grandparents.

Review of Systems (ROS): Constitutional symptoms- Patient denies fever, chills, loss of appetite, difficulty sleeping.

Eyes- Patient denies blurred vision, difficulty focusing.

ENT- Patient denies ear pain, sore throat, nasal congestion.

Cardiovascular- Denies CP or SOB.

Respiratory: Patient denies difficulty breathing, wheezing, pain on inspiration

Gastrointestinal- Patient denies dysphagia, reflux, nausea, vomiting, diarrhea, constipation, hematemesis, abdominal or epigastric pain.

Musculoskeletal- Patient denies joint pain, swelling, muscle pain or cramps, neck pain or stiffness.

Integumentary- Denies changes in skin, rash, or bruising.

Neurologic- Patient denies weakness, numbness.

Psychiatric- Denies, mood changes, anxiety, depression, nervousness, insomnia.

Endocrine- Patient denies polydipsia, polyphagia, polyuria.

Allergic/immunologic- Patient denies seasonal allergies.

OBJECTIVE DATA (O):

Constitutional- VS: Temp- 99.1, BP- 104/72, HR- 89 Height- 5’0″, Weight- 82 lbs.;

General Appearance: 11-year-old female, presents in no acute distress, alert and oriented x 3.

Eyes- sclera white. Conjunctivae pink. Pupils are PERRL, 3 mm bilaterally.

Ear, Nose, Throat- External appearance normal- on otoscopic exam tympanic membranes clear. Hearing is intact. Nose: Bilateral nasal turbinates’ slightly swollen patent. Septum is midline.

Mouth: pink, moist mucous membranes.

Throat: no inflammation or lesions present. Tonsils WNL.

Cardiovascular- S1, S2. Regular rate and rhythm, no murmurs, gallops, or rubs.

Extremities: no cyanosis, clubbing, or edema, less than 2 second refill noted.

Respiratory- Clear bilaterally, no wheezing or rhonchi. Symmetrical chest rise, no use of accessory muscles.

Gastrointestinal- abdomen soft and nontender to palpation, nondistended. Bowel sounds present in all 4 quadrants. Musculoskeletal- Normal ROM, joint stability normal in all extremities, no tenderness to palpation.

Integument/lymphatic- Inspection: No scaling, redness or breaks on neck, or arms, or trunk. Skin warm, dry and intact with good skin turgor.

Neurologic- Grossly alert and oriented x3, communication ability within normal limits.

Psychiatric- Judgment and insight intact, rate of thoughts normal and logical. Pleasant, calm, and cooperative. Lymph nodes not palpable

In Week 6,you began to search the literature discovering more information about your problem. This week, you will complete a Question Development tool and you will identify your EBP question. Below you will find questions from a Question Development Tool referred to in the following text: Dang, D., & Dearholt,S.L. (2018). Johns Hopkins Nursing EBP Model and Guidelines. Sigma Theta Tau International. List and answer each question. Some will require several paragraphs for a  answer.

1.What is the problem? Is there any data that supports that this is a problem at your hospital, clinic, etc.? Data that supports that this is a national problem?

2.Why is the problem important and relevant? What would happen if it were not addressed?

3.What is the current practice?

4.How was the problem identified?(Check all that apply)

____Safety and risk management concerns_

___Quality concerns_

___Unsatisfactory patient, staff, or organizational outcomes_

___Variations in practice within setting

____Variations in practice compared to community standard_

___Current practice that has not been validated_

___Financial concerns

5.Name each PICO component

P(population, patient or problem) = ___________________________

The Covid-19 Pandemic has brought with it unprecedented operational challenges to healthcare systems worldwide.  Overcrowding in the emergency department and staffing difficulties have become a problem in much of the world’s hospitals.  Overcrowding can contribute to poor patient satisfaction, delayed patient evaluation leading  to increased morbidity and mortality, longer length of stays, and an increased number of patients  leaving without being seen  (Gardner et al. 2017). The Emergency departments I’ve worked in have always been complexed with dependance on many systems and subsystems to deliver excellent patient care efficiently and accurately, medical supply issues, staffing difficulties, and operational challenges are now part of the daily obstacles to providing patient care.

“Today, more than ever, we face the need for appropriate tools that can assist in dealing with difficulties introduced by the increase in the complexity of disaster management problems, consideration of environmental impacts, increase in resilience and the introduction of the principles of sustainability” (Simonovic, 2015).  The increased patient census has put a strain on virtually every facet of patient care subsequently the patient experience has changed.

There has been a lot of focus in my department on mitigating the overcrowding and streamlining patient flow through the department and virtually no focus on the potential negative impacts on the patient experience. In my paper I chose to focus on the potential negative impacts this has had on the patient experience, “Has the covid-19 pandemic negatively affected the patient experience in the Emergency Department”?

The rise in the number of patients presenting to the Emergency Department with covid-19 symptoms has changed the way we operate and triage patients. Due to infection control constraints, we are no longer able to safely use hallway beds to help decompress the waiting room as we have in the past. This increase in patient volume has resulted in longer wait times, which has led to a decrease in patient satisfaction.

To improve the patient experience, it is important to understand the factors that contribute to satisfaction. This can be accomplished using evidence-based practice. “Formulating a clinical question in a systematic way makes it possible to find an answer more quickly and efficiently, leading to improved processes and patient outcomes” (Stillwell et al. 2010).

The PICO question for this problem is as follows:

P: Patients presenting to the Emergency Department with covid-19 symptoms

I: Length of time spent in the Emergency Department (<5 hours.)

C: Length of time spent in the Emergency Department (> 5 hours)

O: Report improved patient satisfaction and patient experience

Do Emergency Department (ED) patients with COVID-19 symptoms (P) have a length of time in ED less than 5 hours (I) report improved patient satisfaction and experience (O)?

EBP Question Development Points Possible:24pointsDue:Sunday,11:59 p.m. EST/EDT

In Week 6,you began to search the literature discovering more information about your problem. This week, you will complete a Question Development tool and you will identify your EBP question. Below you will find questions from a Question Development Tool referred to in the following text: Dang, D., & Dearholt,S.L. (2018). Johns Hopkins Nursing EBP Model and Guidelines. Sigma Theta Tau International. List and answer each question. Some will require several paragraphs for a complete answer.

1.What is the problem? Is there any data that supports that this is a problem at your hospital, clinic, etc.? Data that supports that this is a national problem?

2.Why is the problem important and relevant? What would happen if it were not addressed?

3.What is the current practice?

4.How was the problem identified?(Check all that apply)

____Safety and risk management concerns_

___Quality concerns_

___Unsatisfactory patient, staff, or organizational outcomes_

___Variations in practice within setting

____Variations in practice compared to community standard_

___Current practice that has not been validated_

___Financial concerns

5.Name each PICO component

P(population, patient or problem) = ___________________________

I (Intervention)= ___________________________

C(comparison with other interventions) = __________________________

O(outcomes are qualitative or quantitative measures to determine the success of the change) = ___________________________

6.State your EBP question.

References

Gardner, R., Friedman, N., Carlson, M., Bradham, T., & Barrett, T. (2018). Impact of revised      triage to improve throughput in an ED with limited traditional fast     track population.    The American Journal of Emergency Medicine, 36(1), 124-127.     doi:10.1016/j.ajem.2017.10.016

Simonovic, S. P. (2015). Systems approach to management of disasters-A missed             opportunity?. IDRiM Journal, 5(2), 70-81.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-     based practice step by step: Asking the clinical question: A key   step in evidenced-based     practice. The American Journal of Nursing, 110(3), 58-61

Mrs. Edelen is a 55-year-old patient that has come in today to discuss hormone replacement therapy and its alternatives. She has a strong family history of breast and uterine cancer. Mrs. Edelen would like to know the pros and cons to some of the supplements she’s been reading about online. Please discuss 3-4 lifestyle modifications and complementary therapies, listing both the pros and cons to each therapy.

1. Consider Mrs. Edelen’s situation and what options you would discuss with her.
2. discussing any appropriate diagnostic testing with rationale and expected results, 3-4 lifestyle modifications and complementary therapies, and potential prescription treatments. Be certain to describe both the pros and cons to each therapy and patient education requirements for the recommendations. Please make sure to cite 2-3 scholarly sources to back up your decision-making process.