Initial Post

Areas for reflection:

• Describe how you achieved each course competency including at least one example of new knowledge gained related to that competency.
• Describe how this new knowledge will impact your nursing practice.

Course Competencies

• Apply strategies for safe, effective multidimensional nursing practice when providing basic care and comfort for clients.
• Select appropriate nursing interventions when providing multidimensional care to clients experiencing alterations in mobility.
• Explain components of multidimensional nursing care for clients with musculoskeletal disorders.
• Prioritize strategies for safe, effective multidimensional nursing practice when providing care for clients experiencing sensory and perception disorders.
• Apply knowledge of integumentary disorders when providing safe, effective nursing care.
• Describe strategies for safe, effective multidimensional nursing practice when providing care for clients experiencing immunologic, infectious, and inflammatory disorders.

Responses

You are required to give a minimum of two responses and follow the criteria listed below:

• Review how your classmates achieved each course competency.
• Identify new knowledge others gained you had not considered.
• Describe how this new knowledge could impact your nursing practice.

After the post I will one 2 responses for 2 classmates. Please check with me after submitting the initial post.

For this assignment you will be given a case study about a young lady named Sarah Smith. Review the information provided and answer the questions following. Be sure to cite your references. Look at Sarah as if she is a patient in your office seeking care. What are your immediate concerns? What needs to be done for her? Be thorough and succinct in your responses.

Case Study:

Sarah Smith is a 28 y/o African American female who presents to the office with c/o wound to her left foot for the past few days. States she had tripped and fell while barefoot scraping the top of her foot on the pavement. She denies any other injury from the incident. Over the past 24 hours the wound has had “smelly” drainage. Has been experiencing generalized achiness, but denies fever and chills. Did not seek medical attention at the time of injury. Has been using hydrogen peroxide to clean her wound. Is unclear of her last tetanus vaccination. Patient PMHx significant for DM II. States that she takes her medications when she remembers, and does not always check her blood sugar.

PMHx:

Asthma: no hospitalizations for exacerbation.

DM II

PSHx:

Denies

SHx:

Former tobacco user: ceased smoking 2 years ago. Had smoked 1ppd x 5 years

ETOH: socially

Illicit drugs: denies

FHx:

Significant for paternal DM, otherwise unremarkable

Medications:

Metformin: 500mg BID po – did not take the last few days

Albuterol MDI: 2 puffs every 6 hours prn – last use just PTA

Singulair: 10mg po daily

Trinessa: 1 tab po daily – last taken this am

Allergies:

PCN: hives

LNMP: 2 weeks ago.

G0p0

ROS:

General: denies any weight changes, fatigue or fever; + body aches

Skin: denies any rashes; + wound to left foot

HEENT: denies headache, head injury, dizziness, lightheadedness;

            Denies any vision changes

            Denies any hearing changes, tinnitus, vertigo, earache

            Denies any nasal congestion, discharge, nose bleeds or sinus tenderness

            Denies any sore throat, difficulty swallowing

Neck: denies any swollen glands, pain

Breasts: denies any pain, discharge

Respiratory: denies any dyspnea; positive cough and wheezing

CV: denies any chest pain, edema

GI: denies any nausea/vomiting/diarrhea/constipation; denies bloody stools

PV: denies claudication, swelling to LE

GU: denies frequency, urgency, burning;

            Denies vaginal discharge, itching, sores

            Denies penile discharge, itching or sores

MS: positive pain to left foot

Psych: denies nervousness, depression

Neuro: denies Headache, dizziness, vertigo, syncope, weakness; + numbness to right LE

Heme: denies any easy bruising

Physical Exam:

Vital signs: 100.5 (tympanic), 162/88, 118, 22, O2 sat 95% on RA

                        Height: 5’5”     Weight: 250 lbs.

            Blood glucose: 230 (Fasting; states has not eaten yet today)

patient awake, alert, oriented x 4 in NAD

Skin: warm, dry, color WNL. 4 cm lesion noted to anterior left foot with crusting and purulent drng; + surrounding erythema extending up 7 cm proximally

HEENT: head nontraumatic, normocephalic

Pupils PERRLA, EOMs intact; disc margins sharp, without hemorrhages, exudates; no AV nicking noted

Ears: bilateral TM with good cone of light and intact

Nose: mucosa pink, septum midline; no sinus tenderness appreciated

Mouth: mucosa pink, moist; tongue midline; tonsils 1+ without exudate

Neck: supple; trachea midline; no LAD

Resp: regular and unlabored; lungs with end expiratory wheezing throughout

CV: RRR, S1 and S2 noted; no s3, s4 or murmur appreciated

Abdomen: soft, non-distended; Bs + x 4; no tenderness with palpation; no CVA tenderness with percussion

Genitalia: deferred

Rectal: deferred

Extremities: warm and without edema; calves supple, non-tender

PV: no LE edema

MS: + swelling to left foot; + tenderness of 2-4th left metatarsals; + left pedal pulse; CMS intact; Cap refill < 2 sec.

Neuro: alert, cooperative; thought coherent; oriented x 4; cranial nerves II-XII intact

Questions:

1. List your differentials for her current problems. Remember you should have at least three different differentials for each problem. Include rationale for each differential.

2. At this time what medical diagnoses are you most concerned about? Do they impact other diagnoses? If so, how?

3. What diagnostic images would you order? Provide your rationale. What are you trying to rule in or out?

4. What laboratory work would you order? What would you anticipate to be abnormal? Provide your rationale for each.

5. What is your comprehensive plan of care? Include your rationales.

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.

Assignment Requirements

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above)
• consult the Grading Rubric to make sure you have included everything necessary; and
• utilize spelling and grammar check to minimize errors.

 PAPER DOES NOT HAVE TO BE 1,050 WORDS I ONLY NEED 700!!

 EXAMPLE PAPER FROM FORMER STUDENT PROVIDE THAT YOU CAN GO BY

Imagine you are being vetted for a managerial position at a local health care facility. As part of the process, they have provided prompts for which you must write a response.

Write a 700- to 1,050-word paper describing the process for tracking outcomes and improving quality and safety. Include the following in your paper:

• Impact of external and internal standards
• Role of continuous improvement in quality and safety
• Plan for employee development in quality and safety
• Role of technology in quality and safety

Cite 2 references

Healthcare Informatics in Primary Care Pediatrics

The focus of this assignment is to increase your knowledge and understanding of how informatics, specifically the electronic medical record, improves the pediatric patient health outcomes. Caring for the pediatric patient has unique elements that are not applicable in the adult population. Examples are growth and development surveillance, vaccine records, transitional changes that affect “normal findings” by age group. For example, the normal respiratory rate of a newborn is significantly different from a 10-year-old. Additionally, pediatric healthcare providers are expected to educate parents with “anticipatory guidance” according to the age of the patient. For this assignment, you are expected to analyze the utilization of the EMR that you are using in your clinical practicum and evaluate how this particular EMR system is improving health outcomes. For example, does the EMR that you are using have mechanisms in place that track growth and development, which has led to early identification of abnormals?

This assignment has three parts. The first part is identifying the recommended pediatric-specific functionalities of the EMR system you are using. The template will guide you through the first part of the assignment by addressing a sample of key functionalities.

Part 2 addresses some basic functions that would be recommended in any non-specific EMR.

Part 3 asks you to discuss how your system is addressing certain outcomes such as safety, collaboration, and the prevention of medication errors.