History of Present Problem:

Harper Anderson is a 5-month-old female who was brought into the physician’s office for diarrhea and vomiting over the past two days. She had two loose large loose stools the first day and now her mother reports that she has been less active, is not interested in playing, and has been more sleepy today. She is unable to keep any feedings down today. She has had four loose, watery stools and emesis x3 this morning. She has not had a wet diaper since yesterday evening. She is 25 inches (63.5 cm) in length and weighs 14 pounds, 2 ounces (6.4 kg). She weighed 15 pounds, 2 ounces (6.86 kg) at her last office visit two weeks ago. Harper is a direct admit to the pediatric unit where you are the nurse responsible for her care.

Personal/Social History:

Harper’s mother Nicole is 21 years old. She is a single mother and this is her first child. Nicole is not currently working and lives with her parents. Though she has strong social support from her parents, she feels consistently overwhelmed as a new mother.

Past Medical History (PMH):

• Healthy full-term infant that weighed 6 pounds 10 ounces (3.0 kg) at birth.
• No current health problems. Mom is no longer breast feeding and Harper is on formula.
• Mother had no complications with pregnancy.
• Has not had any immunizations from birth, including rotavirus

1.What psychosocial/holistic care PRIORITIES need to be addressed for this patient? with dehydration and vomitting in a child

(Psychosocial Integrity/Basic Care and Comfort)  

2.What educational/discharge priorities need to be addressed to promote health and wellness for this patient and/or family? (Health Promotion and Maintenance

Can I determine the steps for an individualized plan of care?

Can I determine the importance of culture in my nursing practice?

How can we as nurses maintain good outcomes such as early discharge for your patients?

Can I determine the importance and examples of collaborative practice model?

Can I define Maslow’s Hierarchy of Needs concepts? And the meaning

Can I define jurisdiction for my nursing practice? Scope of practice

Can I determine the importance of my patient’s culture when creating educational interventions?

Can I determine which factors the nurse needs to understand when planning care for his/her patient? Health

Can I determine how to properly educate elderly patients on performing daily wound care? steps

Can I determine the priority nursing diagnoses for my patient?

Can I determine my nursing actions when working in a community health clinic to promote health promotion?

Can I determine the importance of evidenced-based practice when conducting quality improvement programs?

Can I determine my priority when admitting new patients to my unit? My first nursing action-

Can I determine the important factors that should be included when planning the provision for health care system?

Can I determine the different activities that are included when conducting health promotion for our communities? smoking

Can I determine the importance of culture when educating my patient about their medical condition?

Can I determine who need to be included when educating patients about his/her illness?

Can I speak to which activities that demonstrate health promotion teaching for your community?

Can I determine what information need to be included when educating my patients about their medical conditions?

Can I determine the importance of return demonstration when educating my patients?

Can I determine proper assessment for my patient who has on wrist restraints?

Can I state the principles of health promotion?

Can I determine the importance of keeping my patient’s linen dry?

Can I determine my actions to reduce infection when bathing my patient? steps

Can I explain to my patient the importance and rationale for oral care?

Can I explain and demonstrate proper steps for patient transfer technique?

Can I explain to my patient how to use his/her crutches? Walk, sitting, stairs

Can I speak to proper steps for handwashing?

Can I explain how to put on and remove my personal protective equipment in the correct order? Separate and both for DOFF- Different Isolations and PPE required for each

Can I speak to my assessment and possible findings for patients who have wrist restraints intact?

Can I recognize when my patient is ready to be educated about new information?

Can I speak to the importance of return demonstration?

Can I speak to proper transfer for my patient with weak legs?

Can I define healthcare associated infection?

Can I determine x-ray transportation procedure for my patient who is in airborne isolation?

Can I speak to if nursing staff or students have problems with patient’s visiting policy for my medical unit?

Can I determine the steps prior to performing my patient’s dressing change?

Can I apply sterile gloves without contaminating following the correct steps?

Can I recognize when my patient needs a social worker consult?

Can I perform oral care on my unconscious patient?

Can I determine my nursing actions if my patient falls?

Can I speak to the rationale for handwashing?

Can I recognize patient’s ethical dilemmas on my nursing unit?

Can I perform proper denture care? cleaning

Can I recognize when I need to fill out fall risks assessment for my patient?

Can I recognize when my patient’s IV catheter needs to be removed after my assessment?

Can I determine the correct steps for placing my patient in his/her wheelchair?

Can I determine the importance of my patient’s gait belt and when to use?

Can I state the different phases of the nurse-client relationship?

impact on the health of our population and our communities is critical for health care and human service professionals in the field. To prepare for and complete this discussion forum: Find a peer reviewed journal article that addresses health disparities or disparities in health outcomes of a particular health condition/concern (i.e., obesity, breast cancer, high blood pressure, infant mortality, etc.). A quick search of the library databases using, for example, the keywords Health Disparities in Breast Cancer, will produce a wealth of information from which to choose your article. Second, in a post of a minimum of 150 words, give a brief overview of the article and discuss what you think the most important take home point is. Try to pinpoint the underlying causes of the disparity and how it is impacting the health of minority or vulnerable populations. Do NOT simply read and paste the abstract. Read the entire article as I may ask you specific questions about it in the forum. Please check to make sure that you are not duplicating another student’s article in the forum.

Article:http://eds.a.ebscohost.com/eds/detail/detail?vid=0&sid=4af59021-2f97-4d96-b414-50518a33ff20%40sessionmgr4006&bdata=JkF1dGhUeXBlPXNoaWImc2l0ZT1lZHMtbGl2ZQ%3d%3d#db=edselp&AN=S000296102030266X

This case involves two people. Both have been admitted to subacute cares units following stays in an acute hospital. However, they are different in many ways. As is the type of care they receive. They are used here to demonstrate some of the differences in the segment of the continuum known as subacute care.

David is 17 years old. He was injured in an automobile accident several months ago. Suffering multiple fractures and some internal injuries, he has been in a hospital for several weeks. While his initial injuries have largely healed, with the help of several operations, he still faces a long, difficult period of rehabilitation. It is for that rehabilitation, as well as monitoring of his overall conditions that he has been transferred to a subacute care unit.

Joyce is 67 years old. She has a long history of heart trouble and was admitted to the hospital following her last massive heart attack. That attack, coming on top of her already weakened heart condition, has left her in a semicomatose state. Her breathing is assisted by a mechanical ventilator, and she must be fed and medicated intravenously.

The subacute unit to which David was sent is known as a general subacute unit. It is operated by, and in conjunction with, a multilevel nursing facility. Joyce, on the other hand, was admitted to a chronic subacute care unit, operated by the hospital from which she was transferred. The difference between the two units is primarily the conditions they mostly treat and the kinds of staff and equipment needed to do what they each do best.

Both of them began their journey through subacute care with an assessment by multidisciplinary teams from the subacute units to which they were being transferred. Those assessments identified physical, medical, and mental conditions and developed individual care plans designed to best achieve the outcome goals identified for them. Because David appeared to be in need of physical rehabilitation, his assessment team was heavily weighted with therapists of one type or another, while Joyce’s assessment team was much more nursing oriented.

David’s outcome goal is to be able to return to his home and eventually back to school. The assessment team estimates that he will regain nearly all if not all of his previous functional independence. To achieve that, he requires intensive rehabilitation, including physical and occupational therapy. His care team is headed by a physiatrist and will focus on those therapies, although his medical condition will be watched.

Joyce’s prognosis is not nearly as bright. The team assessing her agreed that she unlikely to ever improve and sets a goal of maintaining her condition as well as possible until her death, something that is not likely to be that far distant. She does not need rehabilitation, although staff is the unit do some maintenance range-of-motion exercises with her to keep her physical condition from deteriorating. She does, however, require much more intensive nursing care and monitoring than does David and will be cared for under the watchful eye of a cardiologist.

Another difference, based on expected outcomes, is that David will receive close follow-up care after he is discharged to his home. He will probably continue some of his therapy on an outpatient basis and will be tested periodically to make sure he has not regressed in his quest for functional independence. Joyce, unfortunately, will not have that option.

While the probable results of their subacute care are expected to be so different, Joyce and David have a common reason for being transferred to those units. Their care needs are too high for them to be treated at lower levels, such as nursing facilities or at home. Yet, they do not need acute hospital care. A secondary, but very important, factor contributing to those transfers is the cost of care. David is covered by a managed care plan to which his parents belong. Joyce is eligible for Medicare. Both reimbursement sources want to give then them the best care they can, but at the lowest possible cost.

Thus, these two people in such different situations both find themselves in subacute units, between hospital and nursing facility care levels. It is a kind of care that suits them both well. Until only a few years ago, David would have stayed in the hospital for many months, at an unnecessarily high cost. Joyce might have remained in the hospital also, but because she was unconscious and was going to die prematurely due to her condition, it is more than likely that she would have ended up in a nursing facility unprepared to provide her with the care she needed.

Questions:

1a. What is a physiatrist? 1b. A cardiologist?

2. Is either patient a candidate for a living will or advanced directives? Who? and Why?

3. How can subacute care meet the needs of such different patients as David and Joyce?

4. Should both be included in a single care category, or should different levels of care be created for them?

5. In your opinion, is subacute care really a response to patient needs, or is it a way of increasing financing for providers?

Case Study 4 #Think Before You Post

Leadership In a Changing Healthcare Environment

Bernard J. Healey

The CEO of healthcare system X. Marcus Williams, is faced with declin­ing revenues, decreases in quality of care, and the departure of several key leaders. He feels the entire workforce has become reluctant to use its individual creativity In the design of innovations that are so neces­sary in the changing environment the organization faces. Williams has taken several leadership courses and done a fair amount of reading about leadership and its role in getting an organization prepared to respond to extreme change. From these readings. Williams has come to believe he must get his entire workforce involved in Innovation to improve the healthcare facilities' finances along with the quality of services delivered to consumers.

Williams starts this process by holding a meeting with two of the system's vice presidents. Gloria Adams and Shawn McGroarty. The pur­pose of the meeting is for the CEO to explain the importance of getting everyone working together to design a creative approach to solving the system's current problems. Williams asks the vice presidents to survey their managers about their interest in participating in focus groups regarding the financial and quality issues and the development of some potential solutions. It seems that every sector of the healthcare industry Is being disrupted by start-up businesses seeking to make a profit from the enormous change occurring in healthcare services delivery. In fact. much of the current research supports the notion that if you are not Innovating, you are likely not going to be a viable busi­ness in the long-term.

One of the most difficult areas of concern for leaders In healthcare today is to get their facilities and employees to understand the need for change In the way they do business. Over the next few years, almost every aspect of the delivery of healthcare services is likely to change. Most individuals fear change and do not understand why healthcare organizations have a need to change. Despite the desire by organizations and employees to resist change, a tremendous amount of evidence suggests that the pace of change in the healthcare envi­ronment is already accelerating rapidly. These changes in healthcare delivery will require empowered and motivated employees capable of delivering superior services on a daily basis.

1. What are some additional concerns that the CEO should express to his vice presidents at the first meeting regarding the current problems being faced by the healthcare organization?
2. Would a leadership training program be helpful for all the employees of this healthcare organization to spur them to innovate? What areas of training should be included If such a program were offered to staff?

A group of nursing students is sitting in the cafeteria between classes. Nearby, a group of education students discusses how the field of education is a true profession as opposed to nursing, which one of the students describes as a field in which "nurses think just because they say they're professionals, they automatically become professionals." One of the other students adds, "Nurses work shifts, they are paid on an hourly basis, they can't decide on the level of education for entry, and they have an organization for everything. How does that make nursing a profession?" The nursing students discuss how to address the issue in a constructive manner. During the conversation, one of the nursing students questions the professionalism of nursing, asking, "Is that true? Is that how the public views nursing? Do they see us as a group that can't make up our minds or that we are just fooling ourselves about being a profession?"

1. Create an argument for nursing as a profession based on Pavalko's eight dimensions for describing a profession.
2. Why would having multiple types and areas of nursing organizations benefit the nursing profession? Does it help or hinder the profession?
3. How could the nursing students explain how nursing organizations further nursing as a profession?
4. Describe the benefits of obtaining credentials in a chosen specialty. How does this affect professionalism in nursing?

A group of nursing students is sitting in the cafeteria between classes. Nearby, a group of education students discusses how the field of education is a true profession as opposed to nursing, which one of the students describes as a field in which "nurses think just because they say they're professionals, they automatically become professionals." One of the other students adds, "Nurses work shifts, they are paid on an hourly basis, they can't decide on the level of education for entry, and they have an organization for everything. How does that make nursing a profession?" The nursing students discuss how to address the issue in a constructive manner. During the conversation, one of the nursing students questions the professionalism of nursing, asking, "Is that true? Is that how the public views nursing? Do they see us as a group that can't make up our minds or that we are just fooling ourselves about being a profession?"

1. Create an argument for nursing as a profession based on Pavalko's eight dimensions for describing a profession.
2. Why would having multiple types and areas of nursing organizations benefit the nursing profession? Does it help or hinder the profession?
3. How could the nursing students explain how nursing organizations further nursing as a profession?
4. Describe the benefits of obtaining credentials in a chosen specialty. How does this affect professionalism in nursing?

You are asked to evaluate cardiorespiratory fitness for your client in order to create an individualized exercise plan. You do not have access to a metabolic cart to measure VO2 max. Name 2 different ways you can measure max effort. Explain in detail how you will do this. That is, what test will you provide and what 2 measures will you use. Compare and contrast the benefits and cons of each of the 2 measures.

Perform online research to identify 1 healthcare- related app:

• Discuss how this app could impact (positively or negatively) under-served communities.
  • Would you recommend the use of this app to patients in your community? Why or why not?
• Share your experiences with healthcare-related apps and or wearable sensors/devices.
  • Do you use any healthcare related app or wearable device?
    • If yes, what impact does it have on your life
    • If no, why not?
    • Include references

Sheila Baumgarten, PhD, RN has been the director of the medical product line for 20 years. She is also a nurse informaticist and would like to see more use of software for clinical and management analyses. She is responsible for bot acute and post-acute care services, including clinical, diagnostic facilities, and home health services. She has long been challenged by the limited utility of the financial productivity model. She recognizes that some of the resistance of executives has been due to the lack of software applications to collect and sort essential data elements for more comprehensive analysis of multiple data points. The organization recently purchased the ideal software to create a comprehensive clinical productivity system. The nurse executive of the system asked Sheila to lead a team to develop the optimal clinical productivity system. She is excited and also cautious about how to do this work effectively using the current evidence for practice and outcomes and how to be innovative in designing a robust model to address the current challenges. She has decided to start small and selected DRG 89, simple pneumonia and pleurisy, to begin this work. Sheila has identified stakeholders to collaborate with and create the desired model. The following information has been identified by the group as necessary to create a clinical productivity system: Inputs (number of patients with DRG 89 for the past 12 months, hours of care provided to each patient by RNs and nursing assistants, intensity projected needs for patient care [patient acuity] in hours, budgeted hours of care for each patient), outcomes (average actual length of stay, average target length of stay, average cost of care per patient, average HCAHPS score for patients, patient satisfaction with clinical outcomes, number of falls/medication hours/pressure ulcers). The following information was readily available: 200 patients with diagnosis of DRG 89, RNs provided an average of 47 hours to each patient (data extracted from patient acuity system and staffing information), nursing assistants provided an average of 14 hours to each patient, patient intensity hours from the acuity system averaged 65 hours for each patient, budgeted RN and nursing assistant hours for each patient averaged a total of 68 hours for the RNs and nursing assistants, patient satisfaction is 10% lower than the target performance goal, patient falls with injury increased by 10%, and no change in pressure ulcers and medication errors. Case study obtained from D. Weberg and S. Davidson 2021 book leadership for evidence-based innovation page 203-204. This is all the information I have available for this question.

As a team, consider these data and discuss what they mean.

Is this data adequate for new clinical productivity system?

What actions would you take, knowing that the hours used were below both the acuity and budgeted hours?

Canine Patient weight 3kg Drug Robenacoxib 6mg Prescribed 0.5mg The concentration is 1mg/kg PO q 24hr for 3 days what are the calculations for the drug and total amount dispensed ?/Show all math, Next, Patient weight 4 kg, Drug Oclacitnib tab 3.6, Dose prescribed 1.1 mg, Concentration 1mg/kg 24hr. How much in total is the drug dispensed? Next Patient weight 8kg Drug Amatadine tab 100mg

Prescribed 0.2 mg q 12hrs till finished Concentration 3-5 mg/kg/ Next patient 4kg Drug Ciclosporin Prescribed dose 7mg/ml Concentration 100mg/ml How much total dispensed, / Next Patient weight 10kgPrescription Zonisamidie Prescribed 1 mg q 12 hr / Concentration 3-5 mg kg q 12hr How much in total dispensed SHpw calculations for all patient and the correlating drugs prescribed I need the calculations for the medication that is listed for each canine patient along with how many pills/ liquid was dispensed according to each prescription Ex pt weight is given to dose the medication

A 19-year-old woman presents with a burning sensation when urinating and a feeling of urgency to use the restroom every few minutes. The nurse practitioner sends you into the room to obtain a sample.

a. What would you say to the patient? b. How would you handle the specimen? c. What tests are you going to run? d. After you run the tests and are filling out the results form to hand to the doctor, you notice something awry. The sample is now unacceptable and can’t be used. What could have happened?