Tag: Clinical-Nursing

How might the family’s culture and genetic history influence your communication and approach in addressing their health risks? How would you build trust with the family before and during the visit? Support your response with references from the professional nursing literature.

Access and appraise culturally-sensitive, research-based interventions to prevent, improve, and bring comfort to your population group. Community health nurses are critical thinkers informed of all important research finding. Critical-thinking is key. Please read about evidenced-based research in your textbook. Please respond the following: In week 3 and 4, you identified strategies/interventions related to a population group’s heath problem, and categorized them according to the levels and prevention and intervention. Describe whether those interventions are ” evidenced based.” Why or why not? Share at least two strategies/prevention related to your population and it’s health problem that you feel confident are evidenced-based. Why do you think that? Think in terms of research outcomes. Identify one evidenced-based behavior change technique to promote or manage illness among your population group.

Consider the levels of intervention used in the community health setting. The three levels are community-level practice, systems-level practice, and individual-level practice. What do these terms mean? Read about the levels of intervention on page 192 to 193 of your textbook. To improve population health, the community nurse carries out her culturally-competent care sequentially and simultaneously at all levels of intervention. Also, consider community resources as they relate to your chosen population-based health problem. Services provided by others health care providers Lack of services Cultural/ beliefs of community Health/illness beliefs Values, attitudes, health behaviors and practices

Cultural Competence

Review the media presentations and Chapter 7 in the course textbook. Focus particularly on presentation on cultural competence and on pages 146–152 in the textbook which discusses cultural competence. Also, review the Douglas, et al. article on “Standards of Practice for Culturally Competent Nursing Care.” Then, select a major ethnic or religious group from your community. With this group in mind, respond to the following questions: What major ethnic or religious groups are present in your community whose culture is different from your own? Discuss your assumptions about this group. How might a nurse’s positive or negative assumptions influence the care provided, and thus health outcomes? Support your response with references from the professional nursing literature.

Community Assessment To prepare for this Application, review the media presentations for this week and Chapter 15 in the course textbook on community assessment. In addition, use Table 15-5 on page 355 in the textbook to guide your windshield assessment. Include your windshield assessment with your Application. Conduct an assessment of the community in which you live, including a windshield assessment. Then, write a 3- to 4-page paper that includes the following: Demographics Vital statistics Environmental issues Occupational health hazards Vulnerable populations Resources available in the community Other pertinent information about the community

Consider the levels of prevention used in the community health setting. The three levels are primary, secondary, and tertiary. What do these terms mean? Briefly stated, prevention is about taking action to prevent or minimize the occurrence of an event. Read about levels of prevention on page 192 of your textbook. To improve population health, the community nurse carries out her work sequentially and simultaneously at all levels of prevention. Also, as you continue to work on collecting health data. Consider contacting your local community health department this week to find out how they involved in addressing your problem. See what you can uncover. Also, collaborating with other health care professionals, including your team members, will assist you to gain a fuller understanding of both your issue and your chosen population. Please address the following: Think about the three levels of prevention and how they relate to your population group’s health problem. Provide three examples of health interventions, one for each level of prevention, that are appropriate actions to take regarding your population’s problem.

Select a disaster that could happen in your community. Then, write a 3- to 4-page paper outlining the following: The disaster How the professional nurse would use clinical judgment and decision-making skills to provide appropriate nursing care Other health care professionals that may be involved in a response Suggest strategies for improving your community’s response to your identified disaster

Case Study: Sore throat Patient Information: L.A., 25 year-old, male, college student Chief Complaint: Sore throat History of Present Illness Onset: 7 days ago however, since yesterday, he has noticed that his eyes and skin have turned a yellow color. Location: throat associated with swollen and tender neck glands. (is the symptom located in a particular place? if no particular location, you can put “generalized”) Duration: 7 days ago, he developed fever which was low (99 F) to moderate grade (101.1 F). This was associated with swollen and tender neck glands. (how long has the condition lasted? recent or chronic?constant or intermittent? same as past problem and what has been done at that time? is it getting better, same or worse?) Characteristics/Course: He has sore throat but denies having cough, associated with swollen and tender neck glands. Denies abdominal pain but feels as if his upper abdomen has become swollen and he has lost his appetite. Aggravating/Associated Factors: Unknown Relieving Factors: Unknown Treatment: He denies taking any medications. Allergy: Unknown Past Medical History: Patient denied any history of jaundice, hepatitis, blood transfusion, body piercing, tattoos or eating shellfish. Surgical History: Patient denied previous surgery. No known drug allergies. Family History: Family history is non-contributory. Social History: Patient is a collage student who denied use of tobacco, alcoholic drinks or illicit drug.

Review of Systems: Constitutional: Patient is well-developed, in no acute distress. He appears concerned and anxious. Skin – no rashes, no itching, no hair changes or hair loss, no nail changes. HEENT – PERRLA, EOMI, (+) icteric sclerae, (+) pink conjunctivae, T-P erythematous with exudates, no vertigo, no lightheadedness; no blurring of vision, no double vision no tearing; (+) sore throat; no ear discharge, no ringing in the ears, no ear pain, (+)swollen and tender neck glands Cardiovascular – no chest pain, no palpitation Respiratory – no difficulty breathing, no cough Gastrointestinal – (+) loss of appetite, no nausea, no vomiting, no changes in bowel habits Genitourinary – no changes in urination, no pain in urination, Neurologic – no difficulties with speech, memory and motor coordination; no numbness or tingling sensation Musculoskeletal – (+) muscle aches, no pain or tenderness of the joints, no muscular weakness or cramps. Hematologic: No anemia, bleeding or bruising. Lymphatics: (+) enlarged nodes. Psychiatric: appears concerned and anxious no change in orientation Endocrine: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia. Allergies: no seasonal allergies

PHYSICAL EXAMINATION General – patient is awake, alert, weak looking. Patient is well-developed, in no acute distress. He appears concerned and anxious. Vital signs VS: BP – 130/80, PR- 110/min, RR – 20/min, T – 101.4 F, SpO2 – 99%. Skin – moist, no rashes, no bruising, face is flushed HEENT – Normocephalic, normal hair texture, no scalp lesion or tenderness; icteric sclera, pink conjunctiva, extraocular muscle movement intact, pupils equal and reactive to light and accommodation, present red reflex on fundoscopy; no external ear lesions, tympanic membrane is translucent with positive cone of light on both ears, no ear discharge noted; midline nasal septum, no tongue lesions noted, no gum bleeding noted; tonsils and pharyngeal walls noted erythematous with exudates, Neck –posterior cervical lymph nodes swollen, tender and movable, bilaterally. Supraclavicular lymph nodes not enlarged. Heart – PMI palpable in the left 5th intercostals space, midclavicular line, tachycardia, with HR of 110, no murmurs noted Thorax and back – symmetrical chest expansion with breathing, no spinal tenderness, and no costovertebral angle tenderness Lungs – normal resonance on percussion, clear and equal breath sounds, no crackles, wheezing or rhonchi Abdomen – Normal bowel sounds, liver – 14 cm in midclavicular line by percussion, diffuse tenderness over both right and left upper quardrants on palpation.

Extremities – no cyanosis, no clubbing of the nails, no edema, normal range of motion, pulses normal with regular rhythm. Neurologic – patient is awake, alert, oriented to person, place and time; speech is clear and concise, cranial nerves intact; normal muscle tone, no loss of sensation; deep tendon reflexes are 2/4, no problems with motor coordination. Psychiatric: Oriented ASSESSMENT(one primary diagnosis and 2 differential diagnoses) Primary Diagnosis: The most common bacterial infection of the throat is strep throat, which is caused by Group A streptococcus. Rare causes of bacterial pharyngitis include gonorrhea, chlamydia, and corynebacterium. This can be confirmed by doing rapid strep test, and throat culture. Other possible causative organism is hepatitis A, A highly contagious liver infection caused by the hepatitis A virus that spreads from contaminated food or water, or contact with someone who is infected. Symptoms include fatigue, nausea, abdominal pain, loss of appetite, and low-grade fever. This ca easily be rulled out by doing liver fiunction panel laboratory blood test (Brady, 2009, p. 773). Differential Diagnoses: 1. Gilbert’s syndrome which presents with skin and the whites of the eyes to have a yellow tinge due to the buildup of bilirubin. It can be ruled in or out by doing CBC and liver function test. The combination of normal blood and liver function tests and elevated bilirubin levels is an indicator of Gilbert’s syndrome. No other testing usually is needed, although genetic testing can confirm the diagnosis. (Luzuriaga & Sullivan, 2010). Management of IM is usually supportive. 2. Infectious Mononucleosis Often called mono or kissing disease, an infection with the Epstein-Barr virus ( ). Symptoms include fatigue, fever, rash, and swollen glands that matches the chief complaints of the our patient.

PLAN Diagnostics: Strep assay was done and it turned out to be positive. It is recommended though that throat culture for confirmation is done for those with negative rapid antigen test to reduce the unnecessary use of antibiotics (McIsaac, Kellner, Aufricht, Vanjaka, & Low, 2004). Blood panel of CBC was done to determine if there are other type of infection in which case is negative. Hepatitis A,B and C serology is a series of blood tests used to detect current or past infection by hepatitis A, hepatitis B, or hepatitis C. It can screen blood samples for more than one kind of hepatitis virus at the same time, there were no hepatitis antibodies found therefore the result was negative. Lastly uultrasound of the liver was performrd to detect any abnormalities and the cause of an on going symptom, our patient was result revereled normal liver in fiunction and size. Screening: none Rx: Penicilline 500 mg/125 mg by mouth every 12 hours for 10 days and instructed to finish the course of the medication even if he feels better already to prevent complications such as rheumatic fever, or abscess formation. Ten days therapy is recommended to maximally eradicate group A streptococcus (Bisno, Gerber, Gwaltney, Kaplan, & Schwartz, 2002). Education: Home instructions: increase oral fluid intake and rest; avoid close contact with anyone with strep throat; avoid germs; wash hands often; gargle with a solution of 1/4 teaspoon of salt mixed in 1 cup of warm water; stick to foods that are soft and easy on the throat (applesauce and yogurt are good choices) or warm and soothing (such as broth or tea); stay away from anything spicy or acidic; get lots of sleep and drink a lot of water; change toothbrush; Consult/Referral: Alert Provider if the following occur during treatment: fever recurs after being normal for a few days, new symptoms appear, such as nausea, vomiting, earache, cough, swollen glands, skin rash, severe headache, nasal drainage, or shortness of breath, joints become red or painful. Follow-up: To come back to clinic after 2 days if still with fever or no improvement of symptoms.

Begin collecting health data about a health problem or issue that affects your population group. Examples of health data include epidemiological information related to health conditions, reproductive outcomes, causes of death, and quality of life. Important information to include is socioeconomic data (poverty levels) and the presence or lack of health insurance in your population. Read more about epidemiology in your textbook. There are a variety of sources to collect health data – at the local, state, and national level. Access and review the professional literature to support your case. If data is not available to support your heath issue for a local group, use state or national data. Read more about health data collection in your textbook. Some website links are provided in the Course Webliography to help get your started. It takes time to gather data, so don’t worry about finalizing your data collection this week. In weeks 3 and 4, you will continue to collect Health Data by means of contacting your local health department and performing a community assessment. Please address the following: What are some health problems within your population group? Is there a priority health problem that stands out to you? What population-related health problem do you want to focus on for this project? Identify one or more websites that you found to be useful.

Pathophysiology

Interview Data: Ms. Richards tells the nurse, “I have a really bad pain in front of my butt. It hurts so much that I can’t even wipe with a tissue after I go to the bathroom. There is no way I could have a bowel movement right now.” Ms. Richards states that the pain started 2 days ago and is “much worse now.” When asked about her sexual activity, she says, “I’m with a guy, but it’s not exclusive or anything. We see other people and try not to be real serious.”

Examination Data VS: BP 110/80 CR 80 RR 16 Temperature 98.8degrees Fahrenheit

HEENT: Within normal limits

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CV: Within normal limits

Respiratory: Within normal limits ABD: Within normal limits External examination: Typical hair distribution, urethral meatus intact, no redness or discharge. Perineum intact. Extreme pain response to palpation of vaginal opening; edema, redness, and mass detected on right side. Spontaneous, foul-smelling, dark yellow discharge noted with palpation over Bartholin’s glands. Internal examination: Deferred because of extreme pain associated with the exam. Musculo-Skeletal: Within normal limits. Pathophysiology.

Please follow the rubric so you will get the maximum points for this case study. Always highlight the pathophysiology of the disease condition that is chosen as the primary diagnosis. Pathophysiology.

Using the Epidemiologic Triangle concept, consider the relationship among causal agents, susceptible persons, and environmental factors. Then, respond to the following: As a BSN-prepared community health nurse, what steps should Debbie take next? How might information systems be used to support Debbie’s efforts? Support your response with references from the professional nursing literature.