Technological Or Human Induced Disaster

We have already discussed weather related natural disasters and bioterrorism, and now we will focus on other types of disasters. For this week’s discussion, you are asked to research a technological or human induced disaster.

(This not the same as in Weeks 3 and 4 where you might have discussed hostage situations, mass shootings, multiple-vehicle or mass transit accidents with multiple critical injuries, bioterrorism, and disease outbreaks.) Here you want to look at situations such as radiological, nuclear accidents, technological disasters (electromagnetic pulse), and hazardous material spills.

In your post, provide the name of the incident you have chosen, and support your answers with evidence/examples. Please provide a working link and a citation for your source(s).Technological Or Human Induced Disaster

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Select 2 of the items below to discuss:

1. At what point does a technological or man made event become labeled a disaster?
2. Name and explain the impact categories associated with your disaster.
3. How well do you think the United States is prepared for a disaster like the one you selected?
4. Discuss the factors that can influence the effects a disaster may have on a community or region.
5. What nursing interventions would be a priority for these victims?
6. What community resources should be provided to the victims for follow up needs?

Support your answer with evidence from scholarly sources.

Technological Or Human Induced Disaster

Difference Between A Nursing Practice Problem And A Medical Practice Problem

A nursing practice problem is one where a problem arises after the care is given to patient and this practice focuses on the patient as a whole, (Helbig, J., 2018). An example would be of acute pain. A patient may suffer from acute pain after a certain procedure which requires intervention. Care plans are developed to help the patient manage whatever problem they are facing, (Helbig, J., 2018). Another example is a care plan is developed for a patient who has hypertension. The nursing practice helps develop of care plan such as for meal planning. Difference Between A Nursing Practice Problem And A Medical Practice Problem

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A medical practice problem is one where a problem arises during the actual care, the management of medication which requires the right medications, checking of labs, and understanding their injury, illness, or disease. Medical practice problem focuses on the disease, illness, or injury by using medications or certain procedures such as surgery or therapy. The goal for the patient is to manage the disease, illness, or injury, (Harman King, R., & Baum, N., 2018).

PICOT stands for patient, intervention, comparison, outcome, and time. If a problem arises during patient care and is noted by a nurse, nurses are able to use evidence-based practice to allow correction by applying PICOT to support their evidence-based practice. Nurses use evidence-based practice to provide the best possible outcome safely and to improve the outcome by providing quality care, (Helbig, J., 2018).

Using 200-300 words APA FORMAT with references to support this discussion.

Describe the difference between a nursing practice problem and a medical practice problem. Provide one example of each. Discuss why is it important to ensure your PICOT is based on a nursing practice problem.

Difference Between A Nursing Practice Problem And A Medical Practice Problem

Women Health – Week 6 Discussion 2nd REPLY

Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.  Women Health – Week 6 Discussion 2nd REPLY

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Discussion:

Discuss the questions that would be important to include when interviewing a patient with this issue

Kayla is a 16-year old female who presents with complaints of pelvic pain and previously diagnosed with pelvic inflammatory disease. When interviewing an adolescent presenting with these symptoms, it is crucial to ask questions related to social history in privacy (Smorgick & As-Sanie, 2018). Such questions should cover the home situation, school and other activities and potentially sensitive domains of substance abuse, sexual activity, depression, eating behaviors, and safety. In particular, it would be important to ask whether she had experienced any sexual assault in school or at home and if any, whether she noticed any bleeding during the assault. Another important question to ask is whether she has noticed any discharge and the color of the discharge. A normal vaginal discharge is clear and usually odorless. However, changes in the color, amount, or smell of the vaginal discharge may indicate a problem. For example, a white discharge that is clumpy and looks similar to cottage cheese may be a sign of yeast infection, which may cause symptoms such as burning on urination or vaginal itching. Similarly, a yellow/green discharge can be a sign of STIs or bacterial infection, and which can cause pain in the pelvic (Stratton, 2019).

Describe the clinical findings that may be present in a patient with this issue

The most common symptom of pelvic inflammatory disease is pain or tenderness in the stomach or lower abdomen. Other symptoms include abnormal vaginal discharge, usually yellow or green with an unusual odor, fever, tiredness, pain and bleeding during sex, burning sensation upon urination, and pain in the upper abdomen. Other clinical findings include tenderness of fallopian tubes and ovaries and tenderness of the cervix.

Are there any diagnostic studies that should be ordered on this patient? Why?Women Health – Week 6 Discussion 2nd REPLY

There are several diagnostic studies that should be ordered on this patient. A pelvic exam should be ordered first to examine her reproductive organs and look for signs of infection. Vaginal culture can also be taken to check possible bacteria, while the urine test may help to rule out urinary tract infection, which causes similar pelvic pain. Also, the doctor could order for an ultrasound to get clearer images of the reproductive system or CT scans to help detect abnormal structures or growth. Another diagnostic study to be ordered is laparoscopy to view the pelvic organs and check for abnormal tissues or signs of infection.

List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each

Primary diagnosis – Pelvic inflammatory disease – The patient is sexually active and admits to having multiple sexual partners without using a condom. Besides, she has admitted pain and tenderness in the lower abdomen.

Differential diagnoses

Urinary tract infection – Having multiple sexual partners and sometimes without a condom could have caused urinary tract infection.

Ovarian torsion – The patient has come with symptoms of severe pelvic pain that she rates as 10 out of 10.

Endometriosis – The patient admits abdominal cramping and pain in the lower abdomen and pelvis.

Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.

The main goal in the management plan of this patient is to alleviate symptoms and improve her quality of life. The patient needs some pain relievers such as ibuprofen or acetaminophen to provide partial relief from her pelvic pain. The patient may also need some antibiotics to help in case of any infection. In addition, the patient may be prescribed antidepressants to help improve the pelvic pain. Also, the patient needs to be educated about the benefits of practicing safe sex, particularly using condoms every time she has sex and to limit the number of sexual partners (Sanfilippo et al., 2019). She should also be advised to make an appointment for regular screening of sexually transmitted diseases and request her partners to be also tested. Also, the patient can be referred to physical therapists to help her develop coping strategies for the pain. Such include stretching exercises, massage, and other relaxation techniques.Women Health – Week 6 Discussion 2nd REPLY

References

Stratton, P. (2019). Evaluation of acute pelvic pain in non-pregnant adult women. UpToDate. Updated May, 9.

Sanfilippo, J. S., Smith, J. P., & Solnik, M. J. (2019). Chronic pelvic pain and endometriosis. In Sanfilippo’s Textbook of Pediatric and Adolescent GynecologySecond Edition (pp. 214-228). CRC Press.

Smorgick, N., & As-Sanie, S. (2018, March). Pelvic pain in adolescents. In Seminars in reproductive medicine (Vol. 36, No. 02, pp. 116-122). Thieme Medical Publishers.

Women Health – Week 6 Discussion 2nd REPLY

Failure to Monitor Post-surgical Patient

Read the case study at the end of chapter 11.

Instructions: After reading case study, please write a short paragraph depicting which were the most important failures that led to the near death event of the patient?Failure to Monitor Post-surgical Patient

What did you think was the most important contributor of all?

Case Study

A young man, Mr. Steve Goldberg, was admitted to a surgical unit at 6:00 PM after an elective laparoscopic gastric bypass surgical procedure. Mr. Goldberg was stable at the time of admission and was receiving a patient-controlled narcotic infusion at a “high-normal” range for pain management via a PCA pump. He was receiving oxygen via a nasal cannula at 2 liters per minute.

On admission to the surgical unit, Mr. Goldberg’s blood pressure was stable at 142/87. He stated that he was comfortable but at times appeared uncomfortable and restless. At 8:50 PM, the patient denied having pain and wanted his oxygen removed. His oxygen levels were adequate, and the respiratory therapist removed the oxygen cannula at that time but left it in the room per routine procedure. Mr. Goldberg continued to be restless throughout the evening and was observed repositioning himself in the bed for comfort.

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At midnight, the nursing assistant, Ms. Veronica Martin, removed the blood pressure cuff from Mr. Goldberg’s arm for comfort after recording a blood pressure of 92/44. She did not inform the registered nurse, Ms. Margaret Bennington, of the decrease in blood pressure but recorded the blood pressure on her worksheet, a nonpermanent record on a clipboard that contained the vital signs of the patients assigned to her. The nursing assistants used the worksheet to record vital signs for the registered nurse’s review before documenting them in the permanent medical record.

At midnight, however, Nurse Bennington was busy admitting a new patient. One hour later (1:00 AM), Nursing Assistant Martin repeated the blood pressure measurement and documented a blood pressure of 76/34 on her worksheet. Again, Nursing Assistant Martin did not report the increasingly lowered blood pressure to Nurse Bennington.

Nurse Bennington stated that at 2:45 AM she checked on Mr. Goldberg and characterized him as being restless, able to hold a conversation, and complaining of being too hot. Nurse Bennington gave Mr. Goldberg a cool wet cloth and took his blanket off. Nurse Bennington did not check any additional vital signs or ask to see the recorded blood pressure readings, stating that she assumed the patient was stable.Failure to Monitor Post-surgical Patient

One hour later (3:45 AM), Nursing Assistant Martin was assigned for a short time to another unit. She did not communicate any information to Nurse Bennington regarding Mr. Goldberg before leaving the unit. She returned approximately one and one-half hours later.

At 5:15 AM, Nursing Assistant Martin returned to the clinical unit and recorded Mr. Goldberg’s vital signs as 77/34, pulse 100, and respirations 20. Nursing Assistant Martin gave Nurse Bennington a brief report on a second patient and then left to take a third patient’s vital signs.

At 5:30 AM, the surgeon, Dr. Steel, came in earlier than his usual time to evaluate the patient. Dr. Steel’s intentions were to quickly assess the patient and then leave for the airport where he had an early commercial flight to catch. Dr. Steel stated that he could hear Mr. Goldberg snoring as he approached the room, and when he entered Mr. Goldberg’s room, he found the patient cyanotic from the neck up and unresponsive to verbal stimuli. Dr. Steel left the room to get Nurse Bennington for help, and together they returned to Mr. Goldberg’s room.

Nurse Bennington stated that Mr. Goldberg was positioned on his side, which was unusual, and that it was obvious he wasn’t doing well. His color was poor, respirations were slow, and he was unresponsive. At this time, Nurse Bennington repositioned Mr. Goldberg on his back to open his airway and improve his breathing.

Over the next 50 minutes, the narcotic infusion was discarded and Mr. Goldberg received two doses of medication to reverse the effects of the narcotic infusion. His arterial blood gases were assessed, and his oxygen was reinstituted via nasal cannula. He remained on the surgical unit for approximately 50 minutes while, according to each of the three staff members interviewed, Dr. Steel was reclined in a chair in the corner of the patient’s room or at the nurses’ station making phone calls while they suggested interventions to him.

The three registered nurses interviewed expressed concerns about their perceived delays in treatment after Mr. Goldberg was discovered in his unstable condition, and attributed the delays to waiting for Dr. Steel to take the initiative. According to Dr. Steel, he reinstituted Mr. Goldberg’s oxygen, instructed Nurse Bennington to turn off the patient-controlled narcotic infusion, and to give the medication to reverse the effects of the narcotic.Failure to Monitor Post-surgical Patient

Dr. Steel left to catch his plane before the patient was stabilized. Mr. Goldberg showed some improvement before Dr. Steel left. Dr. Steel stated that he thought the patient’s systolic blood pressure was approximately 100, and he had oxygen saturation levels of approximately 92%. Neurologically, his pupils were reacting slightly; he was posturing on his left side and flaccid on the right side, and remained unresponsive to verbal stimuli.

Mr. Goldberg was transferred to the intensive care unit at 6:20 AM where the nurses in the ICU quickly increased the oxygen support and added intravenous vasopressors per protocol after consultation with the on-call physician in internal medicine, Dr. Asvall. A gap of approximately 30 minutes occurred between the time Dr. Steel left for the airport and the time Dr. Asvall arrived to manage the case.

Failure to Monitor Post-surgical Patient

EHR Assignment Research Paper

My experience with learning how to navigate the EHR is through classes given by the hospital I worked at.  This workshop is only given one time and it is a 5-day class.  Most of the work is done individually with an instructor who has questions.  Since covid-19 this work was completed at home and with instruction from skype or zoom.    The class consist of the instructor showing you how to complete a task and you performing it, of course not remembering how you completed it once you hit the floor.  So, through the several years working on Epic I have learned through trial and error and through co-worker’s explanations how to make my page easier. If I were to design a program for my clinical environment centered on EHR it would be several people in the class and two instructors.  They would explain the system and basics, we would all sign on.  Then the students would be given tasks to perform on program.  They would have a certain amount of time and could ask questions.  I feel the only way to learn these systems is to roll up your sleeves and begin the tasks.  When there is an issue one can x out and try again.  I also believe there should be someone working in the hospital and would be on the floor once every two weeks or once a month and would look at the employee’s setup and work with them to make things more efficient. EHR Assignment Research Paper

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A data mining project that would be wonderful for the Emergency room which would extract data using these techniques would be prior visits.  A majority of patient which come into the ER are “frequent flyers”.  Although we are not supposed to use this term it is because it is true.  Several patients present to the ER looking for something specific.  Most of the time narcotics is the reason for admission.  If the EHR would use mining techniques to see the patterns of dates, times, what medications were given and what the diagnosis was along with medications they say they have allergies too.  What was the first allergic reaction to Toradol? This data would be used to help show a pattern, another mining method would be to take blood work from several different visits and explain how there is a specific pattern evolving.  For instance.  Say a patient has an A1C which is increasing over the past five years.  This is a pattern that should be alerted to the provider.  EHR Assignment Research Paper

Twelve-hour shifts are not problematic for patient and nurse safety, hospitals continue to keep the 12-hour shift schedule. This increases continuity of care and better flexibility for work and family balance. In a number of qualitative studies, 12-h shift patterns were seen as positive, contributed to staff satisfaction and also both a good recruitment and retention strategy.  Results from (battle, 2018) highlighted a positive impact on physical and psychological well-being and increased work satisfaction, for the nursing staff working the 12-h shift pattern. Increased continuity of patient care was identified as a positive outcome of the 12-h shift. Rarely have I seen nurses working longer than a 12-hour shift.  Most single parents have chosen this profession because of the ease of schedule.

What recommendations I would give to the management team is during a 12 hour shift the nurse must take all of her breaks.  Nurses become busy and they sacrifice their lunch to help better flow of the unit.  This is unacceptable.  All nurses should enjoy breaks, lunch, and the ability to use the bathroom when needed.  Management team could educate nurses on the problems with working several 12 hour shifts in a row, how it would cause fatigue and then mistakes could be made. I would suggest looking at incident reports whether it be falls, medication errors etc.  Look at the times of the incident and graph them to see a better picture of whether they are happening after 8 hours. EHR Assignment Research Paper