Tag: Clinical-Nursing

Pneumonia Nursing Care Plan Interventions Question

An elderly client with pneumonia has a temperature of 102.2 F (39 C), blood pressure 98/66 mm Hg, pulse 115/min, and respirations 30/min.  Assessment reveals crackles in the right lower lobe, dusky nail beds, and dry mucus membranes.  Arrange the nursing actions chronologically to prioritize care.  
All options must be used.

Pneumonia nursing care actions to arrange

Levofloxacin 750 mg intravenous (IV) every 24 hours

Blood cultures x 2 for temperature >102 F (38.9 C)

Oxygen per nasal cannula at 4 L/min

Teaching incentive spirometer use

Normal saline (NS) solution at 125 mL/hr

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Pneumonia Nursing Care Plan Interventions Response

Correct Response/Chronology

Oxygen per nasal cannula at 4 L/min

Normal saline (NS) solution at 125 mL/hr

Blood cultures x 2 for temperature >102 F (38.9 C)

Levofloxacin 750 mg intravenous (IV) every 24 hours

Teaching incentive spirometer use

Pneumonia Nursing Care Plan Interventions Explanation:

The nurse prioritizes nursing actions for the hospitalized client with pneumonia in the following order:

Oxygen per nasal cannula at 4 L/min
 – This client is in respiratory distress (respirations 30/min, dusky nail beds).  Oxygen administration is the priority action.

NS at 125 mL/hr
 – Most elderly clients with pneumonia present with dehydration (dry mucus membranes, low blood pressure).  Initiation of IV fluids is important to thin secretions, facilitate expectoration of mucus, and provide access for antibiotic therapy.

Blood cultures x 2 for temperature >102 F (38.9 C)
 – Cultures should always be drawn before antibiotic administration, as these can be inaccurate if drawn afterward.  Identifying the causative pathogen is necessary to ensure that the appropriate antibiotic is prescribed.  Cultures are drawn x 2 (from 2 different venipuncture sites) to rule out contaminants.

Levofloxacin 750 mg IV every 24 hours
 – Levofloxacin (Levaquin) is a fluoroquinolone antibiotic recommended for the treatment of pneumococcal pneumonia.  Antibiotics should be administered as soon as possible after the pneumonia diagnosis is made and cultures have been drawn.

Incentive spirometer every 2 hours
 – Deep breathing can be performed after the initiation of antibiotics.  Incentive spirometry increases alveolar expansion, facilitates removal of secretions, and prevents atelectasis.

Educational objective:

The nurse must prioritize nursing actions appropriately by identifying the client’s current health status and acuity level, threats to survival (airway, breathing, circulation), safety issues (infection), and desired outcomes.

Nursing Timeline Of Historical Events Essay

How Does Knowledge Of The Foundations And History Of Nursing Provide A Context In Which To Understand Current Practice? Identify At Least Three Trends In Nursing Practice From The “Nursing Timeline Of Historical Events” Media Piece. How Have These Trends

Pulmonary Embolism and Obesity Question and Answer

A client with obesity is diagnosed with pulmonary embolism (PE).  Which assessment data would the nurse expect to find?  
Select all that apply.

Bradycardia

Chest pain

Chills and fever

Hypoxemia

Tachypnea

Tracheal deviation

 

Pulmonary Embolism and Obesity Question and Answer

Answer

Correct answer

2,4,5

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Explanation

A pulmonary embolus is a 
blood clot
 that usually originates from the deep veins of the legs (>90%), travels to the pulmonary circulation, and 
obstructs a pulmonary artery
 or one of its branches, resulting in decreased perfusion in relation to ventilation and 
impaired gas exchange
 (hypoxemia).

Clients are at risk for formation of venous thromboembolism (VTE) when the conditions detailed in Virchow’s Triad are present.  Clients at risk for PE include those with 
prolonged immobilization
 (eg, during hospitalization if not ambulatory), obesity, recent surgery, varicose veins, smoking, heart failure, advanced age, or history of VTE.

The assessment data most characteristic of PE include:

Dyspnea
 (85%)

Pleuritic chest pain
 (60%)

Tachycardia

Tachypnea

Hypoxemia
 (impaired gas exchange, decreased perfusion with normal alveolar ventilation, shunting)

Apprehension and anxiety

A more atypical presentation can be associated with a larger sized PE, and may include manifestations of cardiopulmonary compromise and 
hemodynamic instability
 (eg, right ventricular dysfunction, pulmonary hypertension, systemic hypotension, syncope, loss of consciousness, distended neck veins).

(Option 1)
  A classic manifestation of PE is tachycardia to compensate for hypoxemia (not bradycardia).

(Option 3)
  Chills and fever can indicate the presence of an infection and are not characteristic of PE.  However, a low-grade fever without chills can occur 1-2 weeks after PE due to inflammation.

(Option 6)
  Tracheal deviation is a symptom of tension pneumothorax.  The trachea deviates from midline toward the unaffected side, away from the collapsed lung.

Pulmonary Embolism and Obesity Question and Answer Educational objective:

Classic clinical manifestations of PE include dyspnea, pleuritic chest pain, tachycardia, tachypnea, hypoxemia,  and feelings of apprehension and anxiety.  Risk factors for PE include those detailed in Virchow’s Triad (eg, hypercoagulability, venous stasis, and endothelial damage).  Massive PE can cause syncope and hemodynamic instability.

Clostridium Difficile Colitis Question and Answer

Question

A client is being admitted to the health care facility with a new diagnosis of 
Clostridium difficile
 colitis.  Which elements of infectious disease precautions are necessary when providing routine care for this client?  
Select all that apply.

Alcohol-based sanitizers for hand cleaning

Client in single-room (private) isolation

Nurse using N95 respirator

Nurse using sterile gloves

Nurse using surgical mask

Nurse wearing disposable gown

 

Clostridium Difficile Colitis Question and Answer

Answer

Correct answer

2,6

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Explanation

Clostridium difficile
 requires 
contact precautions
 under the guidelines published by the Centers for Disease Control and Prevention.

Place the client in 
single-room
 isolation (preferred) or cohort with other 
C difficile
-infected clients

All surfaces within 3 feet of the bed are considered contaminated

Personal protective equipment (
gown and gloves
) must be discarded before leaving the room

Hand hygiene must be performed with 
soap and water

Alcohol-based hand sanitizers do not kill 
C difficile
 spores 
(Option 1)

Dedicated medical equipment (stethoscope, blood pressure cuff) should remain in the room

(Option 3)
  For client care involving airborne precautions, a class N95 or higher grade respirator must be used in lieu of a surgical mask to avoid potential exposure to aerosolized particles.  Surgical masks are rated for barrier protection for droplet splashing and filtration of large respiratory particles only.

(Option 4)
  Regular clean gloves (not sterile) are needed.

(Option 5)
  Surgical masks are rated for barrier protection from droplet-based disease transmission and provide only filtration for large respiratory particles.  Masks are required during any activity with the possibility of fluids splashing (suctioning, wound care).

Clostridium Difficile Colitis Question and Answer Educational objective:

Clostridium difficile
 requires contact-based precautions – private isolation room preferred, disposable gown, and nitrile gloves.  
C difficile
 requires the use of 
soap and water
, not alcohol-based hand sanitizers, to prevent transmission.

Bacterial Meningitis Nursing Care Question.

A 6-month-old is admitted with bacterial meningitis.  Which action is the 
priority
 of care? (choose one of the following bacterial meningitis nursing care options, the answer and the explanation is given below)

1.

Administering antibiotics

2.

Avoiding environmental stimuli

3.

Initiating seizure precautions

4.

Measuring head circumference

 

Bacterial Meningitis Nursing Care Question Answer and Explanation:

Bacterial meningitis
 occurs when infection causes inflammation in the meninges of the brain and spinal cord.  This inflammation may lead to hydrocephalus and increased intracranial pressure (ICP).  Due to the risk for severe complications from meningitis and increased ICP (eg, hearing loss, permanent brain damage, death), the 
priority
 of care is 
immediate antibiotic therapy
.  
Lumbar puncture
 (LP) with cerebrospinal fluid culture is performed to determine the causative organism.  Antibiotic choice may be adjusted later based on LP results.  The client should remain on 
isolation precautions 
for a minimum of 24 hours following initiation of antibiotic therapy.

(Option 2)
  Clients with meningitis are often very 
sensitive to stimuli
 (eg, bright lights, noise).  Although environmental stimuli should be reduced as much as possible, the priority of care is initiating antibiotic therapy.

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(Option 3)
  Seizures may occur in infants with bacterial meningitis and are often accompanied by a 
shrill, high-pitched cry
.  There is no indication that this client has experienced a seizure.  The nurse should carefully monitor for seizure activity and place the client on seizure precautions if necessary.  However, antibiotic therapy is the most critical intervention in treating bacterial meningitis.

(Option 4)
  Although obtaining an initial 
head circumference
 is necessary to monitor for changes related to increasing ICP, the priority is obtaining blood cultures and administering antibiotics as soon as they are prescribed.

Educational objective:

Due to the risk for severe complications (eg, hearing loss, permanent brain damage) associated with bacterial meningitis, the most critical intervention is initiation of antibiotic therapy.  The causative organism is confirmed through LP and blood cultures.

Contemporary moral issue in our society and ethical principle of Utilitarianism

Choose a contemporary moral issue in our society and apply the ethical principle of Utilitarianism to approve and be in favor of this moral issue. You must pick a moral issue that you strongly agree with and apply the utilitarian claims to back up your arguments. In addition, you must apply Bentham’s Felicific Calculus. The paper must be done in MLA format with a minimum of 500 words (quotes are not included in the word count). You must read Chapter 2 and watch the Week 3 Lectures before you do this paper.

How can graphics and/or statistics be used to misrepresent data? Where have you seen this done?

Based on the scientific management theory, what are some of the routines in health care that seem to be inefficient? What examples of participative decision making exist in your workplace? Provide your rationale.

Statistical Analysis on a Selected Data Set Assignment

Conduct
a Statistical analysis on one of the data sets provided or use your own data set. The sample data sets are for the following areas:

A hospital administrator is attempting reduce the length of stay in the inpatient setting at four of the systems hospitals. Each hospital leadership team has attempted to implement strategies to decrease the length of stay over the past year. Conduct an analysis on the data provided to identify the hospital closest to achieving the lowest LOS. What are your results of your descriptive statistical analysis? What other data elements would be helpful for a researcher to collect?

Perform
some descriptive statistical analysis on the data you selected. Include the following standard tests:

Mean

Median

Mode

Percentages

Trends in data over time

This assignment will be broken up as the following:

Introduction

Mean with short explanation and summary of the results and with a graph.

Median with short explanation and summary of the results and with a graph

Mode with short explanation and summary of the results and with a graph

Percentages with short explanation and summary of the results and with a graph

Trends with short explanation and summary of the results and with a graph

What other data elements would be helpful for a researcher to collect?

Conclusion

Data set:

Hospital

Oct

Nov

Dec

Jan

Feb

March

April

May

June

July

Aug

Sept

Year To Date

Hospital A

4.48

4.77

4.51

4.72

4.73

4.84

4.87

4.73

4.67

4.7

4.29

4.45

4.65

Hospital B

4.53

4.23

4.37

4.48

4.58

4.92

4.79

4.97

4.61

4.91

4.58

4.43

4.62

Hospital C

3.63

3.53

3.96

3.51

3.79

3.39

3.91

3.59

3.23

3.77

3.32

3.42

3.59

Hospital D

4.33

4.32

4.34

4.42

4.46

4.59

4.64

4.6

4.39

4.63

4.25

4.3

4.5

Provide
a 350- to 700-word summary of your results, including graphical representations of your findings. Plot the information on your graph. Interpret your findings.

Unionization and the Nursing Profession Essay Assignment

Unionization is a highly charged topic. No matter what your beliefs or thoughts are on the subject, one thing is clear—nurse managers have a significant responsibility to promote the goals of their organizations while appreciating the labor concerns that may prompt employees to join unions. Beyond that, it is helpful to reflect on the core values of nursing and consider the extent to which they align with unionization.

To prepare:

Review the information in the Learning Resources. Conduct additional research on unionization in health care.

Consider the professional basis of nursing and the presence of unions in health care. Does unionization conflict with a professional nursing orientation?

Reflect on the experiences you have had working in unionized settings, or consider what would be required of you in such a setting if you do not have that experience.

Consider how you would address transitioning from being a member of a collective bargaining unit to being a manager who cannot be a member of a collective bargaining unit. How you might prepare to make this sort of transition?

ORDER A CUSTOM-WRITTEN PAPER

Post
 your position on whether unionization aligns with or conflicts with a professional nursing orientation and what this may mean for the role as a nurse manager. Share your experiences working in a unionized setting or describe what might be required of you when transitioning from one circumstance to another.

 

Required Readings

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

Chapter 22, “Collective Bargaining, Unionization, and Employment Laws”

Chapter 22 discusses several key topics surrounding unions and collective bargaining in nursing and health care organizations. Unionization and the Nursing Profession Essay Assignment.

Manthous, C. A. (2014). Labor unions in medicine: The intersection of patient advocacy and self–advocacy. 
Medical care
, 
52
(5), 387–392.

Copyright 2014 by Llippincott  Williams & Wilkins – Journals. Reprinted by permission of Llippincott  Williams & Wilkins – Journals via the Copyright Clearance Center.

Ash, M., Seago, J. A., & Spetz, J. (2014). What do Health Care Unions do?: A Response to Manthous. 
Medical care
, 
52
(5), 393–397. DOI: 10.1097/MLR.0000000000000124.

Copyright 2014 by Llippincott  Williams & Wilkins – Journals. Reprinted by permission of Llippincott  Williams & Wilkins – Journals via the Copyright Clearance Center.