Category: Nursing

Evidence-Based Practice Project—Paper on Diabetes

 Identify a research or evidence-based article that focuses comprehensively on a specific intervention or new diagnostic tool for the treatment of diabetes in adults or children.

In a paper of 750-1,000 words, summarize the main idea of the research findings for a specific patient population. Research must include clinical findings that are current, thorough, and relevant to diabetes and the nursing practice.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.

Genitourinary System Nursing Essay

Describe a patient with a genitourinary symptom or group of symptoms; such as incontinence, burning on urination, irregular menses, pain in the scrotum, erectile dysfunction, and so on. Do not limit yourself to these; for example, there are different types of incontinence. 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 to the patient? Find a nursing journal article about these symptoms.

Bariatric Surgery Discussion Question

1.      What health risks associated with obesity does Mr. C. have?

High Blood Pressure, Diabetes, Physical Inactivity, Sleep Apnea, Cardiovascular Disease.

2.       Is bariatric surgery an appropriate intervention? Why or why not?

According to American Society for Metabolic and Bariatric Surgery (ASMBS). The qualifications for bariatric surgery in most areas include:

·         BMI ≥ 40, or more than 100 pounds overweight (ASMBS, 2017).

BMI ≥35 and at least one or more obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease (ASMBS, 2017).

Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts (ASMBS, 2017).

According to these qualifications he would be a candidate. He has elevated glucose making him at risk of diabetes and abnormal lipid being a risk of cardiovascular disease. He has evidence of high blood pressure and sleep apnea. His BMI is at 47.75.

 

3.      The patient reports eating meals at 7 a.m., noon, and 6 p.m., and a bedtime snack at 10 p.m. Plan an administration schedule that will be most therapeutic and acceptable to the patient.

0600 Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL)

0700 breakfast

1000 Mylanta 15ml PO

1100 Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL)

1200 lunch

1500 Mylanta 15ml PO

1700 Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL)

1800 dinner

2100 Mylanta 15ml PO

2200 snack/bedtime-

Ranitidine (Zantac) 300 mg PO, Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL

 

 

4.      Functional health patterns include

 

health-perception and management- he has always been heavy and needs help with obtaining correct nutritional structure to help with controlled calories, fats, sodium and sugar as well as increasing regular exercise program.

 

nutritional – metabolic- He has gained a large amount of weight over last few years. He needs to learn to control food consumption, also increase of activity. recognizing foods with high fats, high sodium, and making better choices.

 

Elimination- Nothing is mentioned so further assessment should be done. Watch for constipation of loose stools. An increase of fiber to help with constipation. Watch for change in bowels with new medications.

 

activity-exercise- Having an office job and perhaps no desire to exercise can lead to weight gain. He should increase activity by walking at lunch. Joining an exercise gym.

 

sleep-rest-  He is overweight and has sleep apnea, so sleep is probably restless, so a need of a CPAP to get quality sleep may be a good choice.

 

cognitive-perceptual- He is able to make his needs known, he works and with known information is able to care for himself

 

self-perception – self-concept- low self-esteem, feeling that he has always been heavy

 

role-relationship- He is a single man.

 

sexuality – reproductive- Needs further assessment

 

coping – stress tolerance- He may overeat due to stress or low self-esteem. He does watch his sodium intake to help cope with hypertension. He is wanting to change his appearance and enhance his health with a weight loss plan. Recommend exercise to help relieve any stress and help cope with change of lifestyle.

 

5.      What actual or potential problems can you identify? Describe at least five problems and provide the rationale for each.

1.      Patient needs to see a nutritional consult to provide him with a healthy diet. This is important because he needs to learn a healthy pattern before having a surgery. He needs to recognize that his eating patterns are partially responsible for his weight gain.

2.      His sleeping needs to be improved. He cannot have a healthy mind when you are exhausted. Adequate sleep can help improve mental status and provide you energy to make lifestyle changes that are necessary.

3.      He needs to be educated about his high blood sugar. Again, meeting with a nutrition consult can help in this area. He need to have the appropriate equipment to check his own blood sugar.

4.      Patient needs to make sure that he is taking the medications at the appropriate times to benefit his peptic ulcer disease. He also need to make sure that he tells all consults about his medications to avoid adverse reactions with any new medications.

5.      Patient needs to continue to watch sodium intake and be educated about other causes of hypertension, like stress and lack of cardio exercise. Recommend his becoming involved in walking or joining a gym.

 

 

American Society for Metabolic and Bariatric Surgery (ASMBS). (2017). 
Patient Learning Center
.  Retrieved August 28, 2017, from https://asmbs.org/patients/

Surgery Risk Factors

Mr. C is a young gentleman that has various medical problems. He is wishing to have bariatric surgery. At this time he does not qualify for bariatric surgery. He has uncontrolled hypertension, which makes him a risk for stroke, heart attack or death. He also has peptic ulcer disease, which makes him a risk for bleeding and infection. He also has high cholesterol which increases his risk for stroke and heart attack. Diet changes and possibly medication are needed to decrease his cholesterol. He needs to become more stable prior to his surgery. He needs to start an exercise routine, and change his diet to prepare his body for the drastic food intake changes. He needs blood pressure medication started. He also has sleep apnea, and prior to bariatric surgeries MD’s have you do a sleep study test to address and treat any sleep apnea (Pories, 2008).

The above are his risk factors that need to be addressed prior to surgery.

Functional Health Patterns

His functional health patterns are not able to be holistically addressed relating a lack of information in the patient history profile.

Health-perception including health management: health perception is that the patient is wanting to make life style changes by seeking bariatric surgery

Nutritional-metabolic: the patient has excess calories per energy expenditure as noted by obesity. He also has high cholesterol levels. He has peptic ulcer disease which would affect his nutritional status.

Elimination: not addressed

Activity-exercise: sedentary lifestyle with sit down job

Sleep-rest: sleep is disturbed, unrestful and his body is not getting oxygenated appropriately relating sleep apnea

Cognitive-Perception: cognitive and perception is not addressed. He is employable.

Self-perception-self -concept and role relationship:  this area is not addressed in the profile other than being a single male.

Sexuality-reproduction: his sexuality was not addressed

Coping-stress intolerance: his coping and stress tolerance has not been addressed.

 

Actual Problems and Rationale

1-      Disturbed sleep pattern as evidenced by sleep apnea

2-      Knowledge deficit relating healthy lifestyle

3-      Alteration in comfort relating peptic ulcer disease

4-      Alteration in cardiac output relating uncontrolled hypertension

5-      Alteration in nutrition relating hypercholesterolemia and elevated blood sugars

(Ackley  &  Ladwig, 2011)

Rationale: Patient has sleep apnea, which means he stops breathing many times during the night. Sleep apnea increases your risk for stroke and heart attack and causes weight gain. Sleep apnea causes decreased energy during the day.

Rationale: Patient is controlling his hypertension with a low sodium diet, and his blood pressure is uncontrolled and is elevated. He is not caring for his high blood pressure in a safe way. He has a sedentary lifestyle, which increases his chance for medical problems including cancer and heart problems. It increases obesity.

Rationale: He has been diagnosed with peptic ulcer disease which is uncomfortable relating pain, nausea food intolerance etc.

Rationale: He has uncontrolled hypertension which effects his cardiac output. Hypertension increases his risk for stroke and heart attack

Rationale: His good cholesterol HDL is low at 30. His triglycerides are high at 312. His total cholesterol is 250 which is elevated. This puts him at risk for strokes and heart attacks. He should be on a low cholesterol diet. He also has elevated blood sugars. His fasting blood sugar is 146. It should be between 70-100.

Potential Problems

Potential for heart attack and stroke relating hypercholesterolemia, sleep apnea and uncontrolled blood pressure

Potential for bleeding relating peptic ulcer disease and uncontrolled blood pressure

Potential for malabsorption symptoms relating peptic ulcer disease

Medication Schedule

Carafate 1gm 6am

Mylanta 15cc 10am

Carafate 1gm 11am

Mylanta 15cc 3pm

Mylanta 15cc 9pm

Carafate 1gm 9pm

Carafate 1gm 10pm

Zantac 300mg 10pm

Mylanta 15cc 10pm

References

Ackley, B. & Ladwig, G. (2011). Nursing diagnosis handbook: An evidence based guide to planning care (9
th
edition). St. Louis: Mosby, Elsevier

Pories, W. J. (2008). Bariatric Surgery: Risks and Rewards. 
The Journal of Clinical Endocrinology and Metabolism
, 
93
(11 Suppl 1), S89–S96. http://doi.org/10.1210/jc.2008-1641

Nursing Advanced Physiology and Pathophysiology

1.Describe the clinical manifestations, similarities, and differences of the following vitamin deficiencies: niacin, riboflavin (B
2
), thiamine (B
1
), folate, vitamin B
12, 
vitamin B
6,
pantothenic acid (B
5
), biotin, vitamin C, vitamin K, vitamin E, vitamin A, and vitamin D.

2.Discuss the inherited mutation genes BRCA and BRCA 2, their prevalence, risks for different cancers, and recommended surveillance screenings for those with a confirmed genetically inherited mutation

1.Discuss the development of new drugs in the United States as compared to other countries, and evaluate the pharmacoeconomic issues that lead to high prescription costs in the United States

2. Discuss the pharmacological aspects of Benzodiazepine . Give examples of how and when this drug is used.

You are a new data analyst at Liberty Hospital. The HIM Director has asked you to put together a quick report for her to use in an upcoming meeting. The report will focus on the conditions of nursing homes in your area (city/state).

Often times in healthcare you may be asked to perform tasks with little or no direction. For this assignment, you will need to use your critical thinking skills to determine which information will be helpful to the HIM director.

In order to develop this report, perform an Internet search for Medicare.gov’s Nursing Home Compare website. In a 1-2 page report, written in APA format complete the following:

Perform a quality analysis on three (3) nursing homes in your community. Note any information that would be helpful to the HIM Director. You can use the Kansas City Area

Rank the nursing homes from highest to lowest based on their quality ratings.

Be sure your report is free of spelling and grammar errors.

 wanted to direct you to the CMS link for Nursing Homes to assist you in completing this week’s assignment. For this assignment you are the data analyst and have been tasked with putting together a report that focuses on the conditions of nursing homes in your area.Often times in healthcare you may be asked to perform tasks with little or no direction. For this assignment, you will need to use your critical thinking skills to determine which information will be helpful to the HIM director.

In order to develop this report, perform an Internet search for Medicare.gov’s Nursing Home Compare website. In a 1-2 page report describing 3 nursing homes in your area and ranking them from first to last.

I have provided the link CMS link below to help you get started.  You will also need to research the local nursing home for your specific area.

Create a visual depiction to explain the process of how ideas become regulations and rules and how rules and regulations become policy and laws on the local, state, and national levels for the nursing home industry. Research the path of how local, state, and national rules, regulations and laws are created and include the knowledge you find from this research into the visual depiction you create. The depiction should be concise and easy to understand.

Characteristics of an Organization

Large…small…

Urban…rural…

For profit…non–profit…

Acute care…primary care

Teaching organization…research facility

 

Myriad characteristics influence the experiences of patients, nurses, and others in any health care setting. In addition to the factors noted above, the mission, vision, and values that guide an organization, as well as an institution’s commitments to patient care, teaching, and/or research, warrant significant consideration.

As a nurse leader–manager, it is helpful to look at all of these aspects, especially as they relate to strategic planning and the sustainability of the organization. To that end, for this Discussion you compare multiple aspects of two organizations and consider the implications for nursing. In addition, you will apply a Strategic Planning tool, such as SWOT or Balanced Scorecard, or Six Sigma principles to establish one realistic goal or objective consistent with the mission of the organization.

To Prepare

Review the information in the Learning Resources regarding strategic planning; types of organizations; organizational commitments to patient care, teaching, and/or research; and the mission, vision, and values of organizations.

Using the Internet, research various health care organizations (including those with which you are already familiar) that differ in focus, commitment, and mission, vision, and values. For the purposes of this Discussion, select two organizations with significant differences.

Compare information about the two organizations. Based on the information presented in the Learning Resources, how do they differ?

What are some possible implications of these differences for various stakeholders (e.g., nursing administration, patients, and community)? What does this mean for nursing’s role within each organization?

Identify a goal or objective based on a strategic planning tool, such as SWOT or Balanced Scorecard, or Six Sigma consistent with the mission of the organization.

By Day 3

Post 
and Contrast two differing health care organization’s mission, vision, and values, and describe at least two potential implications of these distinctions for stakeholders of each organization. Explain how this informs the focus for nursing, noting the role that nursing administration plays in supporting and fulfilling the mission, vision, and values, and organizational strategies. Write a goal or objective, based on a strategic planning tool, such as SWOT, Balanced Scorecard, or Six Sigma consistent with the mission of one of the organizations.

 

Marquis, B. L., & Huston, C. J. (2015). 
Leadership roles and management functions in nursing: Theory and application
 (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

 

Note:
 This textbook is also used in NURS 6053 and NURS 6241

 

Chapter 7, “Strategic and Operational Planning”

 

Chapter 12, “Organizational Structure”

Read a sample of articles from the following resources. Choose at least one that focuses on Balanced Scorecard or SWOT. You might also want to explore the concepts of Lean operation and Six Sigma.

Abraham, M., & Moretz, J. (2012). Implementing patient– and family–centered care: Part I–Understanding the challenges. 
Pediatric Nursing, 38
(1), 44–47.

Retrieved from the Walden Library databases.

Daly, R. (2014). Building blocks for organizational change. 
Healthcare Financial Management: Journal of the Healthcare Financial Management Association
, 
68
(5), 68–73.

Retrieved from the Walden Library databases.

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.