Tag: Clinical-Nursing

Diabetes

The patient must maintain a good flycemis control. Great point! Patients with diabetes have very comprehensive learning needs. It requires lifestyle changes in order to manage their disease. The teaching plan should be customized according to patient’s needs because there is more compliance on prescribed regimen when they understand what diabetes is. “The learning needs are focused on managing their glucose levels and preventing complications of diabetes. Learning needs for managing diabetes are complex and include: monitoring blood glucose levels, menu/food planning, exercise, medications, skin care, management of co-existing disease processes, knowledge of medications, knowledge of the disease process and how to manage hypo/hyperglycemic episodes

MRSA in wound

Adding one more point to the factors which affects the wound healing are infection and lack of oxygenation to the tissues on affected leg. The impact on MRSA in patient wound can vary from person to person. The patient with MRSA in wound can express more anxiety and pain on affected area. Health care workers needs to find out the suitable dressing to the wound for better healing every day (www.woundinterntaional.com).An effective antibiotic to prevent infection is necessary in case of Ms.G. Also topic application of antimicrobial drug will help to decrease the infection. Ms.G needs to be educated on prevention of infection through proper hand washing .She needs to be educated about the medication and encourage Ms.G to complete the course of antibiotic. Follow up with wound care nurse or home health nurse is essential for Ms.G after the discharge from the hospital. Early ambulation will help to improve the oxygenation to the area affected. Education and follow up is important to prevent further problems

Diabetes, poor diet and infection

Discussion Question

1.The clinical manifestations that Ms. G is experiencing are pain and heaviness in her leg, an open round yellow-red wound above medial malleolus with moderate amount thick yellow drainage measuring 2cm diameter and 1cm deep. Her left leg is red from knee to ankle, her left calf measures 3 inches greater then right calf, and her labs reflect elevated WBCs, elevated Neutrophils and elevated Bands. Ms. G also has a temperature of 38.9C (102.02 F) and a positive wound culture of Staphylococcus aureus.

After reviewing these clinical manifestations, it appears that Ms. G has an infection. Fever along with the red leg swelling and discharge from the wound are all signs and symptoms of an infection. I would call the primary physician asking for orders for antibiotics and for treatment orders for the wound. I would then give her an antipyretic per standing orders to lower the temperature. And lastly, I would encourage Ms. G to drink plenty of fluids. During fever, fluids are lost through insensible water loss which is from the respiratory tract and sweating. Encouragement for fluid intake is crucial since Ms. G is at risk for dehydration.

2.The muscle groups effected by Ms. G’s condition are: Soleus muscle, gastrocnemius muscle, extensor digitarum longus muscle, extensor hallus longus and fibularis brevis

3.Both the subjective and objective data are very significant in determining an appropriate course of action. It provides essential information to guiding the current treatment. Follow-up lab values for WBC, Neutrophils, and Bands as well as monitoring temperature and wound drainage will all allow for determining if the appropriate antibiotic was chosen and if the infection is being effectively treated. “Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections” (Tong, et al, 2015). “Antibiotic is the primary treatment for this infection” (Tong et al, 2015). Due to this localized wound infection caused by a bacteria, the neutrophil counts are high because they “are the early responders to an acute bacterial infection and arrive in large numbers very quickly” ( Copstead-Kirkhorn & Banasik, 2014). The follow up labs for the Neutrophil count after the treatment starts will help to determine if the infection is being resolved.

The data of Ms. G’s weight, height, diagnosis of diabetes, in bed for 3 days with no one to help prepare her meals, and applying a heating pad to a red, painful leg are all subjective and objective data that guide the need for education of current condition as well as education for future preventative care. Adults with diabetes hold responsibility for managing of their conditions. Ms. G will need to understand how to best take care of her diabetes. She will be taught that her weight is a contributing factor to being diabetic. “The more fatty tissue you have, the more resistant your cells become to insulin” (Mayo Clinic Staff, 2016), increasing her need for diabetic medications. The need for a proper diet to control her weight will also help control her blood sugar levels. Ms. G will need to learn to examine her feet for wounds. Diabetes causes less blood flood to the feet, and nerves and blood vessels can be damaged causing neuropathy. This loss of sensation can lead to serious foot problems involving the ankle and leg. Ms. G needs encouragement for a life-style-change. A list of resources for assistance with proper diabetic diet, weight management and diabetes support group will help Ms. G learn more about preventive care for her condition. And it must not be forgotten that Ms. G will also need to learn that applying heat to an area that is inflamed and red will exacerbate the redness and could cause localized skin damage leading to more wounds. There is a lot of education that needs to be provided to Ms. G which is based upon the subjective and objective data collected.

4.Diabetes, poor diet and infection are the factors that are present in this situation that could delay wound healing. Having diabetes causes poor circulation because “narrowed blood vessels lead to decreased blood flow and oxygen to a wound. An elevated blood sugar level decreases the function of red blood cells that carry nutrients to the tissue. This lowers the efficiency of the white blood cells that fight infection. Without sufficient nutrients and oxygen, a wound heals slowly” (Wound Care Center.Org, n.d.). The wound needs to be taken care of immediately which includes being assessed by a wound team and following prescribed wound care treatment.

Precautions to prevent delayed wound healing are for Ms. G to follow a proper diet to ensure she is getting enough protein which is needed for wound healing and not to limit carbohydrates for better blood sugar management. High glucose levels as noted above causes decrease circulation, delaying wound healing. Also, it is essential she follows the prescribed wound treatment orders. If wound bandages are not changed, a build-up of discharge can further exacerbate and delay wound healing. She must complete the course of antibiotics to ensure the bacterial infection is destroyed. And, lastly, with anyone who is diabetic, Ms. G must practice good diabetic management for healthy glycemic control…Diabetes, poor diet and infection…

Healthy People 2020 and Evidence-Based resources

As a healthcare professional, understanding where to locate evidence-based resources in order to help your patients benefit from that knowledge will be useful in your career. One such resource is The National Center for Health Statistics. The Center has established Healthy People 2020 for tracking the nation’s health. In this assignment, you will begin from the topic you selected and propose a culturally competent, as defined by SAMHSA, community based health program.

Go to the Healthy People 2020 website and find the Topics & Objectives. Once you have located the 42 topic areas discussed on the website, choose a topic in which you are interested.

Write a 1,500-1,750-word paper in which you propose a community health program related to the topic you selected. Include the following in your proposal:

An overview of the program you are proposing. What is it? Who are the population(s) it will serve?

A rationale for the program.

A discussion of how the program will be established as and will remain culturally competent.

A discussion of how the program could be affected if budgetary restraints limited research in that field.

APN Role in Teaching

An advanced practice nurse (APN) serves a critical role in today’s health care sector by educating patients, students, staff and other learners. Patient education is an important part of managing patient care to achieve optimal outcome. Patients gain an understanding of their health status, disease processes, treatments, dietary/lifestyle modifications and health promoting behaviors. This enables patients to be an active participant in their health care decisions. In addition, APN’s educate or teach staff by assisting them in developing the knowledge and skills essential for providing care, keeping them up to date with advances in clinical practice, and mentoring/precepting nurses in the practice setting-improving the quality of patient care (Joel, 2013). This role of APN’s also extends to nursing students as they teach and guide their learning in the practice setting.

APN’s should be well versed with the concepts of learning and teaching in order to teach patients, staff, students and others. This helps APN’s in making educational decisions. Teaching process includes assessment of learning needs, planning, implementation and evaluation (Joel, 2013). However, the process is not always linear. APN’s should possess predominant qualities of effective learning like expert knowledge, clinical competence, teaching skills, positive relationships and personal characteristics. APN’s should be able to decipher not just the learning needs, but also the learner’s readiness to learn. This is achieved through questionnaires, pretests and observations. Assessment phase is the most crucial phase as it defines the course of action the APN has to take. Once assessment is complete, different teaching mechanisms can be inherited to impart the knowledge. The group sizeis an important factor. When educating patients or staff/students, an APN has to be innovative in determining the teaching method. The teaching method can include lecture, discussion, clinical conference, case study, multimedia, self-directed instructional methods, demonstrations, and simulations. After teaching evaluating whether the learner has comprehended the knowledge imparted is important as well.

APN’s have an important role in educating patients, staff and students. Nurses in advanced practice are well prepared for their role as an educator with their extensive knowledge base, expert clinical skills, and strong communication skills (Joel, 2013).

References

American Association of Colleges of Nursing (2011). The essentials of master’s education in nursing. Retrieved from http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf

Joel, L.A., (2013) Advanced practice nursing: Essential for role development. (3rd Ed.). Philadelphia: F.A. Davis. Pp 327-346

Penn, B., Wilson, L., Rosseter, R., (2008) Transitioning From Nursing Practice to a Teaching Role.OJIN: The Online Journal of Issues in Nursing; Vol (13/ 3). Doi:10.3912/OJIN.Vol13No03Man03

Advance Practice Registered Nurse (APRN) Role

Overview of the APRN Role

• Advance Practice Registered Nurse (APRN) Role as a teacher:

o Understanding the three domains of learning:

 Cognitive Domain: “… contextualizing and consolidating exiting theoretical knowledge….” (Hayes, 2016, p.861)

 Psychomotor Domain: the learner has retained safe practice skills when the demonstrated through repetition or “… becomes ‘second nature’….” (Hayes, 2016, p. 861).

 Affective Domain: The teacher must gage whether the learner has gained realization of the values and ethical beliefs associated with their practice

o The advanced practice nurse is trained to provide patients and families with the education and skills needed understand their health/treatment, take control of their care and to be more autonomous (Joel, 2013, p. 327)

o Provide students or new graduates with the education and skills needed to feel confident, safe and practice safely/independently

o The APRN must understand the components of teaching (Gaberson & Oermann, 2010) –

 Assess the learner (i.e. student, patient or family member/s)

 Assess the learner’s readiness to learn

 Identify the individual’s needs

 Set obtainable goals (with learners’ participation in planning)

 Monitoring the learner’s progression

 Determine if further education/teaching is indicated

• Ultimate goal:

o Gain an understanding, trusting and professional relationship with learner to better facilitate knowledge retention

o “… patients gain an understanding of their health problems and treatments, how to care for themselves at home, and health-promoting behaviors”

o Promote safe and ethical practices for new graduates/students

Advance Practice Registered Nurse (APRN) Role References

Gaberson, K., & Oermann, M. H. (2010). Clinical teaching strategies in nursing (3rd ed.) New York: Springer.

Hayes, C. (2016). Approaches to continuing professional development: putting theory into practice. British Journal Of Nursing, 25(15), 860-864.

Joel, L.A. (2013) Advanced practice nursing: essential for role development. (3rd Ed). Philadelphia: F.A. Davis, 327-330.

Hypogonadism

Draft … My original question in PICOT format was: In men, ages 45-65, with low testosterone levels, how does using intramuscular testosterone alone compare to using intramuscular testosterone in combination with subcutaneous human chorionic gonadotropin (hCG) in increasing serum testosterone levels after a 6-month treatment period. However, since creating it last week, I have decided to redefine it to: In men, ages 45-55 who present with symptoms of hypogonadism, how does using intramuscular testosterone alone compare to using intramuscular testosterone in combination with subcutaneous hCG in reducing reported symptoms after a 6-month treatment period.

Symptoms associated with hypogonadism are fatigue, loss of muscle mass, increased body fat, depression, decreased libido, and loss of night time erections. Granted, these symptoms alone may not result in a diagnosis of hypogonadism as comorbidities, such as obesity, hypertension and diabetes, must be considered (Lawrence, Stewart, & Larson, 2017).

Background questions are looking to answer general knowledge questions that often can be located in textbooks. They typically have a root question of who, what, when, where, how and why followed by the outcome of the intervention or area of interest (Colorado State University, n.d.). Foreground questions, as defined by Lawrence, Stewart, & Larson (2017), are “those that can be answered from scientific evidence about diagnosing, treatment, oe assisting patients in understanding their prognosis” (p.27).

Background questions would likely deal with the type of symptoms the patient initally reported that encouraged them to seek medical attention. Examples would be what causes fatigue and loss of energy in the aging man? What are the symptoms of low testosterone? What causes low testosterone? The symptoms associate with hypogonadism are easily located in textbooks and on the internet. The foreground questions pose the more clinical questions. An example may be, what other diagnoses may cause similar symptoms as hypogonadism? What does hCG do in the role of treating low testosterone?

Much of the evidence located initially was related to infertility in younger men. As I varied my key words for the searches, my results began to increase. The additional results were more specific to testosterone replacement in various ages and several were specific to older men. There are even fewer results that discuss the use of hCG with testosterone. The most specific article was “A Double-Blind, Placebo-Controlled, Randomized Clinical Trial of Recombinant Human Chorionic Gonadotropin on Muscle Strength and Physical Function and Activity in Older men with Partial Age-Related Androgen Deficiency”, but it was from 2002 and did not use testosterone in combination with the hCG (Liu, Wishart, & Handelsman, 2002). I feel confident that with time and varying the key words in the searches that I will generate more appropriate results…

How management role interacts with colleagues and employees

In two or three paragraphs, assess how each management role interacts with colleagues and employees: Nursing, social services and patient care director.

Community health assessments

Needs Assessment

Community health assessments are used by health planners to identify, and prioritize health problems within a given community. To prioritize health programs and their development, a needs assessment is used. There are four types of needs that should be considered in a needs assessment. Although there is no single way to conduct a needs assessment, the basic steps to conducting a needs assessment can be identified.

Using the South University Online Library or the Internet, research about needs assessments and the types of health needs in your community. Based on your research, create a 2- to 3-page Microsoft Word document that:

Describes the four types of needs and compares them. Explains the interaction of the four types and the role of each type of need in the community assessment process.

Selects one of the four needs and provides an example of how this need can be applied to a health issue in your community. Describes the potential pitfalls of focusing a needs assessment on a single need. Provides examples to support your assertions.

Identifies and describes the basic steps of conducting a needs assessment and also explains the importance of each.

Describes any additional steps that should be considered in the assessment process.

Support your responses with examples.

Cite any sources in APA format.

Maximum Points

Described the four types of needs and compares them. Explained the interaction of the four types and the role of each type of need in the community assessment process.

15

Selected one of the four needs and provides an example of how this need can be applied to a health issue in the community. Described the potential pitfalls of focusing a needs assessment on a single need. Provided examples to support assertions.

10

Identified and described the basic steps of conducting a needs assessment and also explained the importance of each.

10

Described any additional steps that should be considered in the assessment process.

10

Presented a structured document free of spelling and gram

Evolution and Adoption of Health Information Systems

For this assignment, you are asked to perform the following tasks:

1. Describe the evolution of healthcare information technology by identifying key technological advancements in each decade, beginning with the 1960s, that had a direct impact on healthcare administrative and clinical functions.

2. Which decade do you feel was most significantly related to advances in health information systems? Please discuss.

3. Based on your own personal views, which specific law or act had the most significant advances for health information systems. Please discuss.

4. Discuss what the American Health Information Management Association (AHIMA) is and its significance to health information technology.

Your response should be at least three pages in length.

You are required to utilize your textbook and peer-reviewed journal articles from the University Online Library to complete this assignment. Make sure that you support any claims with proper sources, and appropriately cite your sources in APA format.