Mrs. Yu: Adult Urinary Tract Infection, Renal Failure Mrs. Yu is a 39 y/o Korean American female with past medical history of Diabetes Mellitus Type 1 (DMT1), Hypertension (HTN), Chronic Kidney Disease (CKD) & is legally blind.

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DB #3 UTI & Renal Failure

Mrs. Yu: Adult Urinary Tract
Infection, Renal Failure

Mrs. Yu is a 39 y/o Korean
American female with past medical history of Diabetes Mellitus Type 1 (DMT1),
Hypertension (HTN), Chronic Kidney Disease (CKD) & is legally blind. 
She comes to the clinic today for a follow-up visit. You have not cared for her
before, but your colleague who is her Health Care Provider is off, so you have
been assigned to follow-up with her.

 

You review her chart before
seeing her.  She was seen in the Health Clinic 12 days ago & treated
for a Urinary Tract Infection (UTI).  She was put on levofloxacin
(Levaquin) 750 mg PO for a 10 day course.  She was instructed to return after
completing the antibiotic for a follow-up urinalysis & culture. She had no
known drug allergies.  Her home medications include: Lisinopril 20 mg PO
daily, HCTZ 25 mg PO daily, Lantus 60 units SQ BID, Humalog Insulin 10 units SQ
with each meal, & Multivitamin daily.

 

Assessment today:

Vital Signs:  BP 164/96,
HR 94, RR 20, POX 93% RA, Temp 97.8

Physical Assessment: Neuro
A& O x3; Lungs clear; Heart Sounds regular, S1,S2, no murmurs appreciated;
Abd soft, nontender, nondistended, bowel sounds +; Extremities PP+, scant pedal
edema.

 

Labs & a urinalysis/culture
are sent & you ask Mrs. Yu to wait for the results.

§  NA
149, K 6.1, BUN 68, Cr 4.8, Cr Clearance 36; glucose 156

§  WBC
6.2; Hgb 10.9; Hct 32.2; Plt 229

§  Urinalysis:
no nitrates; no leukocyte esterase; specific gravity 1.430; bacteria none

§  Urine
Culture: Pending

4-Review
the pathophysiology of what you consider the priority diagnosis? Support your
decision for your diagnosis. 

5.     -There
are several abnormal lab findings.  Explain why they are abnormal.

6.     -Which
abnormal lab is the most life threatening & why?

 

Discussion Board Requirements Students
will discuss assigned topics integrating information from the reading
assignments and class content to be posted. Additionally, students are expected
to comment on materials/comments posted by fellow students. The postings need
to be thoughtful; that is, they refer to the week’s readings, in the clinical
setting, or on information obtained from other sources, or ideas expressed in
the postings of other class members. References should be included as needed to
support your position. Your postings must demonstrate that you have reflected
on the assigned readings, and synthesized the material with your previous
knowledge and experience. In order to receive credit, all discussion board
posts including responses to peers must be written or pasted into the text box
rather than submitted as an attachment. This reduces the likelihood of viruses.
The initial post is to be posted by 11:59 pm on Thursday of the assigned week
with responses to two peers due by 11:59 pm on Sunday of that same week. All
discussion posts should be a maximum of 500 words. Aim to present your ideas
concisely yet thoroughly. Blackboard Discussion Forum Evaluation Criteria:
Students are expected to make one initial posting based upon the assigned
discussion question and two peer responses. Your peer responses should be
substantive (that is, more than “I agree.”). It should add knowledge,
respectfully challenge, etc. Please remember that all postings should use
professional language and not contain slang or inappropriate language. See
separate rubric for grading criteria.

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A hard-working, intelligent nurse manager/leader who has current knowledge of the principles of leadership and management.

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Wanted

A hard-working, intelligent nurse manager/leader who has current knowledge of the principles of leadership and management. The successful applicant has read the course readings and has successfully completed the unit objectives for Nursing 432. The incumbent has the opportunity to create a new health care unit or organization. This new unit or organization can be a new nursing unit in a large urban hospital, a community health facility, a remote rural health clinic, or another type of health care organization where nurses are employed.

The board expects a written submission of approximately 10-12 typed double-spaced pages, excluding title and reference pages, at the completion of this project. The final submission should include references to current literature on nursing management and leadership. References must be in APA format (6th ed).

Sections to Include in Your Project

  1. Determine the type of unit or organization you are developing. Give your organization a name. Describe the mission statement and values of your organization.
  2. Draw an organizational chart for your organization including yourself (the head person) in the chart.
  3. Describe yourself at the head of your unit or organization – will you be a leader or manager? What attributes or characteristics will you have or seek to develop? How will you go about developing them?
  4. Describe five strategies you will use to empower staff members.
  5. Describe one team that will function in your organization – include a description of your rationale for forming this team and describe how you will ensure the group will function effectively.
  6. On the first day your new unit opens you come across two nurses having a heated debate in the hallway related to how supplies are ordered for the unit. Describe how you would handle this situation.

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The aim of this assignment is to challenge you to make a lifestyle behavior change that will improve your overall health and well-being. It is important to remember that, “Lasting lifestyle and behavior changes don’t happen overnight.

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Description

Written responses should not exceed 2 pages double spaced (1 page single). This page limit does not include the contract which should not exceed 1 page.

Purpose

            The aim of this assignment is to challenge you to make a lifestyle behavior change that will improve your overall health and well-being. It is important to remember that, “Lasting lifestyle and behavior changes don’t happen overnight. Willpower is a learned skill, not an inherent trait. We all have the capacity to develop skills to make changes last. It is important to break down seemingly unattainable goals into manageable portions.”[1] Because of this you are to focus on ONE lifestyle related behavior for this assignment.  I encourage you to take this assignment seriously as we will check in on your progress over the course of the semester. 

 

Background

            For any one that has ever set a new year’s resolution they know behavior change can be tough and take longer then we would like.  Please read PDF of the article provided by the American Psychological Association that discusses how to harness your will power to help you achieve your goals. 

http://www.apa.org/helpcenter/willpower-factsheet.pdf

 

Methods

            Your goal for this behavior change is to complete it within the course this term.  This could be related to your adding in a behavior like getting 30 minutes of physical activity a day, improving your diet, like eating 5 serving of fruits, and 5 servings of veggies a day. Or it could focus on stopping a behavior like reducing your phone by 5 hours a week use or alcohol consumption to no more than 2 drinks when you go out with your friends.  DO NOT SET A WEIGHT LOSS OR WEIGHT GAIN GOAL. Weight loss/gain is not a behavior on its own but the byproduct of a change in behavior.  

 

Please be sure to complete the following:

1.     (5pts) Create a S.M.A.R.T. goal that is focused on your behavior, NO WEIGHTLOSS OR WEIGHT GAIN  (Ch. 4, p.65 if not familiar or additional readings) 

2.     (15pts) Create a contract using the provided sample including additional information from #3 on the list (you must re-type your own contract)

3.     (10pts) List at least 2 mini/short term goals and rewards (with dates) for reaching those goals as away well as your reward for reaching your final/overall goal.  

4.     (10pts) Discuss why it is that you want to make this change, the pros and cons, how this change is going to improve your overall health and wellness. 

 

Be sure to review rubric below, provide any citations used as well as clear and proper grammar.  DO NOT TYPE ON THE SAMPLE BEHAVIOR CHANGE, type your own contract and include additional information in a separate well-written paragraph. 

 

 

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Formulate a research question that can be answered using the data provided (the same dataset that Joe uses in the video).

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Description

you will be expected to write up what you have learned from organizing, describing, and analyzing patient-relevant data. This includes HCAHPS and Press Ganey data. Your three-page report should detail the particular research question you formulated, how you analyzed data to attempt to answer the research question, and insights gained from this exercise.

 Following class discussion and demonstration on data analysis, you will be expected to:

1. Formulate a research question that can be answered using the data provided (the same dataset that Joe uses in the video).

2. Write up what you have learned from organizing, describing, and analyzing patient-relevant data.

YOU MUST USE THE DATASET PROVIDED TO YOU ON CANVAS. This is the same data that Joe Snipp PhD utilizes in his demonstration video. This includes HCAHPS data as described in detail in the data dictionary. Your three-page report should detail the particular research question you formulated, how you analyzed data to attempt to answer the research question, and insights gained from this exercise.

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According to Department of Statistic of Singapore, there are 3 in 3000 population pass on yearly (Singapore Statistic,2019).

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INTRODUCTION

According to Department of Statistic of Singapore,
there are 3 in 3000 population pass on yearly (Singapore Statistic,2019). Death
is an unavoidable experience in the life, it is not openly discussing in this
modern society. However, there is the needs to learn to perceive death as a
natural cycle in life. Healthcare professional has higher chances facing life
and death in their working environment. They face dying patient and
interpreting the process base on their own belief, culture, religion
background.

Nurses has a closer patient relationship in healthcare
setting, death would be face at some point of time in their professional life.
Their attitude towards and fear of death would determine quality of care render
for terminally ill and dying patient. However, many healthcare professional
feeling unprepared to deliver end of life or communicate with families about
the topic of death and dying.

 

Experience of Death

The meaning of death defines differently base on
individual culture, religion, believe and education or experienced. In general
death define as permanent cessation of vital function but it could be other
meaning in nursing who nurse a patient (merriam-wester,2020).

Dealing with death or nearly death patient is a
challenge to a person who is new to nursing. Death is not just simple as I
think as an unresponsive body, but it conceals a lot of knowledge to be deal to
a person. My experience toward death as a student follow by working in
paediatric and oncology broader my mind and perspective on death, same time
change my view on life.

 

 

 

Student time

Beginning on my career, death toward as a novice are
so much different from an experiences nurse. The first encounter of death that
filled with different emotions of fear and anxiety. Moment before to see a dead
body, thought and image appear in my mind. The knowledge that a person lying in
the adjacent room is really an unpleasant feeling. However, enable to complete
my duty in ‘last office’ through cleaning body prior sending to mortuary, I’m
take it as part of my job without consider patient as whole.

The whole process involved in caring for a dying
patient, building a relationship with patient and ended witnessing the patient dying
as a corpse lying in the morgue is frightening and evoke a strong emotional.
According to Cooper and Barnett (2005), such process brought many feelings of
sadness, vulnerability and helpless in the care of dying patient which mirror
myself too. The negative emotion which making me so ineffective to dealing with
death either to patient or their family members. A lot of the time, I’m avoid facing
the dying patient’s family even they in agony of the lost.

Paediatric

In experience as paediatric, I’m embrace a lot of
hope to see all my ‘little angel’ to recover from their illness. I’m always
felt small kids is so powerful to bring joy and portrait strong determination
to stay alive. However, the idea of mine is so much more wrong.

My first cancer patient, he was a little boy. He
always makes me feel world is so harmless and innocent. He always so positive
though don’t know why he keep admitting to hospital. Every time of admission he
will look for me, his mother told me, he likes me, but I knew he was fear and
need to look for a familiar facing to make him comfort.

He is not doing well, he underwent operation.
However, being a nurse and his buddy, I bought a little toys and role play to
let him understand the operation. The toy is our common language and he know
the toys is our guardian angel which will protect him and give him courage

Unfortunate, he passes on and yet I never attend his
wake to has a proper ‘goodbye ‘. I was too young and inexperienced. I could to
better in his palliative treatment in supporting his mother or who love him
too.

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What data deviate from normal findings, suggesting the need for further investigation?

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Mrs. Grace is an 80-year-old woman who was admitted to ED at 1730 with a history of unwitnessed fall. She was found on the floor by her son. She was unable to stand up.  In ED she was found to be in excruciating pain. Her right Leg appeared to be shortened and internally rotated. It was noted she had multiple bruising over her right arm and face and a 4 cm laceration to her right lower arm. She was administered intranasal Fentanyl 100 Mcg by the Ambulance crew.

Her Vital Signs: Bp – 147/77 mmHg, HR 112/min – Irregular, RR – 24/min Spo2 – 99% RA, temp- 37.2C

GCS – E3 V4M6 = 13/15.

 

Regular Medication

Medications Administered in Ed

Rivaroxaban 15 mg

Bupivacaine + fentanyl femoral block

Thyroxine 50 mcg

Panadol 1 g

Amiodarone 100mg

Neurofen 400 mg

Metoprolol 25 mg

Morphine 5 mg

Mrs. Grace had blood taken. She had done a chest x-ray, which was NAD, and Right hip XRay which revealed # neck of femur.

She CT scan of her head has been ordered, which is yet to be done

A – Allergies – Penicillin

M – as mentioned above

P – Hypothyroidism, HTN, AF, IHD multiple falls

L – Last ate around noon

E – Events – Does not remember events leading to the fall

The critical discussion paper should address the following issues:

  1. What data deviate from normal findings, suggesting the need for further investigation?
  2. What additional information should the nurse ask or question?
  3. Describe the patient’s presenting problem focusing on the pathophysiological issues.
  4. Identify 2 nursing diagnosis that needs immediate interventions and discuss the nursing management appropriate for the patient and evaluations of the nursing management plans presented in the literature.
  5. Explain the pharmacokinetics of the prescribed medications in the ED and their indications.
  6. Discuss nursing management of the prescribed medication in ED, the adverse effects of the medications, contraindication, and side effects, with the age of the patient in mind, using evidence-based literature.
  7. Describe in detail the information you would share with the patient and how you will educate the patient about the interactions and long-term effects of the regular medications of Mrs. Grace.

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Nurses in all area of health care routinely encounter disturbing moral issues.

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Discussion Board III: Ethics

Ethics and the APRN Role

Nurses in all area of health care routinely encounter disturbing moral issues. APRNs are expected not only to lead the discussion in recognizing and resolving moral problems, but also serve as role models, creating ethical practice environments and promoting social justice. 

Choose one of the following ethical issues that NPs encounter in primary care:

    • Patient refusal of appropriate treatment
    • Inappropriate patient requests
    • Pressures to see increasingly complex or busy patient load
    • Uninformed patients
    • Inadequate reimbursement
    • Pain Management
    • Interprofessional conflicts 

 

Include the following in your initial post: Provide a short example of an ethical issue relating to your chosen issue above. Using the weekly content and other resources, demonstrate your understanding of ethical decision making, by discussing how you might successfully address a situation like this should you encounter it as an APRN.

Respond to at least two student’s posts with the following:

  • Provide an alternate view to the solution proposed by your peer
  • Provide an experience you have encountered that speaks to your peer’s ethical situation

 

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Pick an idea for your PICO paper/project; some ideas are great, but don’t work as a PICO project, so . . . – THe idea has to be appropriate to NURSING;

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PART A — PICO Topic Selection (25 points):

– Pick an idea for your PICO paper/project;  some ideas are great, but don’t work as a PICO project, so . . .

– THe idea has to be appropriate to NURSING;
 
– You MUST find at least three articles to support your PICO paper/project BEFORE submitting this idea;

 
PART B — PICO Question(25 points): 
 
– Write your idea for research as a PICO question (to support your paper/project idea).
 
– For extra credit, provide another correct name for a PICO question.

Rubric

392 PICO (T) Topic Selection & PICO Question
392 PICO (T) Topic Selection & PICO Question
Criteria Ratings Pts

Topic/ Research Question

DRIVE model,
attribute R: L.O. 2 Students will create a hypothesis for further
study. (“Students prepare a PICO question and hypothesis.”)

5.0
pts

Mastery
The topic/research question fits easily with both PICO(T) structure and nursing quality improvement.

4.0
pts

Proficiency
The topic/research question fits somewhat with both PICO(T) structure and nursing quality improvement.

3.5
pts

Developing
The topic/research question fits with one of the following: PICO(T) structure or nursing quality improvement.

3.0
pts

Beginning
The topic/research question does not fit with either of the following: PICO(T) structure or nursing quality improvement.
5.0 pts

Explanatory Paragraph

DRIVE model,
attribute R: L.O. 2 Students will create a hypothesis for further
study. (“Students prepare a PICO question and hypothesis.”)

5.0
pts

Mastery
A
concise paragraph thoroughly explains how the topic lends itself to
both PICO(T) structure and nursing quality improvement, and includes the
student’s hypothesis regarding the research.

4.0
pts

Proficiency
A
concise paragraph provides some explanation of how the topic lends
itself to both PICO(T) structure and nursing quality improvement, and
includes a hypothesis about the research.

3.5
pts

Developing
A
concise paragraph provides some explanation of how the topic lends
itself to one of the following: PICO(T) structure or nursing quality
improvement; hypothesis may be unclear.

3.0
pts

Beginning
A
concise paragraph provides no explanation of how the topic lends itself
to either of the following: PICO(T) structure or nursing quality
improvement; hypothesis is absent.
5.0 pts

PICO Question

DRIVE model, attribute R: L.O. 2 Students will create a hypothesis for further study.

5.0
pts

Mastery
Correctly identifies all five components of the PICO (T) topic using the following format:
P-
I-
C-
O-
(T)-

PICO (T) question is written correctly and all of the components are inserted correctly.

4.0
pts

Proficiency
Correctly identifies four of the five components of the PICO (T) topic using the following format:

P-

I-

C-

O-

(T)-

PICO (T) question is written with most information inserted correctly.

3.0
pts

Developing
Correctly identifies three of the five components of the PICO (T) topic using the following format:

P-

I-

C-

O-

(T)-

PICO (T) question is written with only some of the information inserted correctly.

2.0
pts

Beginning
Correctly identifies one or two of the four components of the PICO (T) topic using the following format:
P-
I-
C-
O-
(T)
OR Does not use the correct format.
5.0 pts
Total Points:

15.0

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For this assignment you will write a paper in which you explore a common transition faced by older adults. This transition may relate to a health transition (e.g. illness), a transition in living environment (e.g., a move to an assisted living facility or

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Assignment 3: Transitions and Aging | Value 30%

This assignment should be completed sometime between Units 5 and 9.

For this assignment you will write a paper in which you explore a common transition faced by older adults. This transition may relate to a health transition (e.g. illness), a transition in living environment (e.g., a move to an assisted living facility or a long-term care facility), or dying or death. The emphasis in this assignment is to examine how older adults face into a transition, including the psychosocial, existential, and family ramifications. For instance, you might choose to focus on grief and loss as a response to moving into a long-term care facility. Within this paper, you will examine how older adults experience this grief and loss, how family members respond, as well as existential issues that may arise from this transition (e.g., Who am I now that I am institutionalized?)

Assignment 3 must:

  • be seven to eight pages in length; not to exceed eight, excluding title page, references, and appendices;
  • be typed, double–spaced, single-sided, with margins of 2.5 cm on all sides;
  • follow the style guidelines found in the 6th edition of the APA Publication Manual; and
  • include references to provide evidence of application of theory.

Assignment 3 will be marked according to the following grading criteria:

Criteria

Marks
Describes a transition faced by older adults and includes psychosocial, existential, and familial responses to this transition. You may include a short case example to illustrate the topic. /10
Describes significance of this topic to the experience of the older adult (physical and mental health), how the transition is understood in the literature and in nursing research. /40
Analyzes how nurses can respond (assessment and intervention) to aid older adults and family members experiencing transitions. Also addresses two proposed changes to the health care system and a potential research study that could address how transitions impact older adults, family members or the health care system. /30

Scholarly writing style:

  • clarity, logical development, cohesion and tone
  • APA format, grammar, punctuation, spelling, and page length
 /20
Total /100

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Dr. Alison Tothy provides us with incredible insights into pediatrics and the ED. Additionally, The Waiting Room documentary shows us in graphic detail how the ED can be the crossroads of social issues

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Dr. Alison Tothy provides us with incredible insights into pediatrics and the ED. Additionally, The Waiting Room documentary shows us in graphic detail how the ED can be the crossroads of social issues, including but not limited to unemployment, underemployent, education, economic conditions, language and cultural effects, food and housing insecurity, and other significant issues. What is your take on what health care organizations can do to address these issues? Is it their responsibility? What may be the advantage to the organization and the community (ROI) for addressing these issues? What are the ethical considerations that should be discussed? 

 

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