what appropriate techniques that you would use to improve quality of clinical care in the nursing home

thank you

1. How can a public health nurse be involved in disaster preparation? Disaster care?

2. Describe communication challenges in a disaster. What are some solutions?

3. Why does care need to be coordinated in a disaster? What happens when it is not? (Give examples)

Neuro Case Study

Mrs. Greene is a 92-year-old woman who presents to the emergency room with an acute change in mental status and generalized weakness. Her past medical history is unremarkable. She has not had episodes of confusion in the past. Case Study It is determined that Mrs. Greene has a urinary tract infection (UTI) for which she is started on intravenous (IV) levofloxacin (Levaquin). Mrs. Greene’s confusion escalates to visual hallucinations, the pulling out of two IV sites, and restless nights of little sleep. Bilateral soft wrist restraints are prescribed to maintain her safety, the integrity of the IV site, and the Foley catheter. While the nurse is providing care for Mrs. Greene, Mrs. Greene’s son visits. He is very distraught over Mrs. Greene’s state of confusion and her inability to recognize him. Mrs. Greene is unable to answer her son’s questions appropriately and frequently states, “I told you I do not want to cook today.” Visibly upset and tearful, Mr. Greene states, “I don’t understand. She was perfectly normal three days ago. I stopped by to visit and she was outside working in her garden and her conversation with me made perfect sense.”

1. What do you suspect is the reason for Mrs. Greene’s confusion?
2. Would you describe Mrs. Greene’s confusion as delirium or dementia? Provide a rationale for your decision and explain the difference between delirium and dementia.
3. What are three appropriate nursing diagnoses that address Mrs. Greene’s change in mental status?
4. State at least three outcome goals that should be included in the plan of care for Mrs. Greene’s diagnosis of acute confusion
5. Provide five nursing interventions to include in the plan of care for Mrs. Greene’s diagnosis of acute confusion.
6. Briefly discuss strategies that help prevent the need for restraints. List five nursing interventions to include in Mrs. Greene’s plan of care now that she needs bilateral soft wrist restraints for her safety.

1. Explain the reasons why a patient's back type wouldn't match the front type.
2. Explain the reason's and situation where you would have an incompatible crossmatch

What do you think about adult and childhood obesity?  What do you really think is at the “heart” of the weight-loss crisis in America? When you see a 250-pound 10-year-old in public, what do you think? Do you make any assumptions? Do you think the parents are guilty of causing this obesity? If the parents are not guilty, then what are the underlying causes?

What are the local causes of food insecurity in your community, for example in certain population groups, poverty, illness, and disability? If you were invited to speak to your local representatives, what would you recommend to help alleviate the problems of food insecurity and hunger?

1. Effective Interprofessional Communication

Dr. Killbug: Did you see Mrs. Mullins’ urine? That looks pretty bad to me. I wish you had let me know about that urine sooner. Last thing we need is for her to get a UTI and end up back in the hospital again.

Marizze: Actually, I was hoping to talk to you. I noticed that when she was transferred back from the hospital. She now has an indwelling urinary catheter in place. While her urine is cloudy, she is still doing well without any symptoms of an UTI. She does want the catheter out, as it is tugging on her leg. (SITUATION)

Dr. Killbug: Yeah, but she’s probably pretty weak now. Yes, but I’d still like to send a urine culture. Who knows what’s in her urine now? I’m going to put her on Bactrim, once you get that culture.

Marizze: I believe she had an allergic reaction to Bactrim in the past—yep, says here in her chart, “rash.”

Dr. Killbug: Okay, I’ll use Cipro then.

Marizze: I see, but getting back to the catheter, there is no indication provided for it. She has never needed a catheter previously. We are participating in the Long-term care- research /UTI project, and one of the key steps to preventing an UTI is to remove urinary catheters unless they are medically indicated.

Dr. Killbug: Yes, that is a good point you are making. But, how do you think she is doing today?

Marizze: On my assessment, Mrs. Mullins does not meet any of the indications for a catheter, as per the documentation from the hospital, nor does she need further testing of her urine; however, she might be a little dehydrated today, which might account for her cloudy urine.

Dr. Killbug: Great, do you think we should take the catheter out?  

Marizze: Yes, I’d like to remove it and give her a voiding trial. If that’s okay with you, I’ll take it out and let you know how that goes. And let’s hold off on the urine culture and antibiotics. I’ll keep a close eye on her this shift. If anything seems out of the ordinary with her recovery, I’ll call you.

Dr. Killbug: That sounds like a good plan. Where can I get more info about this UTI Long-term care research project?

The practical nurse used SBAR to improve communication with Dr. Killbug. Identify the SBAR elements of Nurse Marizze’s communication using the following prompts. Provide examples of Nurse Marizze’s dialogue:

Discuss the appeal process involved in responding to internal and external audits in healthcare facilities.

Explain the impact of failure to comply with state and federal laws, regulations, and statutes in health care. Be sure to include the doctrine of corporate negligence in your answer. Also, discuss the steps that are employed for ethical decision making in health care, including the four key ethical principles.

Your response must be at least 500 words in length

This week as we continue our discussion on health promotion we will begin to look at health literacy. Health literacy affects everyone we treat. When thinking of health literacy and your current practice or experiences based on the readings and content this week answer the following prompts:

1. Describe an issue where health literacy posed a problem in your practice or experiences-describe this in paragraph format.
2. Provide and describe two evidence-based strategies that can be used to improve a patient's understanding of what "health literacy" is. Support this response with a scholarly source with intext citations and APA formatted reference.

16. The nurse is caring for a patient with cerebral edema and with an order to administer dexamethasone 6.5 mg IVp q6h. How many mL should the nurse prepare to administer if dexamethasone 4mg/mL is available? Round your answer to first decimal place.

17. The nurse receives and order to give Solu-cortef 200mg IM for patient with respiratory infection.

Available is a vial of Solu-Cortef with a direction to add 1.8 mL of sterile water to yeild a solution of 250mg/mL. How many mL should the nurse administer?

18. A nurse is caring for a patient newly diagnosed with tuberculosis. The prescriber ordered to administer the first dose of Streptomycin 0.5g IVP. The pharmacy send Streptomycin with instruction to reconstitute with 9mL of sterile water for a concentration of 400mg / 2mL. How many mL should the nurse prepare to administer? Round your answer to first decimal place.

19. The nurse receives and order to give Solu-cortef 200mg IM for patient with respiratory infection.

Available is a vial of Solu-Cortef with a direction to add 1.8 mL of sterile water to yeild a solution of 250mg/mL. How many mL should the nurse administer?

18.A nurse is caring for a patient newly diagnosed with tuberculosis. The prescriber ordered to administer the first dose of Streptomycin 0.5g IVP. The pharmacy send Streptomycin with instruction to reconstitute with 9mL of sterile water for a concentration of 400mg / 2mL. How many mL should the nurse prepare to administer? Round your answer to first decimal place.

19. The nurse is calculating the patient's intake for the morning meal. What is the total intake in mL?

The patient consumed:

1 box of milk (6oz)

3/4 glass of cranberry juice (1 glass=8 oz)

4 coffee creamer (0.5 oz each)

1 cup coffee (1 cup = 6 oz)

20. The nurse weighs the patient and weighed 250 lb after 2 weeks of dieting. The patients record shows a weight of 285 lbs prior to dieting. What is the percentage of change in the patient's weight?

In Community Health Planning, Can you provide me with several examples of population-level versus program level versus individual level health planning? Thank you

A 50 year old truck driver has been diabetic and has required insulin therapy for the past 20 years. Diabetic neuropathy has led to several complications, including end stage renal disease, which he developed two years ago. He now receives hemodialysis 3 times a week and has an AV fistula in his left forearm. Yesterday, C.S presented in the ER with respiratory infection and was hospitalized with pneumonia, hypertension, and fluid overload. He will receive dialysis while on your nursing unit.

1. What is hemodialysis and name 3 side effects and patient teaching in reference to hemodialysis?

2. What medication therapy is limited by kidneys inability to excrete?

3. What lab values would indicate the kidney is not functioning well?

4. What are the clinical manifestations of end stage renal dialysis (ESRD).  

solidifying concepts.write five things about grief that you didnot know before reading the text