You are caring for an older male patient who has been admitted for pneumonia. The patient requires minimal assistance with ADLs. You have cared for this patient the last few nights, and at around 8 PM, he thinks he is at home, he calls for his dog, his thought processes are disorganized, and he is restless. What disorder is he experiencing, and what nursing interventions would be appropriate for this patient?

Please respond in no less than 250 words.

Research the delivery, finance, management, and sustainability methods of the U.S. health care system. Evaluate the effectiveness of one or more of these areas on quality patient care and health outcomes. Propose a potential health care reform solution to improve effectiveness in the area you evaluated and predict the expected effect. Describe the effect of health care reform on the U.S. health care system and its respective stakeholders. Support your post with a peer-reviewed journal article.

Please make each answer is no fewer than 4 full sentences but no longer than 10 sentences. Be clear and concise.

1. What are some examples of sentinel events?

a. Describe the impact of poor quality care on the individual, family, community, and the United States.

b. Create a core value statement.

1. HYPERVOLEMIA

A patient was admitted in the medical ward with chief complaints of shortness of breath. Further assessment reveals the following findings:

• BP –140/90 mm Hg
• HR –111 bpm
• RR –24 cpm
• +2 bipedal edema
• Bibasilar crackles upon auscultation

The doctor initially ordered furosemide 20 mg ampule TIV every 8 hours and the following laboratory tests: Complete Blood Count (CBC), Serum Sodium, Serum Potassium, Blood Urea Nitrogen, Serum Creatinine, Total Protein, and Chest X-ray.

1. Write down three (3) prioritynursing diagnoses for the patient and create a hypothetical FDAR.
2. What laboratory test may give the hint to the doctor about the oncotic pressure of the patient?
3. Create a drug study for FUROSEMIDE specifying the following:
   1. Drug classification
   2. Mechanism ofaction
   3. Indication (*for the case of the patient mentioned above)
   4. Contraindication
   5. Side effects
   6. Nursing Considerations

2. HYPOVOLEMIA

A teenage patient was rushed to the emergency department due to wrist laceration from a suicide attempt. The patient is lethargic and have the following findings upon assessment:

• BP –80/50 mm Hg
• HR –110 bpm
• RR –25 bpm

The doctor initially ordered fluid resuscitation with PNSS 1L, to fast-drip 200 cc then the remaining fluid to run for 6 hours. Stat blood typing was ordered, and 3 units of whole blood was ordered to be transfused immediately after proper cross-matching. The patient was hooked to oxygen 8 liters per minute via face mask.

1. What parameters will the nurse check while the patient is undergoing rapid fluid resuscitation?
2. For a patient who will undergo blood transfusion, enumerate the steps that the nurse should prudently undertake while performing the procedure.
3. List down three (3) priority nursing diagnoses for the patient and create a hypothetical FDAR.

3.THIRD SPACE EDEMA

A patient with portal hypertension secondary to chronic liver cirrhosis was admitted in the surgical ward. The patient presented with emaciated body build, distended abdomen with prominent veins, and jaundice. The doctor ordered paracentesis and the following laboratory tests prior the procedure: Prothrombin time (PT), Activated Partial Thromboplastin Time (APTT), Total Protein, Albumin-Globulin ratio, AST, ALT.

1. List down two (2) nursing diagnoses and create a hypothetical FDAR for the patient.
2. Why is there a need to check the PT and APTT levels of the patient prior paracentesis?
3. What is the rationale behind the order of checking the Total Protein, Albumin-Globulin ratio?
4. Enumerate the following regarding the nursing role in assisting with paracentesis:

• Position of choice
• Site of insertion
• At least three (3) nursing considerations.

Case Scenario: Your patient, a 70-year-old male recently admitted to the hospital, has a pCO₂ of 64, pO₂ of 69, and pH of 7.4. He is short of breath and has rattles in the bases of both lungs.

1. Question: Give an admitting diagnosis based on blood gases. Defend your answer using specific facts, data, and other information drawn from the textbook and at least one other supplemental source.

Describe the steps of preparing a sterile field and applying sterile gloves. While preparing a sterile field, you noticed that one of the necessary equipment is touching the drape 0.5 inches from the border of the drape. What would you do next and why?

Discuss ways that nursing informatics could be applied to all areas of professional nursing practice, including clinical practice, administration, education, and research. Provide examples of each. What do you see as the biggest significance of nursing informatics, and why?

Nursing Research for Evidence-Based Practice

chapter - 1 Connection Between Research and Evidence-Based Practice

1. What is the difference between EBP vs EBR?
2. What are some influential factors on EBP?
3. Define research.
4. How do these play a role in EBP: nursing confirmation, nursing expertise, decision-making process, and holistic patient care.
5. Describe quantitative and qualitative research.
6. What is the significance of generating evidence, provide some examples where EBR has impacted nursing practice.
7. What are some possible obstacles that are found in nursing research, please explain?

What client assessments are imperative for an individual taking corticotropin therapy who is also taking digitalis and an oral Glucophage?What client assessments are imperative for an individual taking corticotropin therapy who is also taking digitalis and an oral Glucophage?

85-year-old female diagnosed with ovarian cancer 5 years ago. She was treated with surgery and chemotherapy. Surgical treatment included bilateral salpingo-oophorectomy and total abdominal hysterectomy. At that time, the clientwas found to be BRCA1 positive. She declined any prophylactic surgery or treatment. She was subsequently diagnosed with breast cancer 18 months ago and underwent a lumpectomy of the right breast, followed by chemotherapy and radiation. Two months ago, she was diagnosed with Stage IV metastatic disease in her bones, brain, and liver. Question 1. What is the priority in caring for Amira Quintona? What are two nursing interventions you can utilize when caring for her, please provide the rationale. Question 2? You hear a nurse talking about “Death Rattle.” What is this, and what is the significance of it in a patient who is in hospice care? 3. Describe the ethical and legal issues of advanced directives including the role and responsibilities of the healthcare surrogate decision-maker. 4. Discuss the nursing management of the client-family unit at end-of-life. 5. Based on what you’ve learned about the nursing process, describe one applicable nursing diagnosis, treatments and nursing considerations for this diagnosis

Discussion Topic

Maya Korrapati was diagnosed with T1DM when she was 7 years old, and her appetite suddenly soared.
“She was a skinny little thing,” her mother says, “even though she kept eating and eating and eating. She had six hot dogs one day at a neighbor’s backyard barbecue, and I was so embarrassed. I asked my neighbor, ‘Why didn’t you stop her?’ but they all thought it was cute. It was then that I noticed she was constantly running into the kitchen all day for a drink. I just thought at first it was because—hey, you know—it was summer, after all, and Maya was a very, very active little girl. It was my sister who finally said, ‘Maybe you should just get that checked out. You know why.’ I guess up until then, I was in a kind of denial. So I took her, and, of course, she was diagnosed with T1DM.”

When Maya was first diagnosed, her mother was given instructions on how to administer conventional insulin therapy. Now, however, Maya is starting her freshman year of high school, and she is requesting a switch to an intensive insulin therapy regimen.

“I’ll be in school all day and going to after-school activities. I’m on the girls’ soccer team and I am determined to make varsity by my sophomore year. So, my eating is going to be kind of weird.”

Her mother clicks her tongue in frustration at this, and the two exchange unhappy looks.

After a pause, her mother says, “I think Maya’s anorexic.”

“What? No! Stop it, Mom. You’re embarrassing me.”

“I’m concerned,” Mrs. Korrapati says.

1. Now that Maya is gaining a little more independence and is spending a little more time away from home, she wants to switch her insulin regimen. What might be her rationale for this? Do you think switching her regimen is a good idea?

2. Mrs. Korrapati suspects that Maya may have an eating disorder. What kinds of signs might the nurse look for to determine whether this is the case?

3. Mrs. Korrapati reports that she and Maya frequently argue about Maya’s involvement in team sports.
“I’d feel better if she’d switch to art or playing a musical instrument. Of all the extracurricular activities you could have chosen,” she says to Maya, “why go with sports when you know you have diabetes?”
Maya becomes resistant when her mother talks like this.

She responds now, “It’s not a death knell, Mom, and I’m good. I want to make varsity and then work for a scholarship. Don’t you always talk about wanting me to get a good scholarship?”

“Not if it makes you sick,” her mother says.

Her mother has to admit that Maya has always been pretty healthy, despite her T1DM; and as far as anyone can tell, she has been responsible about diet, maintaining good blood glucose levels, and managing self-administration. Based on these facts, how should the nurse advise Maya and her mother?

Question: How can data collection for diseases be improved? What tools do we need? What are medical intelligence and syndromic surveillance, and how are they used or how could they be used?

Informatics History, Theory, Concepts & Competencies

Definitions:

• Informatics history, theory, and concepts

• Need for Healthcare Data Management

• Computer literacy vs. information literacy

• Informatics competencies and continuous education

• Knowledge management and transformation

• Informatics and nursing workflow