Scenario 1:

Your patient C.S is 78 years old. Admitted to the nursing home you work at, with a diagnosis of dehydration. C.S., has been ordered to increase her oral fluid intake to 2500cc per day. When offering her a glass of water, she pushes away your hand and says “I hate water and I don’t drink it much”. You note that after one and a half days she has dry mucous membranes and poor skin turgor.

Questions:

1. What should your assessment be on this patient? Explain in detail.
2. After completing your assessment, what should your next step be? Be specific.
3. Write 3 complete nursing diagnosis from above information. Include all 3 sections (NANDA, Related to (R/T) & Evidence based practice (EBP) & include 2 nursing interventions for each nursing diagnosis.

Scenario 2:

Ms. Cohen is hospitalized for repair of a fractured hip after a fall at home. She requires intravenous (IV) antibiotics after surgery. Shortly after the first dose she became restless and started picking at her IV line and frequently tried to get out of bed. Several restraint alternatives were attempted; but, because of her restlessness, she was successful at pulling out her IV line and getting out of bed. It becomes necessary to restrain Ms. Cohen.

Questions:

1. You know that a health care provider’s order is required for the restraint. What are essential components of the restraint order?

2. Which assessments do you need to perform on Ms. Cohen while she is restrained?

3. The physician orders a belt restraint. Your assessment of Ms. Cohen the next day reveals that during the day she is alert and pleasantly confused but not attempting to get out of bed. Do you continue use of the restraint? Explain.

Homework

Read the case study on Ted Alexander.

Ted Alexander Case study

Mr. Ted Alexander, a 50 year old white divorced salesman from Las Vegas, was on a business trip to Atlantic City when he developed pain in the right lower abdominal quadrant.  He took Alka –Seltzer with little relief, and the pain persisted for the next two days.  He was busy with appointments during the day and evening and was able to ignore the pain.  He ate very little and took two sleeping pills at night.  On the afternoon of the third day, the pain became much more intense, and when it continued for several hours and he began to vomit repeatedly, he went to the emergency department.

Physical examination and laboratory data at this time revealed an alert, well-groomed male with generalized abdominal tenderness, rigidity of the abdominal wall, presence of a palpable mass in the right inguinal area, absent bowel sounds, and a WBC of 20,000/mm’ (normal = 5000-9000).  The diagnosis of ruptured appendix was made.  He was admitted to the hospital for initial medical management, with surgery anticipated at a later date.

Your examination of the patient reveals the following: B/P = 140/80, P=116, Resp=26 and temp 101.2.  The patient indicates that he is 6 ft. 2 inches tall and weighs 196 lbs.  He is alert and oriented and states, “My gut is killing me.” His skin is warm to the touch and slightly diaphoretic.  The patient states that he had been a heavy drinker for 15 years and was admitted to the hospital with cirrhosis two years ago by his family doctor, Dr. Manland, but has never had surgery.  He denies drinking for the past two years but smokes two packs of cigarettes daily.

Mr. Alexander is tense throughout your conversation and shares a number of concerns with you, including his separation from his two teenage children who live with him.  He is also anxious about being cared for by an unfamiliar physician.  The ED Nurse indicates that he wears contact lenses and is concerned because he has left his case and supplies as well as his glasses in his hotel.  He gives you $750 in cash and traveler’s checks to deposit in the hospital safe.  He has a partial lower plate of dentures and caps on his four front teeth.  Further inquiry reveals that the patient prefers a low-fat diet, occasionally uses laxatives, and has had several occurrences of urinary urgency and nocturia in the last six months.

The physician states that his treatment plan includes gastric suction, antibiotics and IV fluid therapy with electrolytes and vitamins until the patient is stabilized enough for exploratory surgery.  Mr. Alexander agrees to this plan but is concerned about his job demands and wonders how he will deal with “getting back home when all of this is over.”

Using the assessment sheet below, complete an assessment of Mr. Alexander.

Client Assessment Tool – Orem

Basic conditioning factors

Age ______________             health state _______________

Sociocultural orientation __________________       Health system _________________

Patterns of living _______________________________

Environment _________________________            Resources _____________________

Universal Self-care Requisites

Air

Water

Food

Elimination

Activity/rest

Solitude/social interaction

Prevention of hazards

Promotion of normalcy

Developmental self-care requisites

Prevention/mgt of condition threatening

Health deviation self-care requisites

Seeking medical attention when health status altered

Awareness/mgt of disease process

Awareness of potential problems associated with regimen

Modification of self-image to incorporate changes in health status

Adjustment of lifestyle to accommodate changes in health

Now consider, how time efficient is this model?

Did you assess anything using the model that you wouldn’t have assessed using your usual method?

Are there patients that you don’t think this model would work well for?  Who?

What’s your thoughts

The servant leader is a leader who serve first then follow by the desire to lead (Grand Canyon University, 2020). A servant leader prioritizes the team’s growth and well-being, letting their own needs and ambition take a backseat by serving others. The fundamental principle of a servant leader as described on the text are: To be a leader you must be an excellent listener, empathy, healing, awareness, persuasion, conceptualization, foresight, stewardship, commitment, and building community (GCU, 2020).

The two qualities of a servant leader are listening and stewardship and both support interprofessional communication in providing patient care. Communication begin with listening and servant leaders have an innate ability to hear what others are saying through both verbal and nonverbal communication and reflect upon what they hear to lead a group to its full potential (Grand Canyon University, 2020). When a staff member is talking to you as a leader, give them your full focus and attention do not interrupt them until they finish their speaking. This is one of the simple ways to make your subordinates feel valued and they know you care. Another quality of servant leader is their act of stewardship committing to serving others and focusing on creating a culture of acceptance of all and work to prepare an organization, and its people, to contribute responsibly and ethically in society (Grand Canyon University, 2020). In stewardship you lead by example and set the tone for your subordinates, so do not ask people to do things you would not do yourself.

1) Minimum 5 full pages (No words)

2)¨******APA norms (Mandatory)

All paragraphs must be narrative and cited in the text- each paragraphs

            Bulleted responses are not accepted

            Dont write in the first person 

Dont copy and pase the questions.

Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

3) It will be verified by Turnitin and SafeAssign

4) Minimum  6 references not older than 5 years

5) ***************Identify your answer with the numbers, according to the question.

Example:

Q 1. Nursing is XXXXX

a) Accordinto XXXX

Q 2. Health is XXXX

a)  These are the issues that arise

_____________________________________________________________

 Dorothy Johnson’s Behavioral System Model 

1) Introduction (1/2 page)

a) Identification of theorist including a brief background of the theorist (accomplishments, career, accolades, research efforts)

2) Analysis of basic components/concepts and major relationships in the theory (Minimum 2 pages)

a) Briefly discuss the theory’s core concepts

b) Use a secondary source that covers the selected nursing theory, you must have a minimum of 3 references from nursing literature (only one from a non-article source like a secondary source/text) to support your discussion in this section.

3)  Relevance (Minimum 2 pages)

a)  Personal relevance if any of the authors described (connect the theorist to the theory)

b) Relevance to healthcare and the client discussed (connect the theory to healthcare today)

c) Application to research and/or practice provided (connect the theory to current research/practice)

d) Use at least two peer-reviewed/research articles that detail the nursing theory being applied in clinical

e) Practice/research, and summarize key findings of both articles including results and implications for future practice

4)  Summary (1/ 2 page)

Include theory strengths and limitation in the summar

To Prepare:

• Review the Resources and reflect on your thinking regarding the role of the nurse in the design and implementation of new healthcare programs.
• Select a healthcare program within your practice and consider the design and implementation of this program.
• Reflect on advocacy efforts and the role of the nurse in relation to healthcare program design and implementation.

The Assignment: (2–4 pages)

In a 2- to 4-page paper, create an interview transcript of your responses to the following interview questions:

• Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?
• Who is your target population?
• What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?
• What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?
• What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?
• Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?