Archive for category: Nursing

JH is a 49 yo man was seen in the ED 2 days ago, diagnosed with alcohol intoxication and released after 8 hours to his brothers care.  He was brought back to the ED 12 hours ago with an active GI bleed and is being admitted to the ICU, his diagnosis is upper GI bleed and alcohol intoxication.

You are assigned to admit and care for JH for the remainder of your shift.  According to the ED notes, his admission vital signs were 84/56,110,26 and he was vomiting bright red blood.  His labs were remarkable for Hct 23%, alanine transaminase ALT 69 IU/ml. aspartate transaminase (AST) 111 IU/ml and serum alcohol 271 mg/dl.  He was given IV fluids and transfused 6 units of packed RBC’s in the ED.  On initial assessment, you note that JH’s VS are BP 154/90mmHG, pulse 98 beats/min, he has a slight tremor in his hands, and he appears anxious.  He complains of a headache and appears flushed. You note that he has not had any emesis and has not had any frank red blood in his stools or black tarry stools over the past 5 hours.  In response to your questions, JH denies that he as a alcohol problem but later admits to drinking approximately a fifth of vodka daily for the past 2 months.  He reports having been drinking just before his admission to the ED.  He admits to having had seizures while withdrawing from alcohol in the past.

1. Which data from your assessment of JH are of concern to you? Explain your points.
2. What are the two most likely causes of JH symptoms?
3. What is the most likely time frame for someone to have withdrawal symptoms after abrupt cessation of alcohol?
4. Is JH exhibiting any withdrawal symptoms now? if so identify them.
5. If JH does not receive any additional treatment for his alcohol withdrawal what additional symptoms might he exhibit and identify the timeframe for them to occur.
6. Identify what medications would you recommend JH receive for this alcohol withdrawal and why?
7. What assessment tool or tools would you use to assess JH withdrawal symptoms?
8. What are 3  priority nursing diagnosis that you would indicate on JH’s care plan and explain why they are a priority for you?
9. What are at least 3 nursing goals or outcomes for JH?

 

Suppose a community team identifies lack of access to exercise modalities as a public health issue. If the team were to determine that pedestrian walkways need to be constructed, discuss at least two factors that would facilitate the development of the walkways and two that would hinder the development. For the hindrances, discuss ways that the team might work to overcome those hindrances.

Pros for pedestrian walkways

One factor that could be utilized for the development of pedestrian walkways is to emphasize the safety benefits for a its citizens.  According to U.S. Department of Transportation, “Annually, around 4,500 pedestrians are killed in traffic crashes with motor vehicles in the United States.  Pedestrians killed while “walking along the roadway” account for almost 8 percent of these deaths.” (US DOT, 2013)

The second factor is the benefits of mobility.  The expanded walkways can help to get more and more people options of being able to get around on foot.  People are more opt to walk or ride a bicycle if they had a safer way to do so.  These people also reduce the numbers of cars that are on the road because the decided to take an alternative. The DOT writes “Sidewalks provide many benefits including safety, mobility, and healthier communities.” (US DOT, 2013)

Cons for pedestrian walkways

One of a major cause for a lack of pedestrian walkways is a lack of financial backing to pay for them. According to City Lab “But as the city has grown and the community has called for a more walkable public realm, relying on property owners to cough up the thousands of dollars to build publicly accessible sidewalks has become less than ideal.” (City Lab, 2012) There are areas in the United States that aren’t able to afford walkways because it hasn’t been budgeted.  The other dilemma is that depending on where you live and if it is remote then the less chances that a walkway will be built unless someone privately funds it.

The second cause for pedestrian walkways is due to not enough population in the town to justify constructing them.  Walkways would be built as a means for people to get around safely and in order to do so you need people.  Hence, the predicament that many small towns argue when dealing with situations such as this.

1. Provide a description for whooping cough. Include symptoms, mechanism, duration, and recovery in your description.
2. Discuss and evaluate methods used to identifyBordetella pertussis. Which method is considered confirmatory? What are the downfalls of culture and PCR?
3. What is an antibiotic? Which classes work best forBordetella pertussis?
4. What are the pathogenic mechanisms of Bordetella pertussis?What virulence factors does it have?
5. What is a vaccine?
6. Compare cellular and acellular vaccines used in the treatment of Bordetella pertussis.
7. What are some of the reasons parents may refuse to have their children immunized against pertussis?
8. What are some consequences of diminished vaccination to Bordetella pertussis?What impact does vaccination have on herd immunity?
9. Referring to the CDC statistics found in the graph in Figure 1, as well as the research-supported information provided in this case study, provide reasons as to why there is a resurgence of whooping cough.
10. Do you think vaccines should be mandated by law? (There are no wrong answers here and you can abstain from answering if you choose.)

 

Create a 1-2-page resource that will describe databases that are relevant to EBP around a diagnosis you chose and could be used to help a new hire nurse better engage in EBP.

Evidence-based practice (EBP) integrates the best evidence available to guide optimal nursing care, with a goal to enhance safety and quality. EBP is crucial to nursing practice because it incorporates the best evidence from current literature, along with the expertise of the practicing nurse. The concern for quality care that flows from EBP generates a desired outcome. Without these factors, a nurse cannot be an effective leader. It is important to lead not only from this position but from knowledge and expertise. To gain the knowledge, you require a good understanding of how to search for scholarly resources, as well as identify which databases and websites are credible for the purposes of implementing evidence-based changes in practice.

Demonstration of Proficiency.
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.
Explain why the sources selected should provide the best evidence for the chosen diagnosis.
Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
Describe the best places to complete research and what types of resources one would want to access to find pertinent information for the diagnosis within the context of a specific health care setting.
Competency 4: Plan care based on the best available evidence.
Identify five sources of online information (medical journal databases, websites, hospital policy databases, et cetera) that could be used to locate evidence for a clinical diagnosis.
Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
Describe communication strategies to encourage nurses to research the diagnosis, as well as strategies to collaborate with the nurses to access resources.
Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.
Professional Context
As a baccalaureate-prepared nurse, you will be responsible for providing patient-centered, competent care based on current evidence-based best practices. You will be required to do research, analysis, and dissemination of best evidence to stay abreast of these best practices. Understanding where to go to find credible sources and locate evidence, as well as which search terms to use, is the foundation of incorporation of best practices.