Category: Nursing

Describe a patient with an abdominal symptom or group of symptoms, such as bloating, flatus, and eructation; constipation; nausea and vomiting; diarrhea; or abdominal pain. Do not limit yourself to these examples. Remember that there are different types and locations of abdominal pain. What questions would you ask as part of your focused assessment? What history might be associated with the symptom, if any? What are the known risk factors for this condition? What physical examination techniques would you use? What patient education would you give the patient? Find a nursing journal article about these symptoms.

Choose one area of the head and neck and then select a common complaint (symptom or group of symptoms) patients may have in that area. For example, you may select headaches, earaches, ringing in the ears (tinnitus), sinus drainage and pain, sore throat and cough, and so on. Do not limit yourself to these examples. What questions would you ask as part of your focused assessment? What history would be associated with the symptom? What are the risk factors for this condition? What physical examination techniques would you use? What patient education would you give the patient? Find a nursing journal article about this symptom or condition.

Middleville Regional Health Care is one (1) of three (3) hospitals serving a community of 350,000 people. Summary statistics on Middleville and its competitors, from the 
AHA Guide
, are shown below in Table 1. All three organizations are not-for-profit.

 
Table 1: Middleville, Brierfield, and Greystone Health Care Systems

 

Name

Beds

Admissions

Census

OP Visits

Births

Expenses (000)

Personnel

Middleville

575

13,000

350

221,000

2,300

$125,000

2,000

Brierfield

380

17,000

260

175,000

1,200

$130,000

1,875

Greystone

350

10,000

180

40,000

900

$80,000

1,200

 

The governing board of Middleville hired a consulting company to evaluate its strategic performance, specifically in the areas of Human Resources, Information Technology, Financing, and Marketing. As part of the consultant’s evaluation, several leaders of Middleville’s units were asked their perspective of the organization’s performance.

 
You are working for the consultant. Your job is to identify the issues from the response that should be considered further by the consultant team and possibly discussed with the governing board and the CEO. The firm has a rule, “Never offer a criticism or negative finding without suggesting how the client organization can correct it,” so you must indicate what sort of correction you would recommend as part of your list. Because you know there were about two (2) dozen other interviews, you decide you should rank your issues in importance, to make sure the most critical are discussed.

 
Write a six to eight (6-8) page paper in which you:

Explain the governing board’s role in these strategic initiatives, determining its responsibility and involvement.

Evidence-based management means that operational and strategic decisions are made based upon the evidence that goals and objectives are actually being met. Quantitative measurements must be identified and measured. This data is then used to evaluate the HCO’s performance. Name three (3) performances Middleville can use to measure its success in providing quality healthcare to the community, and identify quantifiable, measureable indicators that can be used to do so. Explain the importance of each performance measurement.

Given the statistics of Middleville and its two (2) competitors provided in Table 1, recommend to the HCO what areas it should focus on to maintain its competitive market share as well as continue to provide healthcare to the community in the 21
st
 century.

Some of Middleville’s Board members are very interested in pursuing advanced technology systems over the next five (5) years, while others are concerned about the enormous expense and need assurance that the investment in technology will be worthwhile. In both monetary and process terms, describe the costs and benefits associated with implementing EMR and associated health data systems. Lay out a plan for how various systems can be implemented.

Middleville has faced many challenges in recruiting and retaining nurses and other clinical employees. The economy has hit the area very hard and budgetary limitations have reduced the amount of money available for salary increases. The Board knows it needs to provide other benefits to their valued employees. Provide at least two (2) suggestions to Human Resources to promote employee satisfaction and, therefore, retain experienced personnel.

Use at least three (3) quality resources in this assignment. 
Note:
 Wikipedia and similar Websites do not qualify as quality resources.

Format your assignment according to the following formatting requirements:

Typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides.

Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page is not included in the required page length.

Include a reference page. Citations and references must follow APA format. The reference page is not included in the required page length.

 
The specific course learning outcomes associated with this assignment are:

Examine how healthcare management concepts and theories are applied to critical issues in healthcare organizations.

Analyze the critical management issues, purpose, functions, and performance measures of different departments within healthcare organizations.

Explain how public policy has shaped the development of the U.S. healthcare system.

Use technology and information resources to research issues in health services organization management.

Write clearly and concisely about health services organization management using proper writing mechanics.

What should the nurse include in a focused
exam
for a client prescribed any antihypertensive medication?

 

List general instructions the nurse would provide a client who is prescribed any antihypertensive medication.

 

Which antihypertensive drugs are more likely to cause “rebound hypertension” if abruptly discontinued?

 

List common adverse effects from beta blockers (BBs) What should the nurse teach a client prescribed this medication? When should BBs be held?

 

Which drug class could contribute to an asthma/COPD exacerbation or interfere with signs/symptoms of hypoglycemia in a diabetic client?

Shock is a clinical syndrome that is a result of inadequate tissue perfusion that creates imbalance between the delivery of and requirements for oxygen that support cell health.  Signs and symptoms of excess fluid volume or inadequate tissue perfusion characterize heart failure.

Address the Following:

Describe the differences in the nursing management for patient diagnosed with hypovolemic shock, cardiogenic shock, and heart failure.

Because heart failure can be a chronic condition, identify a priority teaching intervention for the patient with a new diagnosis of heart failure.

Base your initial post on your readings and research of this topic. Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do 
not
 count towards the 250 word minimum.

A good intervention for an immunosuppressed patient is an incentive spirometer.  My grandmother would use an incentive spirometer for her COPD.  It wasn’t always easy to have her use the spirometer.  In addition, I have had to teach myself to use it, when I was diagnosed with pneumonia and had a very bad cough years ago.  It’s quite difficult to use when you are feeling ill and all choked up.

Some effective obejctives for a spirometer as a nurse include:

1. Teach patient of benefits of  Incentive spirometer

2. Teach patient that the reason for incentive spirometry is to help him fully inflate his lungs

3. Patient will report number of times used daily and mark progress with indicator

4. Patient will demonstrate knowledge of COPD process, meds, therapy and follow up care.

Pulmonary Mucormycosis is most common in patients that are immunocompromised. Early diagnosis for early treatment is essential for this life-threatening disease. Yes, depending on the patient’s reason for having a low immunity, neutropenia can occur and increase the patient’s risk for infection even greater. But, the patient in our DQ had a high WBC count. The lab did not show differentiation of the WBCs. Doesn’t the elevated WBC count mean the person’s immune system is trying to fight the fungus? I do not think our patient needs colony stimulating factors for neutropenia. But our patient may need surgery as you pointed out. “There are four determining factor in the successful treatment of mucormycosis: early diagnosis, amphotericin B, surgical resection and reversal of host impairment” ( Oluwatobi, et al., 2016).

In your post, you mentioned that most common place of infection from mucor is in the lungs. Research supports this as, “the most common place of involvement was lung (89.4%)” (Noorifard et al., 2015). According to the Centers for Disease Control and Prevention the signs and symptoms of pulmonary mucormycosis was fever, cough, chest pain, and shortness of breath (2015). Interestingly it was found that “fever was the most popular sign of the infection (100%)” (Noorifard, et al., 2015).

I NEED YOU TO COMMENT FROM THIS POST, 150 WORDS NEEDED AND A REFERENCE PLEASE

Post an assessment of the consequences (on payers, providers, and the general population) of continuing current levels of health care spending in the United States as well as the potential consequences of reducing the level of spending. Explain which stakeholders should make health care spending decisions and why.

Complete a modified Gemba Walk

Prepare for your preliminary walk by completing the following:

Refer back to this week’s Gemba walk presentation.

Survey your department or another area of your choosing. Decide upon where you will focus your walk.

Research both the setting where you will be doing your walk and explore external resources that will inform your setting.

Complete the walk by asking and answering the four W’s outlined in the Gemba Walk Presentation

Utilizing systems thinking concepts produce a 525- to 1,050-word executive summary.

Discuss the four Ws and your findings. Complete a modified Gemba Walk.

Where do you see opportunities to decrease 
muda
 (waste) and increase creativity and flow within processes or departments within your organization?

ORDER A PLAGIARISM-FREE PAPER NOW

Answer the following two questions on separate sheets of paper it’s important that you DO NOT include these answers in your Gemba walk Credit WILL NOT be given if you do so. Title page is not necessary for your answers but can be used

1,) Review and consider the content you covered during Week Two.

Post a 260- to 350-word response to the following questions

Using Trbovich’s article, identify one area in your organization where you think you might be able to incorporate systems thinking.

Provide examples from this week’s readings and external research.

Cite at least 2 peer-reviewed, scholarly, or similar references.

Format your citations according to APA guidelines

.

)Read the Gemba Walk Presentation

Post a response to the following question Complete a modified Gemba Walk.

How will you prepare to begin your Gemba Walk?

Grading Criteria

 

Modified Gemba Walk-Executive Summary

 

This assignment is due in Week Two.

 

Content

70 Percent

Points Available

7

Points Earned

X/7

Additional Comments:

The student chose their department or other area and wrote an Executive Summary of their Modified Gemba Walk, in which he or she addressed the following:

Discuss the four Ws and your findings.

Where do you see opportunities to decrease 
muda
 (waste) and increase creativity and flow within processes or departments within your organization?

 

 

 

Organization/Development

15 Percent

Points Available

1.5

Points Earned

X/1.5

Additional Comments:

·         The summary is 525 to 1,050 words in length.

·         The introduction provides sufficient background on the topic and previews major points.

·         The conclusion is logical, flows, and reviews the major points.

 

 

 

Mechanics

15 Percent

Points Available

1.5

Points Earned

X/1.5

Additional Comments:

·         The paper is consistent with APA guidelines as directed by the facilitator. The paper is laid out with effective use of headings, font styles, and white space. Complete a modified Gemba Walk.

·         Rules of grammar, usage, and punctuation are followed; spelling is correct.

 

 

 

 

Total Available

Total Earned

 

 

10

 

 

 

Gemba Walk

To set the stage for the Gemba Walk, a survey was conducted within the healthcare billing department to determine the areas that would use some realistic improvements. At the conceptualization stage, the need for the Gemba Walk had been slightly overlooked. But compared to the time wasted in redundant tasks within the department and general unproductivity, it was evident that Gemba Walk was necessary. Complete a modified Gemba Walk. The bi-weekly staff meeting in the billing department acted as an opportunity for the survey to be conducted. This is considering that the facility has a policy for each department to hold regular staff meetings in the departments where a peer review process ensues. Complete a modified Gemba Walk.

The review process acts a learning opportunity that supports quality improvement among personnel as well as their development. The process evaluates staff practices to identify successful trends and areas that require improvement. In essence, it ensures staff performance consistency by allowing for consistent application of the best approaches, improving service quality using training and correction plans (Mann, 2014). As such, the bi-weekly review process can be considered as constructive collaborative erudition experiences for the healthcare billing department staff.

Completing the Gemba Walk entailed observing the staff, asking them questions, taking an interest in their tasks completion and completing team audit charts. The purpose of the audit charts was explained to the staff under observation as a tool that would identify their learning opportunities. The presence of an observer (the researcher applying Gemba Walk and using the audit charts) empowered the staff to identify their department’s problems and their possible solutions. As staff engaged within the department at the most intimate level, the department personnel are expected to identify the systematic and broader problems plaguing their department as well as likely solution (Hafey, 2015).

Four key responsibilities were identified for the Gemba Walk. Firstly, a quality assurance manager was identified to review and sign off on the presented correction plans, as well as linking with the other personnel to communicate areas that require improvement and may have been overlooked, prevailing health industry trends, and outcomes as the correction program proceeds. Secondly, a correction program manager who ensured that approval is received from the facility administrators to include their signatures, the proposed corrections are formalized and completed, and a timeframe is identified for each step with defined due dates Complete a modified Gemba Walk. Thirdly, the department staff who act as the correction program personnel whose responsibility is to contribute to the review process based on experience and education levels, and implementing the correction program guided by the existing timetable and timeframe. Finally, the research (compliance manager) who is responsible for ordering the whole process, as well as collecting and reporting the data (Mann, 2015).

All through staff observation and data collection process, it was noted that a lot of staff members were not confident in the audit process. The audit chart left these staff members with a lot of questions with a lot of interpretations offered for each question. Some of the staff were unfamiliar with the audit terminology. In fact, there were a group of staff members who expressed discontent with the review process and considered it a waste of their time since they could be engaging in other more productive activities. Complete a modified Gemba Walk. Still, it is undeniable that the Gemba Walk offered some insight into the nature of water within the department and how improvements could be carried out to eliminate the wastes. The bi-weekly staff meetings acknowledges areas requiring improvement even as they identify documentation trends, issues with resources, systematic issues, and barriers against improvement. Overall, Gemba Walk makes it easier to identify strategic issues for improvement.

References

Hafey, R. (2015).
Lean Safety Gemba Walks: A methodology for workforce engagement and culture change
. Boca Raton, FL: CRC Press/Taylor & Francis Group.

Mann, D. (2015).
Creating a Lean Culture: Tools to sustain lean conversions
(3
rd
ed.). Boca Raton, FL: CRC Press/Taylor & Francis Group Complete a modified Gemba Walk.