Category: Nursing

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.

stimulation of the man’s T lymphocytes and adaptive immune system

Boundaries Legislation and Malpractice in Nursing Learning Outcomes

1. Evaluate legislative standards.

2. Compare and contrast legislative standards applicable to professional nursing.

3. Analyze malpractice in professional nursing care.

4. Discuss the use of technology in clinical decision-making.

5. Demonstrate an understanding of professional nursing boundaries.

Introduction

Nursing practice has a set of guidelines that inform professional nurses. It is imperative that nurses practice within the scope of these guidelines as defined by the ANA. Failure to abide by the rules, regulations, and professional standards of nursing oftentimes lead to malpractice. This week you will evaluate legislative standards of professional nursing. You will also examine the steps taken by legislatures to determine malpractice. Finally, you will demonstrate an understanding of maintaining professional boundaries with your clinical team and your patients.

Legislative Standards in Professional Nursing.

Nursing is a very dynamic field. In that, the nursing profession is influenced by both nursing standards and legislative policies. As a professional nurse, it is important to note that not only are nurses practicing, but they are also becoming increasingly involved in political and legislative processes. Find a key legislative constituent in your state or region that is an RN/APN. (This is for your own personal knowledge/reference.)

For this discussion you may go the ANA Home page or any source (the source you choose must be valid and reliable [i.e., .gov, .org, etc.]) and find a piece of legislation that impacts nursing practice. As you write your discussion, provide information on the following:

• State whether or not the legislation passed or failed to pass. Provide an overview of why the legislation passed or failed to pass.

o If the legislation passed, what implication(s) might this legislation have for the future of professional nursing practice? (Base your answer on your research and/or reading.)

o If the legislation failed to pass, what are the factors surrounding the failure to pass? How can it be improved, so it can be passed? (Base your answer on your research and/or reading.)

Steps to Malpractice
.

Malpractice is defined as a professional conduct that is misaligned with the nursing profession and causes verifiable harm to a patient. Malpractice is decided based on proof of intentional harm to a patient; this means that there are steps taken to decide proof of such injury. It is important to note that technology systems are now used in nursing to assist in clinical decision making and to minimize the risk of malpractice lawsuits.

For this discussion, find (by research or from experience) a case of malpractice.

• Briefly provide an overview of the case and then evaluate whether or not the alleged malpractice was in fact intentional negligence.

• Then, discuss how the precipitating event(s) could have/should have been handled to avoid the lawsuit.

• Include a discussion on how clinical decision support systems (CDSS), such as electronic medical record systems (EMRs), have impacted your practice.

• What is the overall influence of ethical principles, as it relates to malpractice? Provide a summary.

Professional Nursing Boundaries.

Boundaries in nursing relates to when nurses transgress professional nursing standards and ethics while providing care to patients. For example, a nurse accepting financial gifts from a patient as gratuity. Professional boundaries in nursing is a topic of much debate. Nurses must maintain boundaries in order to provide the most effective care to their patients. Although professional boundaries may be clear in some aspects, in others there still are ambiguities; especially when the aspect of ethics is not astutely followed.

Review the case study you read during Week Two in the “Health Promotion, Disease Prevention, and Illness: A Community Perspective” chapter of your textbook regarding the “5-day-old premature baby;” then read the “Words of Wisdom” associated with this case. In this assignment, analyze the ethical principles relating to nursing care, based on these and other readings for this week. Address the following items in your paper:

• Discuss the importance of professional boundaries in your practice.

• Highlight how you will or have utilized professional nursing boundaries in your practice. Give a one-to three-paragraph scenario.

• Highlight the key take-away from “Words of Wisdom.” How would it apply to your practice?

• Include a short paragraph indicating how professional nursing ethics would apply to the problem you identified in Week One (Phase 4 of 5).

• Conclude/summarize of your findings on professional nursing boundaries.

Your paper

• Must be two to four double-spaced pages in length (not including title and references pages) and formatted according to APA style

• Must include a separate title page with the following:

o Title of paper

o Student’s name

o Course name and number

o Instructor’s name

o Date submitted

• Must use at least three scholarly sources in addition to the course text.

• Must document all sources in APA style as outlined in the Ashford Writing Center.

• Must include a separate references page that is formatted according to APA style.

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.