1. A nurse is caring for a client following a bronchoscopy. Which of the following actions should the nurse take first?

1. Inform the client they might experience a low-grade fever.
2. Provide the client with sips of water.
3. Check the client's gag reflex.
4. Instruct the client to report bleeding.

2. A nurse is assessing an older adult client at a health fair. Which of the following statements by the client is the nurse's priority?

1. "I can't seem to get reading materials far enough away to see the words."
2. "I've noticed that there is a gray ring around the colored part of my eye."
3. "In the last day, I have had a severe headache and pain around my right eye."
4. "I'm having more difficulty telling the difference between blues and greens."

3. A nurse is preparing to discharge a client who has a halo device and is reviewing new prescriptions from the provider. The nurse should clarify which of the following prescriptions with the provider?

1. Take tub baths instead of showers.
2. May place a small pillow under the head when sleeping.
3. May operate a motor vehicle when no longer taking analgesics.
4. Increase intake of fiber-rich foods.

4. A nurse is providing discharge teaching to a client who has a new prescription for sublingual nitroglycerin. Which of the following client statements indicates an understanding of the teaching?

1. "I can keep my medication for 1 year before replacing it."
2. "I should discontinue this medication if I develop a headache."
3. "i can take up to five tablets in 15 minutes before seeking medical attention."
4. "I should lie down when I take this medication."

GU Unit – Chapter 55

Student Readiness Activity

You receive a 56 year old male patient newly admitted to your general medical floor who presented to the ED with complaints of severe right flank pain (rated 10/10 on numeric pain scale), nausea & vomiting for the past 36 hours, fever of 101.5 degrees, hematuria, & dysuria. This patient was diagnosed with a 0.7cm nephrolithiasis in the right kidney, seen on renal ultrasound.

1. Write out 3 nursing diagnoses (include ‘related to’ and ‘as evidenced by’ (AEB) statements) that are appropriate for this patient. Remember you do not need to include AEB statements for ‘risk for’ nursing diagnoses.
2. Identify a patient outcome for each of your nursing diagnoses.
3. Identify 2 nursing interventions for each nursing diagnoses (minimum 6 nursing interventions total) that you would include in your care plan to help the patient achieve their outcomes.

What is endocrine axis and write a sample for one hormone?

Pain Assessments and Interventions:

Assessment: The patient was alert and orientated X 3/ X 2 and reported left hand pain at the IV site as a 5 on a scale from 0-10 at 0900 d/t potassium infusion; heat pack was placed at the site and IV rate was lowered, reassessment at 0930 was a 0. The patient demonstrated facial grimacing during movement and appeared to be discomfort through out clinical shift. She stated pain level as 0 at 0730 and 1430 when vitals were recorded.

Interventions:

Respiratory Assessment and Intervention:

Assessment:Patient on room air. Frequent, nonproductive, dry cough noted after an increase in activity. Patient appears to be in no distress. Barrel chest. Normal lung sounds auscultated in all lung fields. HOB is elevated to 30 degrees. No use of axillary muscles. No signs of pallor or air hunger.

Interventions:

Neurosensory Assessments and Interventions:

Assessment: Patient is alert and orientated X3, sometimes X2. Easily arousal. PEERLA present. No use of corrective lenses/glasses. Patient has slowed, comprehendible speech. Verbal and able to follow two-step commands. Purposeful responses and purposeful movements. Generalized muscle weakness and fatigue.

Interventions:

Cardiovascular Assessments and Interventions:

Assessment: Patient’s HR 75 at 0730 and 79 at 1130. BP 108/60 at 0730 and 107/52. Patient is placed on remote telemetry. S1 and S2 sounds present. All four extremities are warm and dry. Skin turgor immediate recoil. No signs of clubbing/splitting. Dorsalis Pedi +1 weak pulses. Radial pulses +1 weak. Capillary refill less then 3 seconds. Patient’s color is WNL. No peripheral edema. Abdominal ascites present. SCD’s present. Patient has a hx of HTN, coagulopathy and anemia.

Interventions:

Musculoskeletal Assessments and Interventions: (include activity)

Assessment: Patient has limited ROM in all four extremities and needs partial assistance with ADL’s. Decreased ROM in all four extremities: RUE-mild LUE- mild, RLE- moderate, LLE- moderate. Decreased tone in all four extremities. No muscle contractures present. No peripheral edema or tenderness present. No traction or casts present. No abdominal binder. Able to transfer to bedside commode with one assist. Patient is on high fall risk and a bed alarm is set.

Interventions:

Gastrointestinal Assessment and Intervention: (include ordered diet)

Assessment: Patient is on a general diet. Patient did not eat her breakfast; she ate 25% of lunch and 25% of her dinner. Patient’s abdomen was distended and ascites was present. Hypoactive bowel sounds present in all 4 quadrants. Patient given protonix for gastric mobility at 0900. Patient had loose brown/yellow bowel movements 4 X in the commode. Patient was on lactulose, which was discontinued in the AM.

Interventions:

Endocrine Assessment and Intervention:

Assessment: Patient has a hx of DM II. Accuchecks every 6 hours and on a sliding scale. Patient’s glucose was 170 at 1200 and was given Insulin aspart 3 units at 1200. Patient has a history hypothyroidism; synthroid 50 mcg was given on an empty stomach at 0900. Patient does not exhibit diaphoresis, nervousness, or change in skin color. No signs of heat or cold intolerances.

Interventions:

Reproductive Assessment and Intervention:

Assessment: Patient had two children 36 and 40 years ago.

Interventions:

Vascular Access Assessment and intervention:

Assessment: Patient has an IV in her left hand and another IV in her right brachial. Dressing dry and intact. No continuous IV fluids running at this time. No signs of infiltration, redness or phlebitis at either IV site. Patient stated burning at left hand IV site during potassium chloride infusion, infusion lowered and heat pack given.

Interventions:

Safety Assessment and Intervention:

Assessment: Patient is at a high risk for falls. Three-side rails are up and the bed is in the lowest position. Bed alarm is on. Call light is with in reach. Turn patient every two hours to prevent skin break down. Ensure HOB is 30-45 degrees.

Interventions:

Psychosocial Assessment and Interventions:

Assessment: The patient lives in a house in Chicago with her son Tommy. She has two grandchildren that came to visit her at the bedside. She was a former smoker and alcoholic. She stated that she currently drinks one mixed drink of vodka each day. Her husband passed away 15 years ago and that’s when her drinking got bad. She stated, “I’m not as bad of a drinker as my father was.” She stated that she enjoys cooking because it makes her feel happy, however has not been able to cook as much because of her limited mobility and pain.

Interventions:

When using a mechanical lift to transfer a patient out of bed the nurse is aware of which of the following to ensure safety except?

A patient who is 4 days post–coronary artery bypass surgery reports she is having new chest pain that is “different from my angina pain.” The pain’s onset was 5 or 6 hours ago upon first waking up in the morning. The patient has a new pericardial friction rub and a low-grade fever of 100.5°F. The patient is diagnosed with acute pericarditis. a. Why was this patient at risk for developing pericarditis? b. Why is this patient now at risk for cardiac tamponade? c. What are the signs or symptoms that would be indicative of cardiac tamponade in this patient? What is the underlying pathophysiology of these signs and symptoms?

Write a critical appraisal of an evidence-based translation model in nursing including the name of the model, who developed it, why it was developed, the steps of the model, strengths, and weaknesses of the model and how the model can be used to support evidence-based practice.

How are the ethical principles of nonmaleficence and beneficence violated by ransomware that could be in a healthcare organization's information system?

Scenario:

Your AMTRAK train has just derailed while crossing the Northern Plains of the U.S. during wintertime. Fortunately, you and your traveling companion (both trained in first aid) have escaped with minimal injury, but many passengers are injured in the rail cars that overturned. Emergency crews are limited in this remote rural area, and the severity of the weather is a major concern. As you arrive on the scene of the overturned cars you see that many injured passengers are being dragged from the wreckage. After a quick assessment of the injured and the available resources, you and your partner select a 10 year old child with obvious musculoskeletal injuries. Other bystanders are not available to help, since they are either involved with other victims or they have themselves sought out shelter.   This area does not have 9-1-1 service. Emergency services are being called in, but response times will obviously be more than 30 minutes, mainly due to location and number of victims involved. Decide what your assessment steps will be when approaching the scene and victim, how you will budget out the supplies you have at hand and what you will do with your victim until advanced help is available.

Your available resources include:

A single broken snow ski (one 3 ft. board)

A single short piece of debris (one 1 ft. board)

A blanket

Strips of cloth torn from clothing (triangular bandages)

Magazines

A pillow

Paper towels

One roll of gauze (luckily found in your travel gear)

You discover the following signs/symptoms:

• Closed fracture of the upper arm on the victim’s right side (arm presented bent) (no open wound)
• 4 in. laceration of the right upper leg (1/2 in. deep)
• Moderate to severe bleeding of the lower right leg at the sight of a protruding bone (leg presented straight)
• Small avulsion with bleeding on temple (just above ear) on the right side
• Large scrape with minimal bleeding (superficial) covering the majority of the left forearm
• Potential for Hypothermia due to weather conditions

1. What will your assessment steps be upon arrival? (The things you do and check upon recognizing that an emergency exists until you begin bandaging and splinting. Think back to the first four chapters of the NSC text.)

2. How will you use items from your resources to address the victim’s injuries? Describe what materials you will use for each injury and briefly describe how you will treat the injury/illness.

3. What will you do with your victim after you have completed first aid treatments? (Are you moving them or staying put and any additional steps you should take.)

create an E Portfolio for a surgical technologist

1. In the CNS, morphine _______.

Marie earned her bachelor’s degree in HIM. After working intraditional HIM roles for a few years, she decided that she wanted tobe involved in the selection and implementation of the EHR andother healthcare information systems. Marie went back to school andearned her master’s degree in health informatics. After graduation,Marie worked for an information system vendor for several years.She decided to take another turn in her career path and become aprofessor in an accredited HIM program. She took a position as afaculty member in a bachelor’s-level HIM program. Marie nowteaches the information system courses for the HIM program and isable to give the students real world examples from her experience inthe traditional HIM departments and the information system vendor.Marie enjoyed her position so much that after teaching for a while,Marie went back to school again to earn her doctorate degree inadult education.

1. Identify how this Real-World Case ties to this chapter.

2. In the Real-World Case, Marie earned a bachelor’s degree, a master’s degree, and a doctoral degree. Do you think that some or all of the new roles discussed in this chapter will require graduate education? Why or why not? How do these roles tie into HIM Reimagined?

26. The nurse is educating the community regarding Food Safety. The nurse explained that Botulism comes from which of the following food source?
A. improperly home-canned foods
B. under cooked meat
C. egg dishes
D. soft cheese
27. The nurse is caring for a patient who's religious belief is Muslim. Which of the following actions by then nurse displays understanding of the Religious Dietary Restrictions for this patient? The nurse:
A. provides food available, turkey and ham sandwich
B. notify food services to deliver a food tray with no pork
c. would warm the roast pork in the tray
d. request a dinner for the patient

The capstone project is designed to be completed in sections. This is part three of the assignment.

Review your logic model, change proposal, and initiation plan. Describe in detail how the overall change plan will be evaluated, and the resources needed to evaluate the project. Discuss the evaluation process in relationship to the projected outcomes.

Create a dissemination plan. Explain how the outcome of the project will be disseminated externally (outside the setting to health care community) and internally (unit or hospital where the change process has taken place). A detailed plan answers the questions who, what, where, how, and when.

I am writing about Medication errors in emergency departments. The goal is to reduce medication errors in emergency using barcode technology