List down known health benefits from each listed ingredient. How does each of the listed ingredients benefit sleeping?

Ingredients: 

· L-Tryptophan

· Valerian, Goji (Wolfberry)

· Chamomile

· Lemon Balm

· Passion Flower

· L-Taurine

· Hops

· St.John’s Wort

· Gaba

· Skullcap

· L-Theanine

· Ashwagandha

· Inositol

· 5-HTP

· Melatonin

In this Discussion, you examine scenarios that feature workflow issues related to the HITECH Act and its meaningful use objectives. You identify specific workflow gaps and consider how you would conduct a gap analysis to gather more information about the gaps. This Discussion allows you to explore workflow gaps and meaningful use objectives to prepare you for completing the Course Project, which is also centered on workflow gaps and their relevance to meaningful use objectives.

Scenario 1:
Stephanie is a nurse practitioner at Central Care Hospital who is often involved in administering prescribed medications for patients in the general care ward. When a physician sees a patient, he or she uses the hospital’s EHR system to document findings and recommendations for treatment, but submits medication and drug orders by faxing prescriptions to the hospital’s pharmacy. Before Stephanie administers the medications from the pharmacy, she must cross-check the medication and dosage with the physician’s notes and patient information in the EHR system. In doing so, Stephanie often identifies problems with the medication the physician prescribed; patients are sometimes prescribed a medication to which they have a known allergy or one that conflicts with another medication they are currently taking. In addition, the pharmacy sometimes sends the wrong medication or the wrong dosage. Furthermore, for patients who have been transferred from other parts of the hospital such as the intensive care unit or the maternity ward, Stephanie often encounters duplicate drug orders or incorrect medications sent from the pharmacy.

Scenario 2:
General Health Hospital is implementing new outreach programs and preventive care support groups for patients with certain conditions or health risks such as diabetes, smoking, and obesity. Philip, a nurse leader, is the manager of a team of nurses who have been asked to organize these programs and groups and to identify patients who would be eligible for and interested in being involved in these opportunities. However, Philip and his team have run into a variety of challenges and problems as they attempt to complete these tasks. In identifying patients to contact about the outreach programs and support groups, Philip’s team has had to browse the hospital’s EHR system. The team has also run across significant holes in the EHR system as they try to contact patients; many patients’ contact information is inaccurate or out of date. Furthermore, Philip’s team has partnered with the hospital’s appointments desk personnel in sending reminders about meeting dates and times to patients who express interest. However, the appointments desk often either neglects to send out these reminders or sends duplicate reminders to only a few patients because the personnel do not have a way of tracking who should be contacted and when.

Scenario 3:
Robert works in the medical records office at Garden View Hospital. Because the hospital does not have a policy of providing clinical summaries to patients after each visit, Robert frequently receives calls from patients requesting copies of their health information (such as test results, vital statistics, diagnostic information, and medication lists and dosages). For every request, Robert must retrieve the patient information from the hospital’s EHR system, print out hard copies of the records, and then either mail the records or wait for the patient to retrieve them in person. Additionally, Robert’s hospital often receives lab test results for patients from certified third-party providers. These results are not automatically transferred from the provider’s EHR system to the hospital’s EHR system, so Robert often must contact the providers before responding to a patient’s request. Robert also finds that he and his colleagues in the office spend a considerable amount of time printing, mailing, and faxing immunization records to patients’ workplaces, schools, and volunteer organizations, which can be disruptive to the office’s other responsibilities. 

To prepare:

• Select one of the three scenarios provided to use for this Discussion.
• Review this week’s Learning Resources on workflow, gap analysis, and meaningful use,      and consider how they connect to the scenario you selected.
• Determine the most prominent workflow gap you see in the scenario. Where does the gap lie, what factors contribute to the gap, and what are the consequences of the gap?
• Explore how this gap relates to one meaningful use objective. Refer to this week’s Learning Resources for more information on meaningful use.
• If you were involved in the scenario, consider how you would go about conducting a gap      analysis to gather more information about the gap you identified, and determine possible strategies for addressing the gap. How would you gather data? Who would you contact, interview, and/or observe? How would you determine strategies for addressing the gap?

Discussion: Post an explanation of the most prominent workflow gap in the scenario you selected, including who is responsible for the gap and the outcomes or consequences. Explain how you would conduct a gap analysis to gather further information, and determine strategies for addressing the gap and provide the steps in the selection of the best strategy.  

 One of the most powerful things that we can engage in as public health nurses is to be involved in policy and procedure making! This is such an important aspect of public health nursing. Engaging in policy work allows nurses to influence practice standards to ensure quality of care (Burke, 2016). 

1. What is the public health nurse role in policy and procedure making?

2.Have any of you had any prior experiences with this for your communities? 

1 page and include at least 1 reference 

Nursing Care Plan Template

In the care plan template provided, identify 4-6 actual or potential physiological patient problems.

Identify all objective and subjective patient assessment data which supports your clinical reasoning in selecting these issues (i.e. how do you know that this is a problem for this patient?).

• This should be specific assessment data e.g. SBP 88mmHg instead of just saying ‘hypotensive’

Identify the optimal outcome that your patient should achieve before they are discharged.

• This should be a specific target that is appropriate for your specific patient e.g. SBP 110-130mm/Hg, urine output > .5mls/kg/hr, GCS 15/15, etc.

Do not include nursing interventions in the template.

Problems may be:

•   actual health problems: a health problem that is currently present or occurring and needs intervention to either end or reverses its effects. There will be patient signs and/or symptoms that support the manifestation of the problem.

Examples:     Dehydration due to ……..

Wound infection related to ……

Acute pain related to ….

Impaired skin integrity due to ….

Inadequate tissue perfusion related to……..

•  potential health problems: a health problem which has not yet occurred, however based on assessment items there is a risk that the patient may develop this problem if no interventions or prevention measures are initiated.

                                The patient is ‘at risk of’ falls due to …

                                The patient is ‘at risk of’ developing a  DVT due to….

The patient is at risk of infection due to………

For potential health problems, please consider that you are identifying the risk based on evaluation of the data you have been given in the case study. As such, the assessment data will be what puts the patient at risk rather than the assessment data the patient would have if they had this problem as an actual problem. For example, the assessment data for an actual DVT will be redness, swelling, pain, heat while the assessment data for a potential DVT might be reduced mobility, low BP, activation of inflammatory response.

Focus on those problems and nursing/patient outcomes that nursing interventions could contribute to or could be completed during one standard nursing shift.

Actual or potential problem     

Assessment data                         

Nursing outcome

Actual problem: the patient is dehydrated related to decreased fluid intake

• Low blood pressure (or ↓BP) – SBP 88mmHg
• Tachycardia – HR 125bpm
• Patient states he is thirsty
• Dry mucous membranes
• Low urine output – 100mls in 6 hours
• Patient will return to a normotensive state with a systolic BP between xx and xxmmHg
• HR will be between x and x
• Lack of reported thirst
• Moist mucous membranes evident.
• Urine output will be at least xmls/hr

The patient is ‘at risk of’ infection due to compromised host defences

• Low neutrophil count
• Receiving radiation therapy for cancer
• Pt will remain free from any nosocomial infection
• WCC will remain between x and x
• Pt will verbalise how to prevent acquiring infections
• Pt’s family, friends, and hospital staff will use appropriate infection control include PPE and HH

Note: you can use commonly used abbreviations or symbols, e.g. BP for blood pressure.

No marks are allocated to the template, however it is required to be submitted in order to receive a pass grade for this assessment.

Nursing Care Plan Report – 2000 words

From your nursing care plan template select 2 (two) physiological problems. These may be actual problems, potential problems or one of each.  Do not select psychosocial problems as you will not be able to discuss the pathophysiology of these and they will not be marked.

For each of your chosen problems:

• Explain the pathophysiology and how this relates to the patients clinical presentation. I.e. What is happening in the body to cause the signs and symptoms that the patient has?
• Identify the key nursing interventions required specifically to treat or prevent the problem you have chosen. These interventions should be supported by contemporary clinical guidelines, policies and high quality best-practice evidence. Nursing interventions should include a rationale supported by evidence. Nursing interventions may be
• Independent interventions – nurse led, nurse initiated
• Collaborative interventions – with other members of the multidisciplinary team
• Dependant interventions  – for example dependent on a doctors order
• These interventions should focus just on interventions which will specifically treat or prevent your chosen problems. Please do not include general nursing care which would be applicable here, or interventions which are required for all care (i.e. there is no need to identify obtaining consent, hand hygiene, etc. as this is required for all nursing interventions always). You do not need to describe the intervention, just state what you would do and why (not how you would do it). 
• Identify the intended goals of care and patient outcomes for your problem, considering how you would evaluate this. I.e. what do you want to achieve for your patient specifically, how will you measure the patient’s progression towards this goal and how often will you take these measurements?
• Include specific outcomes here appropriate for your patient. The idea is that if someone were to read your plan of care without knowing the patient they would still be able to achieve patient specific goals. For example, your patient might have a history of COPD with CO2 retention and the target oxygen requirements would be 88-92%. Instead of your outcome being ‘satisfactory oxygen saturations’ you should specify ‘oxygen saturations of 88-92%’. Instead of saying “acceptable BP” as an outcome, identify what range you want the BP to be in for your patient.

 As this is a formal academic report you should include

– an introduction: identify which patient case study you are using and the purpose/direction of your report e.g. “… This report will discuss compartment syndrome and surgical wound breakdown as two actual problems experienced by Mr. Smith. The pathophysiology of these conditions will be outlined along with nursing interventions required to treat these problems…”

– a conclusion: 1 or 2 sentences only which sum up your work. The conclusion should not include references as it is a summary of your ideas only. 

– at a third year BN level, for a 2000 word report you should have at least 20 high quality sources of evidence