Question

1. A nursing student is assigned to work in a heart failure clinic that focuses on preventing and reducing heart disease. The clinic is experiencing a steady increase in the number of patients with heart failure.

• What could be contributing factors to the increase in patients presenting with heart failure?

• What impact are these factors having on health care?

2. The nursing student is observing the RN planning the discharge of a patient who has poorly controlled diabetes.

• What are the key characteristics of professional nursing practice that the student nurse should see in the care of this patient?

• What elements of the discharge can be delegated to other team members?

3. The nursing student is participating in an interdisciplinary team meeting to set goals to improve the quality of care for a regarding a patient in a long term acute care facility who has not been meeting his goals.

• What are key components of QSEN that should be considered in quality improvement?

Answer 1

1.a) Contributing factors to the increase in patients presenting with heart failure. Today's lifestyle has changed a lot. Everybody is having fastfood.

• HIGH BLOOD PRESSURE; The increased blood pressure may lead to increased pumping of blood into the heart. The chambers get larger and weaker.So maintain blood pressure below 130/80 mmof hg.
• CAD ; Eating fast and junk foods which contains excessive oil may lead to deposition of cholestrol in the walls of heart walls. Another name is atherosclerosis. This may cause blockage of blood flow, heart attack may occur suddenly.
• MYOCARDIAL INFARCTION;Past history of hreart attack may lead to increase or worsen the situation.
• ABNORMAL HEART VALVES; This may be due to infection such as endocarditis, Some babies also born with abnormal heart valves.
• HIGH BLOOD SUGAR; Diabetes may also increase the risk for heart failure.
• OBESITY; Obese patient can have increased risk for heart failure.

IMPACT ON HEALTH CARE DUE TO STEADY INCREASE IN NUMBER OF PATIENTS:

• The number of health care provider must be increased to handle the situation.
• The sudden increase in the number of patients may cause very busy and huzzle in the clinic.
• There is increased chance to have medication errors, or any other issues.

2.THE RN IS GIVING DISCHARGE SUMMARY TO THE POORLY MANAGED DIABETES PATIENT, THINGS THE  STUDENT NURSE SHOULD KEEP IN MIND IN THE CARE OF THE PATIENT ARE:

• The patient should be advised to have a sugar free diet at home/ He should follow the diabetic diet chart which the doctor advised.
• The patient should be advised to wear chappals/ or shoe while walking to avoid injuries, beacause a small injury develop into a big wound and cause infections.
• Advise to monitor blood sugar level regularly.
• If the patient is on insulin control then advise to take the injection properly, dosage should be explained. Advise the patient to keep any type of juices and biscuits at hand in emergency beacuse in diabetic patient there may be risk to develop hypoglycemia at any time.
• Teach the patient about the symptoms of hypoglycemia i.e, excessive sweating, shivering, blurring of vision, syncope etc..
• Advise to come in the hospital for regaular checkups.
• Advise to come earlier in the emergency or whenever required.

THE ELEMENTS OF DISCHARGE WHICH CAN BE  DELEGATED TO THE OTHER TEAM MEMBERS ARE;

• With discharge all reports should be handed over and take a handover signature.
• One team member should advise the patient to remove hospital gown and help the patient to wear his clothes.
• Another team member should ask the patient for the satisfactory level which he experienced in the hospital whether it was good or not.If there is any complaint he apologise for that then tell him and his family that we will look after the problem and try to improve it.
• Ask the patient / family member if they have to arrange an ambulance to go home.
• Another team member will look after the patient to remove hospital cannula,nasal feeding tube, urinary catheter, and hospital identity tag etc. All these things should be removed before leaving the hospital.
• And the main thing to look after is to check that all the hospital payements have cleared or not.
• Arrange a wheelchair for the patient to send the patient safely to the ambulance or cab

3.COMPONENTS OF QSEN THAT SHOULD BE CONSIDERED IN QUALITY IMPROVEMENT

• Safety- To reduce the risk of harm to the patient sand providers through both system effectiveness and individual performance.
• Quality improvent- To improve the quality of care whivh the nurse is providing.
• Team work and collaboration- This function is effective. team work, shared decision making should be there. If in busy schedule only one nurse work properly then she will be tired, so divide the work and do every thing. There should be a quality of work and sequence of work. All comes through team work and collaboration.
• Patient centered care- Provide full compassionate and coordinated care based on respect for patient's feeling preferences, values and needs.