Question 5: You are caring for a new mother with her newborn. She is of Hispanic descent. Please discuss what transcultural nursing care is. Discuss the difference between cultural competence, awareness and diversity when providing nursing care to this mother. Please do not just copy definitions.

1. Compare and contrast the social organization of Songhai and the Mali empire. You answer should include a description of the social structures of each civilization and where they overlapped or not

• The roles different people played in society
• General social relations
• The effects the social organization had on the political structure of each of the two empires

Medication Assisted Therapy (MAT) Case Presentation

A 21-year-old Caucasian male presents to the outpatient detoxification and rehabilitation facility, for opioid detoxification. For the past two weeks, this patient has being using 15 bags of heroin intravenously. According to the patient, the main reason for his seeking medical attention is to avoid going to jail. The patient has a history of law violations and has been monitored by a probation officer once a week. The probation officer worked with the patient and his family to arrange the probation treatment program instead of jail. The patient voluntarily agreed to be evaluated for admission to the outpatient treatment facility.

History

Mr. W is a 21-year-old single male who was referred for treatment by his probation officer. Mr. W is currently unemployed, and lives with his friends in a different location each day because his relationship with his family deteriorated due to addiction, he is no longer welcomed in the family house. According to Mr. W, he is not homeless “I always find a place to crash for a night”. Mr. W states that he has been using marijuana from age 15 but it is not his drug of choice any longer. He was introduced to heroin by his best friend about five year’s age during very stressful times in his undergraduate school. He states that his parents and two sisters are aware of his addiction problems and do not support him at all. However, his grandmother understands him more than anyone, and supports him financially in order to prevent him from stealing. Mr. W states that “If you do not admit me today, I will go and get high, and I do not care what happens to me after.”

History of present illness

Mr. W presents for opioid detoxification and rehabilitation. He has no past medical history or any hospitalizations for medical conditions. However, he states that he was found unconscious by his mother in August 2016, and was hospitalized at Hospital due to a heroin overdose. He left the hospital against medical advice after two days of admission. He denies any history of head injury, trauma, asthma, hypertension, diabetes mellitus, or seizures. He is not on any prescribed medications. In addition, he denies any history of food, drug or latex allergies. Mr. W also denies any surgical history.

Psychiatric history

Mr. reports that he has struggled with severe anxiety and mild depression from an early adolescent age. He stated that he cannot remember the time when he was free of anxiety without using some kind of drugs. According to the patient, he was never hospitalized for anxiety or depression. However, he states that he did have suicidal ideations in the past, but not suicidal attempts. He denies any history of self-inflicted cuts or injuries. He has been prescribed benzodiazepine (Xanax) a medication for anxiety and seroquel, antipsychotic (an atypical type for depression, but stopped taking both medications two years ago. “I am not crazy and don’t want to be hooked on it.” Currently he is not under either a psychologist’s or psychiatrist’s care and does not take any psychiatric medication.

Review of systems

Mr. W reports that he was not feeling well, because he took his last bag of heroin at five in the morning. He denied recent visual changes, eye pain, discharge or inflammation. Denies a history of shortness of breath, wheezing, chest pain, or chest palpitations or arrhythmia. Mr. W states that he is very nauseous and had diarrhea in the morning, but denies abdominal pain. Mr. W is very restless, states that he has pain in his back, rated five out of 10 and just feels uncomfortable sitting in the chair although he denies a history of joint disease. Denies skin rash, moles, or changes in skin pigmentation. Denies any urinary incontinence, urgency or frequency. However, he states that his appetite has decreased during the past year and has been constipated for the past week. Denies use of any over-the-counter medications for his constipation.

Physical Assessment

Well-developed and nourished, slightly disheveled White male. Patient is alert and oriented to person, place, time and situation. Easily irritable, angry and very talkative. Vital signs are: BP 130/88 (left arm, sitting position) HR 104 RR 22 Temp. 98.8 Fahrenheit. Normocephalic, atraumatic, short hair and symmetric flushed face. Eyes: pupils are constricted bilateral, round, reactive to light and accommodation, sclera is red and teary. Ears with normal ear canal and tympanic membrane. Runny nose no erythema of nostrils and normal septum. Dry oral mucous membranes, poor dentations, and missing back tooth. Neck supple with midline trachea and no lymphadenopathy or jugular vein distention. Heart rate is regular but mild tachycardia (104), no murmurs, rubs or gallops, bilateral dorsalis pedis pulses 2+. Anterior and posterior lungs sounds are clear to auscultation bilateral, no wheezing, crackles or rhonchi. Bilateral upper extremities with multiple tattoos and fresh needle track marks in the antecubital area and popliteal space in the lower extremities. Bilateral hand tremors with extended arms, no edema noted on upper or lower extremities. Bilateral feet with dry, cracking and peeling skin, patient states that it is very itch at times. Bilateral toenails and fingernails with in normal limits, no cyanosis or clubbing of nails noted. In general, Mr. W is able to make his needs clear, however his speech is very rapid, and his pupils are constricted/pinpoint (1 mm).

Assignment

1. What diagnostic tests would you order? Provide rationale.

2. What diagnosis will you give this patient? Differentials?

3. Assuming MAT with Suboxone to be the treatment modality, describe the sequence of treatment for this patient.

4. What are the concerns with initiating Suboxone treatment for this patient?

5. How will you address his psychiatric care along with the MAT? What medications might you consider for any psychiatric conditions? Provide rationale.

What complementary and alternative approaches to health have you tried? What influenced your decision to use those approaches?

Question 1 (5 marks, 1 each)

Therapeutic communication includes five levels: interpersonal communication, transpersonal communication, small-group communication, intrapersonal communication and public communication.

Define these levels.

Question 2 (5 marks, 0.5 each)

The HCP might employ different techniques to establish a relationship with the patient. The selection of the technique depends heavily on the purpose of collaboration and the ability of the patient to communicate verbally. Therapeutic communication helps patients to trust and relax, while non-therapeutic communication causes patients to feel uncomfortable and untrusting and builds walls barring communication between caregiver and patient.

Classify the following techniques into therapeutic or non-therapeutic communication techniques.

• Paraphrasing.

•Asking personal questions.

• Giving personal opinions.

• Providing information.

• Focusing.

• Asking relevant questions.

• Defensive responses.

• Self disclosing.

• Passive or aggressive responses.

• Arguing.

Question 3 (5 marks, 1 each)

Alberto Mendez, a 46 year old man with a family history of heart disease, has shown up 30 minutes late for a routine physical examination. Mr. Mendez does not speak English, but he has brought his 15 year old daughter with him to serve as interpreter. After his arrival in the office and before his being shown into the examination room, the front desk receptionist explains to you that he is late because his car was rear-ended by another car. When you walk to the examination room to interview and prepare Mr. Mendez for his visit with his physician, you sense immediately that he is upset. Your responsibilities are to take his signs, pulse, temperature, blood pressure, respiratory rate.

Based on this scenario, discuss five factors that may act as barriers and impair the communication process.

Question 5 (5 marks, 1 each)

Describe the interpersonal skills that are essential for successful healthcare professional.

How can you improve patient outcomes with evidence-based practice?. Describe at least one situation in which you applied evidence-based nursing practice. Identify how and where you found the evidence-based guidelines. Explain how your behavior in the situation is different than it would have been without your additional education from this RN to BSN program

Cancer is one of the leading causes of death in both men and women. Caring for the cancer patient and family requires a multidimensional approach.

What does it mean to provide a multidimensional approach? What are some examples of how the care team can meet the patient and the family’s needs? Who are the members of the care team and how are they involved in providing multidimensional care?

Sarah is a 69-year old female that presented to the emergency department with shortness of breath. Her past medical history includes heart failure and COPD. Her pulse oximetry on room air is 82%. You notify the provider, and he orders oxygen at 4 L via nasal canula NC. Sarah’s chest x-ray reveals bilateral pneumonia. Her arterial blood gas result are below:

Sarah is admitted to a general medical floor. You are the nurse assigned to Sarah.

1. What potential problems can occur based on the above findings?
2. How would you provide multidimensional care for Sarah?
3. Describe the roles of other departments in Sarah’s treatment plan.

1. The Institute of Medicine has found the quality of healthcare in the United States to be fairly uniform, the same in all settings.

   1. True
   2. False
2. Question 2

   5 Points

   The major focus for CQI decision making is the collection of data.

   1. True
   2. False
3. Question 3

   5 Points

   Optimizing the delivery of health care and improving outcomes are reasons for using CQI in the US health system.

   1. True
   2. False
4. Question 4

   5 Points

   Hospitals using CQI adopt methods first pioneered by Deming's business model.

   1. True
   2. False
5. Question 5

   5 Points

   The Triple Aim became the Quadruple Aim which was a focus on improving the lives of vendors of healthcare equipment.

   1. True
   2. False
6. Question 6

   5 Points

   One goal of successful CQI is to empower employees so that are motivated to assist in the process.

   1. True
   2. False
7. Question 7

   5 Points

   Recent increased use of CQI in US health care results, in part, from the Affordable Care Act.

   1. True
   2. False
8. Question 8

   5 Points

   PDSA and PDCA are the only acceptable tools to use in the CQI process.

   1. True
   2. False
9. Question 9

   5 Points

   CQI is simultaneously two things: a management philosophy and a management method.

   1. True
   2. False
10. Question 10

    5 Points

    Healthcare Element of CQI includes use of epidemiological and clinical studies (evidence based medicine).

    1. True
    2. False
11. Question 11

    10 Points

    The PDSA cycle is continuous and involves the following steps Blank 1.

    • Blank 1
12. Question 12

    5 Points

    If you want to innovate in the hospital which you manage, you should

    1. A) lead by dictate.

    2. B) increase staff pay.

    3. C) institute extensive patient surveys.

    4. D) lead by example.

13. Question 13

    5 Points

    The culture of excellence which CQI aims to foster resembles a

    1. A) culture of achievement.

    2. B) safety culture.

    3. C) culture of enrichment.

    4. D) quality culture.

14. Question 14

    5 Points

    The _______________ definition of quality of care is “the extent to which health care services provided to individuals and patient populations improve desired health outcomes.

    1. WHO

    2. IHI

    3. AHRQ

    4. IOM

15. Question 15

    5 Points

    The Structural Elements of CQI include

    1. a. Use of process improvement teams

    2. b. Use of CQI tools

    3. c.Creation of parallel organization (Quality Council) to monitor CQI

    4. d.Gain commitment from top management

    5. all of the above

    6. only a and b

16. Question 16

    5 Points

    Philosophical Elements of CQI include

    1. Involves a Strategic Focus

    2. Customer Focus

    3. Systems View

    4. Data-driven

       (evidence-based) Analysis

    5. all of the above

    6. none of the above

17. Question 17

    5 Points

    _________________________focuses on conformance quality, which is defined as “conforming to specifications; having a product or service that meets predefined standards”

    1. Total Quality Management

    2. Quality Assurance(QA)

    3. Continuous Quality Improvement

    4. None of above

18. Question 18

    5 Points

    _______________is defined as a structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations.

    1. CQI(Continuous Quality Improvement)

    2. Total Quality Management

    3. Quality Assurance(QA)

    4. Non of above

19. Question 19

    5 Points

    Poor quality care has an impact on

    1. a. patients

    2. b. services which provide care

    3. c. society at large

    4. d. all of above

    5. e. only a

Case Presentation:

            Mr. J, a 65-year-old married man, presented at the emergency room in acute respiratory distress. He was anxious, alert, and gasping for air. His shortness of breath made talking with him difficult. He was accompanied by his wife and nephew.

            Mr. J was fairly well known at this hospital because he had been treated there for almost a decade for his chronic pulmonary disease. His illness progressed over the years to the point where he required assistance dressing and eating, and this assistance was provided by his wife, who cared for him at home. Mr. J had been admitted to the hospital ten months before, at which time he was intubated and placed on a respirator. Later, there was great difficulty weaning the patient from the machine, but the pulmonologist managed to do so after two weeks. According to the family, Mr. J expressed strong feelings at that time that he should never be placed on a ventilator again.

            During the current presentation, Mrs. J and her nephew spoke with the attending physician in the Emergency Department while Mr. J was taken to the treatment room. They explained what they believed to be the patient’s wishes. That is, they asked that Mr. J be given any helpful medications but not be intubated. They also asked that his code status be “do not resuscitate.” The family said the Mr. J should be made “comfortable” and that necessary medications could be given to him.

            The family did not enter the treatment room with the physician. The physician examined the patient, and in the presence of the nursing staff and respiratory therapists, the physician explained the need for intubation to Mr. J, who agreed to this by nodding his head “yes.” This process took place quickly due to the emergency conditions. Mr. J was intubated and placed on a ventilator within ten minutes of admission. Upon learning of the intubation, the family became very upset.

1. Case Question: In one or two sentences, what is the problem and what is the decision to be made?

2. Parties involved and positions: List the parties to the conflict/discussion/consultation and describe their positions in the discussion. (What do they want or not want to be done?)
   1. Patient:
   2. Family members:
   3. Medical team members:

3. Ethical issues: What are the ethical issues involved in the case and what are the positions of the various parties? List ethical principles in conflict or theories of interest.

4. Options available: What are the options available to the parties and what are the potential outcomes of each option?

5. Principle priority: Given all of the facts of the case, the principles/theories involved and the potential outcomes for the parties, which principle and/or theory should take precedence in this case? Why?

6. Case analysis: Although it is virtually never the job of the ethics consultant to decide what to do, for these case analyses, you are asked to state what you see as the preferred option for the parties in this case. What do you think should be done and why?

Briefly describe a method you would use to identify your personal performance in the workplace in terms of feedback from others (in 30-50 words each).

Briefly describe a method you would use to identify your personal performance in the workplace in terms of self-assessment (in 30-50 words each).

Identify the four (4) factors that may affect the achievement of your work objectives.

Discuss the disease process of nephrotic syndrome, acute kidney disease, and chronic kidney disease. What nutrients should the patient include and exclude in their diet plan to avoid further kidney damage? Use evidence from one scholarly source other than your textbook or ATI book to support your answer. Use APA Style to cite your source. PLEASE TYPE.