For this discussion, consider the ways in which technology and informatics are used to support evidence-based practice. Please address each of the following questions in your discussion response for this week: Choose a specific evidence-based practice (examples: CAUTI reduction, sepsis protocol, SCIP protocol, bedside shift report, etc.). Describe how technology and informatics are used to support the interventions used in practice? Describe how employing evidence-based practice guidelines improves patient outcomes? What benefits and challenges have you experienced with (the integration of) information technology in your practice? What strategies did you, or could you, use to overcome these challenges?

a nurse is reviewing mobility with the family of a client who is quadriplegic. which of the following statements should the nurse include in the teaching?

a. "place their feet against the footboard of the bed to prevent foot drop."
b. "perform active range of motions exercises daily."
c. "change your family members position every 6 hours."
d. "apply and remove splints every 2 hours."

a nurse at a community clinic is preparing an educational guide about cultural variances in expression of pain. which of the following information should the nurse include?

a. native American cultural practices include being outspoken about pain.
b. Puerto Rican cultural practices include the view that outspoken expression of pain are shameful
c. middle eastern cultural practices include hiding pain from close family members
d. Chinese cultural practices include enduring pain to prevent family dishonor

Chapter 46 Acute Kidney Injury Disease

Acute Kidney Injury

Patient Profile

A.S. is a 70-year-old white woman who presented to the emergency department because of a 4-day history of increased shortness of breath and generalized weakness. A.S. stated that she has been able to do her daily chores at home independently, but for the past few days, it was getting difficult for her to get around and that she needed to take frequent breaks because she was short of breath and had no energy. She has a long history of heart failure, type 2 diabetes, and hypertension. She is admitted with a tentative diagnosis of acute kidney injury (AKI).

Subjective Data

• Has been having headaches on and off, with nausea and dizziness
• Reported that she had not been taking her medications regularly at home because of “forgetfulness”
• Has not been urinating a lot
• Feels “puffy” in her legs and hands

Objective Data

Physical Examination

• Blood pressure 178/96, pulse 110, temperature 98.9°F, respirations 24, and an oxygenation of 93% on room air
• Alert and oriented to person, place, and time
• Mild jugular venous distention
• Fine crackles in bilateral lower lobes
• Heart rate regular, no murmurs
• Bowel sounds normoactive and present in all four quadrants
• 2+ edema bilateral lower extremities and hands

Diagnostic Studies

• Echocardiogram shows decreased left ventricular function
• Urinalysis: Urine dark yellow and cloudy, protein 28 mg/dL, negative for glucose and ketones, positive for casts, red blood cells and white blood cells
• 24-hour urine output = 380 mL
• Laboratory Tests:

Case Study Questions

• 1. A.S. has to have a 24-hour urine collection performed, as she is not urinating a lot. Describe in steps the collection procedure by the nurse.
• 2. What is your interpretation of A.S.'s BUN, Cr, and BNP?

BUN (10 -20 mg/dL)

Cr (<1.2 mg/dL for women <1.4 mg/dL for men)

BNP (<100 pg/mL):

3. Should you be concerned about A.S..'s potassium level of 5.2 meq/L? (Yes/No)

List two treatment types that the health care provider might prescribe if deciding to treat A. S. hyperkalemia.

1.

2.

• 4. Based on A.S.’s presentation, what nursing assessments, interventions, and monitoring skills need to be performed by you the registered nurse? Student must list at least six:
• 5. What orders do you as the nurse, anticipate the physician will order? Student must list at least six (frequencies not necessary to list; only what you think the physician will order):

6. Explain what might have contributed to A.S.’s present condition as described above? What are two evidence-based preventive health care provisions/programs that if put in place early might have prevented this from occurring?

Explain what might have contributed to A.S.’s present condition:

Evidence-based Preventive Health Care Provisions/Programs:

1.

2.

7. What is the significance of A.S.’s Hemoglobin, Hematocrit, and RBC levels being significantly decreased?

8. You are planning discharge for A.S. What would you include in your discharge instructions/teachings and what other interdisciplinaries/health professionals would you include? Student must list at least five each:

Nursing Teaching/Instructions                    Other Health Professionals

1.                                                                 1.
2.                                                                 2.
3.                                                                 3.
4.                                                                 4.
5.                                                                 5.

Reference:

Describe what you have learned in the course and what you are looking forward to learn in the future within the program?The program i pick is Allied health mananagement.

Elements of assignment:

• 1-2 Pages (NOT including the cover or reference page)
• 12 Font, Times New Roman
• Double Spaced
• APA format
• Well-thought out commentary

Compare and contrast the four types of diuretics for uses, side effects, precautions, and contraindications. Please make sure you cite your references used in APA format. Thank you

Do you think that a clinician socio-demographic characteristic such as: age, gender, religion, ethnic background, nationality, will have an influence on following or not the clinical practice guidelines?

Mrs. Williams is a 45-year-old Caucasian woman who sought medical attention for fatigue that developed during the previous month. She reported no chest pain, but did feel mildly short of breath with exertion such as after walking up a flight of stairs. She denied any rectal bleeding, but she had heavy menstrual periods for about a year. Her past medical history included being treated for anemia following her third pregnancy 10 years earlier. She was not taking any prescribed medications. Her family history revealed that her parents were born in Italy and died when she was in grade school. She did not know their medical history.

A physical examination revealed that Mrs. Williams’s general appearance was pale but with no acute distress.

Her vital signs were blood pressure 125/90 mm Hg, heart rate 118 beats/min regular, and respirations 26 breaths/min. No significant changes in the blood pressure and heart rate were noted between the supine and upright positions. Other findings included pale conjunctiva and moist mucous membranes without lesions. No adenopathy or hepatosplenomegaly was noted.

Breath sounds were clear to auscultation, and the heart had a regular rate and rhythm with a murmur. The abdomen was soft, nontender, and nondistended.

A rectal examination revealed no masses, and heme-negative brown stool was present. Additionally, Mrs. Williams reported that she was taking aspirin 81 mg daily, she is a vegetarian who eats a lot of cereal, and she did not have an urge to eat ice. Mrs. Williams’s laboratory tests revealed the following results:

CBC = complete blood count; WBC = white blood cells; Hgb = hemoglobin; Hct = hematocrit; RBC = red blood cells; MCV = mean corpuscular volume; MCH = mean corpuscular hemoglobin; MCHC = mean corpuscular hemoglobin concentration; RDW = red cell distribution width;
LDH = lactate dehydrogenase.

1. Which type of hematologic disorder would you suspect based on Mrs. Williams’s history, physical examination, and laboratory values?
   1. Infectious mononucleosis
   2. Iron-deficiency anemia
   3. Pernicious anemia
   4. Thalassemia
2. Which of Mrs. Williams clinical signs are reflective of the body’s effort to compensate for her red blood cells’ decreased oxygen-carrying capacity?
   1. Heart rate 118 beats/min and respiration rate 26 breaths/min
   2. Hematocrit 24% and hemoglobin 8 g/Dl
   3. Blood pressure 125/90
   4. Persistent fatigue

Mrs. Williams was placed on iron supplements. Her hemoglobin (Hgb) was expected to be normal after approximately 8 weeks of iron therapy, which was anticipated to raise the Hgb about 1 g/dL per week. However, her Hgb was 9.5 g/dL after 8 weeks.

Following those results, Mrs. Williams was asked whether she had been taking the iron supplements as ordered and whether she had been tolerating the medication. Additionally, she was asked whether she was having dark, tarry stools, which would indicate gastrointestinal bleeding.

Mrs. Williams reported that she had taken the iron supplement for only 2 weeks because it made her nauseated and constipated. Mrs. Williams was instructed to take the iron supplement with a light carbohydrate such as crackers or toast to minimize the nausea and to take measures to prevent constipation (e.g., increasing fiber and water intake). After implementing these measures and taking the iron supplement as ordered for 8 weeks, Mrs. Williams’s Hgb returned to normal.

3. In addition to iron supplements, which kinds of food would be recommended for Mrs. Williams to consume?
   1. Milk, cheese, soybeans, broccoli, and almonds
   2. Green leafy vegetables and avocados
   3. Orange juice, raisins, bananas, cantaloupe, and fish
   4. Liver, red meat, eggs, dark green leafy vegetables, nuts, and legumes

Define/explain in detail Kurt Lewin change theory, include the advantages and example, relate it to covid19 pandemic. please include the creditable site

Neurology Assignment 1

Bystanders found a 28-year-old, unhelmeted, male prone and unconscious after he had lost control of his motorcycle and went off the road. He was brought to the Emergency Department via ambulance intubated. The physical examination revealed a GCS of 3T, 4 mm bilaterally fixed pupils, negative corneal response, right parietal cephalohematoma, and cerebral spinal fluid (CSF) otorrhea on the right. CT of the head showed subarachnoid hemorrhage with left frontal and temporal subdural haemorrhage, effacement of the suprasellar cistern, and effacement of the 3^rd and 4^th ventricle. He also sustained a frontal base fracture.

1. Briefly explain how TBI is diagnosed.
2. Describe the pathophysiology of traumatic brain injury
3. What are the signs and symptoms associated with TBI?
4. Outline the medical and surgical treatment of TBI
5. Briefly describe three (3) classes of medications used in the treatment of patients suffering from TBI
6. What are the nursing considerations/management for this patient?
7. Develop a plan of care for this patient. Two (2) actual problems and One (1) potential problem.

case study: Patient A is a 30-year-old male was admitted to the hospital from home after 1 week of cough, profuse nocturnal sweating, loss of appetite, and hyposomnia. He was seen by an emergency room physician who noted signs of depression. The patient has a history of intravenous drug abuse and hepatitis B.

Q1. Explain the steps in which the specimen is collected, handled, and how the specimen is analyzed.                      

Q2. Evaluate and explain the patient’s lab results.

Q3. Explain the lab tests and methods that you will carry out and use in order to diagnose the patient.

Q4. Explain how you would determine the acceptability of quality control test result data.

please answer

Surgery Assignment

A 25-year-old female client is being admitted to the postanaesthetic care unit (PACU) following a thyroidectomy for hyperthyroidism. The client had undergone three months of preoperative treatment with antithyroid medications and iodine preparations to establish euthyroid status prior to her surgery. At the client's bedside the nurse has set up a tracheostomy set, endotracheal tube, laryngoscope, and suction equipment. There are ampules of calcium gluconate on hand. The nurse places the client in a semi-Fowler's position and is supporting her head and neck with pillows and sandbags. The nurse frequently checks the client's vital signs and assesses her suture line for strain or bleeding. Once the immediate postoperative period has passed, the client will be transferred to the surgical ward where she will recuperate and learn about lifelong thyroid replacement therapy.

1. Why is it so important for the client to be euthyroid prior to thyroidectomy?
2. Why is it mandatory to have emergency equipment and ampoules of calcium gluconate on hand following thyroidectomy?
3. Why is it important to support the client's head and neck with sandbags and pillows?
4. Develop a plan of care for this patient two (2) actual and two (2) potential

In this case study, Ruth’s previous encounters with mothers of premature infants and her knowledge of the family experience inform her nursing actions. Experienced nurses incorporate much information simultaneously. Notice that Ruth determines that the baby’s physiologic condition is stable while she is beginning to interact with the mother. In this action, she is prioritizing patient safety. While she interacts with the mother, Ruth may interpret Cassandra’s behavior as a pattern sometimes displayed by mothers in the NICU. She understands how frightening it is to have a hospitalized newborn and knows from experience that fear can take on many faces. This may be evidence of Ruth’s intrapersonal characteristics that value empathy and consider the patient experience. Rather than focusing on Cassandra’s negative response to her, Ruth focuses on relationship building before moving on to teaching. This action opens the door to effective teaching. Notice that Ruth takes some time afterward to consider what went well in this challenging situation. This will inform future interactions with mothers of patients.

In what ways could reflection on the action be encouraged as part of nurses’ professional lives?

How do the interpretive and standards-based approaches to clinical judgment compare in relationship with the goal of patient-centered care?