Nursing

Stroke case study: Joe (54 years old) is a carpenter who presents to the emergency room at the local emergency department with acute aphasia, right facial droop, and right-sided weakness. Onset of the symptoms was sudden and occurred at work. One of his co-workers called 9-1-1. The Emergency Medical Team evaluated Joe’s neurologic deficits and glucose on the way to the hospital. Glucose was 85. The EMS notified the emergency department of a possible stroke patient. Continue: Upon arrival in the emergency department (ED), the nurse gather the patient’s medical history from his wife who met him at the hospital. The wife report his history of uncontrolled hypertension (often non-compliant with anti-hypertensive medications), diabetes (diagnosed 2 years previously, taking oral medications). Joe is reported to smoke 2 packs per day for at least 20 years and although he has attempted to stop smoking several times, none of the attempts were successful. Joe’s parents both died in their early 60’s from heart attacks. His wife expresses concern that Joe spends most of his free time watching TV and is not physically active when not at work. Following review of the CT scan and lab test the ED physician advises the patient, his wife, and the nurse that the evidence indicates Joe is having in the early stages of an ischemic stroke. Once informed consent is obtained, the patient receives thrombolytic therapy. Although Joe continues to report right sided hemiparesis, the treatment is considered successful and the patient is admitted to the nursing unit for further monitoring of his condition. On admit to the nursing unit Joe’s vital signs are as follows: blood pressure-150/62; heart rate-72; respiratory rate 15; temperature-98.9 degrees F. Physical assessment reveals no facial drooping, tongue protrudes midline, PERRL, Glasgow coma scale 15. Right arm and leg are slightly weaker than the left. Joe denies any numbness or tingling. Questions: 1. What are the priority nursing diagnoses and interventions for Joe?   2.       What risk factors does Joe have for a stroke? 3.What are priorities for educating the patient regarding prevention of another stroke? Three hours later the nurse enters the room to for an hourly neurological assessment and finds Joe snoring very loudly. His wife state this is unusual for him. The nurse is not able to arouse Joe from his sleep. Questions: 4. What should the nurse’s priority action be at this time? 5. What do you think is the number one priority test the patient needs at this time? 6. Please write out the SBAR report for this patient at this time?   Situation:Background: Assessment:Recommendation:

Describe how the nursing profession is viewed by the general public. Discuss factors that influence the public’s perception of nursing? Describe ways to educate the general public on the professional nurse’s role and scope of nursing within a changing health care system Note (two or more references using in-text citations and source referencing in APA 6th ed. formatting)

Not all EBP projects result in statistically significant results. Define clinical significance, and explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project?  No need for an introduction or conclusion. My capstone proposal project will be about Hygiene between healthcare workers and any hospital worker to help in reducing acquired infections. The setting at Larking Community Hospital in Miami, FL. I will attach extra information about my project; that way, you will know what to talk about it. Please read it. Thanks.

Consider how compensation for healthcare services shape delivery of care, and reflects policy and policy changes and write a paper that addresses the bullets below. Be sure to completely address each bullet point. There should be four (4) sections in your paper; one for each bullet below. Separate each section in your paper with a clear brief heading that allows your professor to know which bullet you are addressing in that section of your paper. Include a “Conclusion” section that summarizes all topics. This assignment will be at least 1250 words.  This week you will reflect upon accountability in healthcare finance to address the following: Discuss the history of private health insurance and manage care and how it involved into a healthcare industry?  Identify the key federal laws that protect individuals who are enrolled in private insurance. Briefly discuss consumer-driven healthcare and the empowerment of the healthcare consumer. Explore the opportunities which have emerged for nurses within the private insurance market.

Manny Castillo and his partner, Andy White, have just moved to Kinzig from the bustling city of Chicago. They were hoping to move out of the busy city to reduce Manny’s stress level because it has taken a toll on his health. Due to uncontrolled hypertension Manny has been diagnosed with renal insufficiency. Manny is being followed by Dr. Martin, a nephrologist in Kinzig who was recommended by his nephrologist in Chicago. His records were sent to Dr. Martin’s office and Manny has set up his first appointment with Dr. Martin. Manny went to Dr. Martin’s office and had blood work drawn. Dr. Martin conducted a comprehensive exam and reviewed his health history, medications and developed a plan of care for Manny. Manny left the office with a new medication regime to treat his renal insufficiency. The medications he will take are: 20mg furosemide once a day, 10mg enalapril once a day, and 1 Nephplex vitamin capsule once a day. · What are the indications for the furosemide, enalapril, & Nephplex vitamin? · What non-pharmacological treatments could help Manny? A few days later Manny received the test results and was educated that he needed to be sure to follow his medication regime and watch his diet. A couple weeks after the visit with Dr. Martin, Manny and Andy received a phone call from the adoption agency notifying them of a possible little girl who they could adopt. This was great news for Manny and Andy because they have been waiting for this phone call for years! They want nothing more than to be parents and now it could be possible. Even though this was going to add stress to Manny’s life, they decide to go through with the paperwork as this was their ultimate dream. · What could the added stress do to Manny’s health? · How can Manny decrease his stress level during this intense time? A few months later Manny started feeling bad and went back to the nephrologist. Dr. Martin ordered more lab tests and a urinalysis. Two days later Manny received a phone call from Dr. Martin’s office regarding his blood work and lab tests and was asked to immediately come to see Dr. Martin. In fear of bad news, Manny called Andy and he met Manny at the Dr.’s office to provide support. Once they arrived to the office, Dr. Martin reviewed the blood work with Manny and Andy. Manny’s BUN is 50mg/dL, creatinine is 5.6mg/dL, GFR is 14mL/min, K is 6.2 mEq/L, Phosphorus is 5.4mEq/L, Hemoglobin is 8.2mg/dL, Hematocrit is 27.3. His UA revealed protein and glucose in his urine. · What do you think is happening here? · What are normal BUN & Creatinine, GFR, K, Mg, Phosphorus, Hemoglobin and Hematocrit levels? · Why did he have protein and glucose in his urine? Dr. Martin instructs Andy to immediately take Manny to the hospital because he will need to be admitted for emergency dialysis. This news worried Manny and Andy’s ability to adopt their little girl. They worried they would not be approved due to Manny’s declining health. An interesting point about the little girl they could possibly adopt is that she too has renal issues and requires special medical care. Manny was admitted to the hospital and a hemodialysis catheter was placed and dialysis was done. His lab values trended back to normal and he was able to go home but on a dialysis schedule of Monday, Wednesday & Friday. During his hospital stay he had an AV fistula created in his left lower arm by a very skilled vascular surgeon, Dr. Evans. Manny understand that he still needs to continue having his dialysis using his hemodialysis catheter until his AV fistula matures. He was also sent home with a different medication regime. His new regime is: 10mg enalapril PO BID 800mg Renvela PO TID with meals 50units/kg Epogen IV 3 times a week (during dialysis) 100mg Iron sucrose IV 3 times a week (during dialysis) 1 Nephplex vitamin PO BID · What are the therapeutic indications of each of these drugs? · What are the adverse reactions/side effects of each of these drugs that you would need to teach Manny? · What dietary restrictions are you going to educate Manny about? · What will you educate Manny about regarding his new AV fistula? Manny goes home and reports Monday to an outpatient dialysis clinic for his dialysis session. After 30 minutes on the dialysis machine, Manny complains of severe cramping and pain. · What can the nurse do for him to alleviate the cramping and pain? Good news, the adoption was approved and Manny and Andy have their little girl!

What role has nursing theory played in research, in knowledge development?  How does nursing theory inform advanced practice nursing?  Does nursing theory have a role in providing culturally competent care? Tie in with The Transcultural Nursing Theory or Culture Care Theory by Madeleine Leininger

The advanced practice nurse is updating the plan of care of nursing home patients with hypertension. 1- Briefly describe the therapeutic actions of drugs affecting blood pressure (diuretics, ACE inhibitors, ARBs, CCB, sympathetic nervous system drugs). 2- What important teaching points should be addressed for patients receiving antihypertensive drugs?

Identify a Community Health Assessment Model. (This document from the CDC lists commonly used community assessment models: https://www.cdc.gov/stltpublichealth/cha/assessment.html ) What are some benefits of using a specific model to assess a community? What agencies should be included with the assessment? What is a reasonable time frame in which to complete a community wide assessment? What is the role of the public nurse in implementation of the chosen model? At least 400 words in length

JUST ANSWER THE QUESTIONS ON THE CASE SCENARIO BELOW, IN AN APA 7TH ED FORMATTED PAPER…. CASE: You have successfully passed your advanced practice registered nurse (APRN) certification course and received your credentials to practice as an APRN. Although you have worked in a hospital for several years, you are interested in pursuing other practice areas and have received several requests for interviews. You are surprised at the difference between the job search as an APRN from your previous experience as a registered nurse (RN), and you realize that your preparation needs to reflect these differences. You are interested in working for a full-service facility that focuses on prevention and wellness, and you become very excited when your most desired facility contacts you via e-mail expressing interest in your resume and requesting a preliminary telephone interview. The facility is scheduled to open in 45 days and is considered to become the most forward-thinking, state-of-the-art facility in the region. QUESTIONS: 1. During the preliminary telephone interview, the talent acquisition specialist asks whether you believe you could make the transition from the traditional approach of hospital care to their model of care. How should you respond? 2.To prepare for your formal interview, you are creating a list of questions to ask the interviewer. You identified the practice specialty, environment, and patient population in your first telephone interview. What other questions should you ask? 3. Describe the four basic methods by which you can negotiate salary compensation and choose the best method for your circumstances.