1. Explain how the following factors can affect fecal elimination (having a bowel movement) and explain why? Personal habits, Diet, Fluids, Activity, Medications, Aging, Disability etc.
2. Explore the Personal Support Worker role on the interprofessional team when working with clients with elimination such as providing journals and descriptions. What could you put in the client’s elimination journal or diary?
3. Can the Personal Support Worker administer an enema or suppository? If your answer is no, then explain why not?
4. Discuss the importance of the Personal Support Worker monitoring intake and  output?

what is your preconception on Cultural Learning Reflection?

Case Study- Mobility Adaptive

You have been assigned to care for Mr. Rich Tilly, a 32-year-old admitted to your short-term rehabilitation unit after a lengthy hospitalization following a bike crash that occurred during a triathlon competition. He had sustained a closed head injury resulting in a 14-day coma but is now awake, alert, and oriented. He also had fractures to the right femur and tibia and right radius. The leg fracture sites were stabilized with external fixation devices providing skeletal traction. He has a fiberglass cast on his right arm extending from his hand to his elbow. He can bend the right elbow. He is permitted no weight-bearing on the right leg. Goals of his rehabilitation include reconditioning and independence in mobility and self-care activities.

1. Due to the prolonged recovery from his head injury as well as musculoskeletal compromise, Mr. Tilly is at risk for the hazards of immobility. Discuss the system changes you should be looking for during the admission assessment. Include both a subjective (how would the patient verbalize the problem) and the objective measurements (physical assessment data) of the potential system effects.

Mr. Tilly says to you during your morning assessment, “I just don’t know how I will ever recover from this—I can’t do anything for myself—I am so used to training every single day and now I can’t do anything I would call exercise. How can I get ready for all this rehab work?”

2. What type of exercise should be initiated with Mr. Tilly to regain muscle strength? Why?

3. Mr. Tilly wants to be able to help himself reposition in the bed telling you, “I am either stuck in one spot or sliding down in the bed. I want to be able to move myself instead of asking the staff to help me.” Keeping his injuries and treatment methods (external fixation and casting) in mind, what kind of positioning devices would be appropriate for him to use?

4. Discuss concerns with Mr. Tilly’s external fixator (skeletal traction). What are your priority assessments? How would you care for the site?

After completion of admission protocols the physician writes the following orders:

• OOB to chair for all meals, no weight-bearing to right leg

• May ambulate to bathroom with assistance, instruct in use of walker

4. . Mr. Tilly wants to get out of the bed as soon as possible. You sit him on the side of the bed but he complains of being “woozy and nauseated.” What is happening to him and how will you intervene?

5. How could you have assessed for the potential of this event occurring in this patient?

6. In consideration of the methods available to transfer patients out of bed, which method would be best to implement for Mr. Tilly at this time? Give a rationale for your decision.

7. Discuss the proper body mechanics that are imperative to safe patient care and transfers in any situation.

A week after admission Mr. Tilly is progressing slowly in his rehabilitation. He has verbalized frustration at his inability to ambulate freely. He states, “I just don’t know 264 Unit 4 | Supporting Physiological Functioning 2923_SE_Ch32_261-268 13/01/14 2:06 PM Page 264 if I am ever going to get better and some days don’t even feel like trying.” He has difficulty walking the required distances due to his musculoskeletal impairment and fatigue and has resorted to using a BSC instead of using the bathroom with assistance.

8. Formulate two nursing diagnoses, using a three-part format, that reflect the present issues being experienced by Mr. Tilly.

9. For each nursing diagnosis, identify the most appropriate outcomes for this patient. Develop an individualized goal for each that reflect the uniqueness of Mr. Tilly’s present situation.

10. Formulate three appropriate nursing interventions to facilitate the goals from above that are individualized to Mr. Tilly’s present health status.

11. At the sixth week of his recovery, the cast on his right arm is removed after diagnostic radiology shows that the fracture to the right radius has fully healed. The wrist and hand joints are very stiff and weak, and he is encouraged to move them as much as possible. Describe the aspects of range of motion of those joints that you should teach Mr. Tilly to do to facilitate a full return of function in that extremity.

Wrist:

Hand/Fingers:

12. Gaining strength in the arm has been a positive enforcer for his recovery. He asks you, “Why can’t I have a pair of crutches instead of that walker to help me get around?” Using an SBAR format, how would you address this with the physician?

13. Describe how you would teach Mr. Tilly to use crutches. What are the safety concerns you should address with him in the use of this modality?

research what outbreaks, disease, or pandemics have used the mitigation measure of Contact Tracing. After identifying those three outbreaks, write a three (or more) page paper that describes what type of infection was attempting to be contained, what patients were told to do to prevent the spread (if possible) the country(s) where the contact tracing occurred (for each), and what signs and/or symptoms patients or contacts were told to look for. This should be written using APA formatting

Roy’s Adaptation Model

Your closest friend has been diagnosed with breast cancer. Following surgery and chemotherapy she learned that the cancer has metastasized. She is single and has a daughter who is 6 years old.

Identify her adaptive needs in the physiological adaptive mode. What interventions would you provide?

Consider her possible adaptive needs in the self-concept mode. What possible interventions would you discuss with her?

What would be her needs in the interdependence adaptive mode? What possible interventions would you discuss with her?

Identify her adaptive needs in the role function adaptive mode. List an intervention you could offer to provide.

Mrs. Cass is an 87-year old African American client living in her own home. Her daughter lives nearby and is Mrs. Cass’s primary care giver. Mrs. Cass is a widow but has a few long-time friends who are concerned about her welfare. Due to mobility issues, they have difficulty making trips to visit her, limiting her socialization. She “gets by” financially, as she describes her situation. “I don’t have many needs, but my medication is expensive.”

Mrs. Cass suffers from pain related to bone cancer metastasis. As her nurse, you have been visiting her for several months in her home. You have noticed behaviors consistent with increasing pain. During your current visit, you ask Mrs. Cass to respond to a verbal rating scale by asking her to rate her level of comfort on a scale from 0 to 10, with 10 being the highest possible level of comfort. She rates her comfort at 2.

In past visits, she has expressed concern about her future, questions how long she will live, and whether she will have relief from her pain. You and her daughter will plan comfort measures for Mrs. Cass.

QUESTION

Based on the first case study, apply the Theory of Comfort in planning strategies to increase your client's level of comfort. Describe interventions to increase comfort in the   three areas of relief, ease, and transcendence within two of the four contexts (physical, psychospiritual, social, and environmental).

Read the case scenario and apply the FIVE STEPS OF THE NURSING PROCESS.

Identify:

-Three appropriate nursing diagnoses (Problem related to Etiology as manifested by Signs and Symptoms, problem related to Etiology, problem)

-For each nursing diagnosis provide one goal/expected outcome (goal should be SMART)

-Three nursing interventions each diagnosis with scientific rationale (independent, dependent, collaborative)

-One evaluative statement (goal met, goal partially met, goal not met)

Follow the standard format of a nursing care plan.

Levi Yosh is a 36-y/o police officer assigned to a high crime police precinct. One week ago he received a surface bullet wound to his arm. Today he arrives at the outpatient clinic to have the wound redressed. While speaking with the nurse, Mr. Yosh mentions that he has been promoted to the rank of detective and has assumed new responsibilities. He states that since his promotion, he has experienced increasing difficulty falling asleep and sometimes staying asleep. He expresses concern over the danger of his occupation and his desire to do well in his new position. He complains of waking up feeling tired and irritable. During interview the nurse notes that he is pale, drawn with dark circles under his eyes. Temp: 37.0 C Pulse: 80 bpm, Resp: 18cpm, BP: 140/90mmHg

Create a Pathophysiology (concept map) based on the case Scenario

A 56-year-old man with a history of smoking rush to ER with shortness of breath and cough for several days. His symptoms began 3 days ago with runny nose. He reports a chronic morning cough productive of white sputum, which has increased over the past 2 days

Past Medical History
He has had similar episodes each time of raining season for the past 4 years. He always experiences fatigue, worsening cough, increased breathlessness and waking up in the morning with headache.

Family History
(+) Tuberculosis
(+) Hypertension
(-) Cancer
Personal and Social History
He has smoked 1 to 2 packs of cigarettes per day for 40 years and continues tosmoke. He denies hemoptysis, chills, or weight loss and has not received any relief from over-the-counter cough preparations.

Chest x-ray shows hyperinflation and right lobe pneumonia. ABGresults wasPh7.24,PO2-35 mmHg, PCO2 60mmHg, HCO3 30, O2 sat - 85%. Spirometry with FEVI 35%predictedthat does not change significantly after inhaled bronchodilators. ECG was ordered.

Physical Examination:
Took vital signs which are: BP: 130/80, T: 37.5 Celsius, PR:89, RR:30. Examinationdisplayedtachypnea, respiratory distress, use of accessory muscles, and intercostal retraction. Barrel chest is a common observation.

In the video LDI Louise Batz, her daughter mentions 3 reasons preventable medical errors occur and her conviction about the importance of patients and families being an integral part of the healthcare team.

1. As mentioned in the LDI Louise Batz video, how does lack of teamwork, lack of knowledge and lack of technology impact the occurrence of preventable medical errors?
2. How do Human Factors influence healthcare errors? Describe what you have seen in either your professional or personal life.
3. How can patients and their families be included in the healthcare team and how would this impact healthcare?

2. a) Name a relevant POLICY and PROCEDURE to refer to if an intervention was to be included in Tim’s behavioural support plan.

b) Provide an example of an intervention that might be appropriate.

(Below I have included Tim's information for further help)

Tim is a 25-year-old man and is an enthusiastic music festival fan. Every opportunity Tim has to attend a festival he will do so. Tim sustained an acquired brain injury (ABI) when he was 18. He lives in supported accommodation with Indigo Supported Living Services (ISLS) and has four workers who assist him with tasks of daily living (showering, dressing, simple meal preparation, his medication and going on outings).

Tim has an individual support plan that was discussed, agreed and implemented with Tim, his advocate and the service’s supervisor. It is reviewed as needed or every six months as agreed. He lives with epilepsy and when overstimulated is susceptible to having a tonic-clonic seizure. Tim’s support staff are fully trained and competent in the management of Tim’s seizures should they occur.

Tim has limitations to his speech due to his ABI which can be worsened by environmental factors (such as a hot day) resulting in Tim yelling loudly. Staff usually address this by reminding Tim to use his ‘Proloquo2Go’ app on his smartphone as being able to express himself reduces his anxiety. He gets upset if hears someone speaking to him in a patronising manner. Staff are aware of the triggers for Tim and engage appropriate interventions to assist him to manage them.

Tim is looking forward to attending the Falls Festival at Byron Bay. In accordance with the service’s policies and procedures and work health and safety staff have done a risk assessment prior to the visit.

You are attending the Falls Festival with Tim and he is thoroughly enjoying the festival and all the interactive experiences. It is a hot day and there has been a lot of walking around and queuing for the toilet and drinks. Whilst lining up for a snow cone a fellow festival-goer bumps into Tim. Tim is clearly upset by this however you realise quickly what is happening and manage to defuse further escalation by reminding Tim to express himself using the ‘Proloquo2Go’ app, talk to Tim about the next act and remind him about what a great day it has been so far.

After the final act, you realise that Tim’s medication is almost due and whilst you have time you are mindful of getting to the car as quickly as possible to support Tim with it. As you are leaving the tent Tim suddenly drops to the ground and experiences what you recognise to be a tonic-clonic seizure. He has hit his head on the side of the tent pole as he falls and his scalp is bleeding. You note the time and after the seizure has finished (90 seconds) you roll Tim in the recovery position and check his breathing. The security officer witnesses Tim’s seizure and radios for the paramedics who are on-site to come straight to the tent. The Paramedic (Reece Lansdown) commences treatment after it becomes evident Tim is having a second seizure (lasting 45 seconds). After checking with you about allergies and telling Tim what he is doing Reece gives him 30 mg of Diazepam (Valium) intravenously and applies a dressing around his head to stop the bleeding). Reece tells Tim that he will be transporting him to the local hospital for further treatment and asks if he would like you to ride with him.

At the hospital, Tim is seen by Dr Clare van Rooy who stitches Tim’s scalp. Tim is discharged after six (6) hours observation with instructions for dressing changes, a letter for his GP and a referral to Dr Denise Crimmins, Neurologist. All of this is explained to Tim and you check that he understands.

You let Tim know that you have contacted your supervisor Elizabeth Brown at Indigo Community Services and Health Hub and Susan Smith at Indigo SLS as required by Indigo Critical Incident Management policy and procedures.

Elizabeth checks that Tim is not at risk and is ready to return home, praises your responses, asks you to complete an incident report and to tell Tim that she will call to see him in the morning.

In 400 words, make an ethical argument either in support in surrogacy or against surrogacy. Make sure that you support your argument by both ethical principles?

Discuss the ambiguity and conflict in nursing roles required in critical care areas, balancing the biomedical model of care with holistic nursing of patients and families. What societal trends have increased family caregiver stress and burden? All sources must be referenced and cited using correct APA (including a link to the source).