Priority nursing concerns and related nursing interventions

Joyce is a 65-year-old school nurse who has recently retired from an elementary school. She is beginning to feel rather lonely now that she is no longer working. She is a widow with adult children living out of the area. Her children have suggested that she may want to move to their city and to be closer to her grandchildren. She has been avoiding these discussions with her family and tells them all is fine. Moving seems like a major upheaval to her. Although she has been in fair health physically, at her last visit to the health care provider, she had lost 10 pounds and is just below her desired weight.

See the link to the Overview of the Nursing Process document to assist with this assignment.

Initial Discussion Post:

Select a developmental theory presented in this module and apply it to the scenario above. Use the chosen theory to address the following:

  • Explain Joyce’s behavior.
  • State two (2) priority nursing concerns and related nursing interventions for her.

Base your initial post on your readings and research of this topic. Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.

Ethical challenges or implications for patients and families with disabilities or with chronic illnesses, trying to achieve comprehensive self-management

The essential goal of the RN is to provide information and resources to assist the patient and family with chronic illnesses or disabilities so they can manage their own care over the course of the illness or disability.

Initial Discussion Post:

  1. Compare and contrast the terms “disability” and “chronic illness”. What are the similarities and/or differences? Can they coexist? Give reasoning behind your evaluation.
  2. Discuss two (2) legal and/or ethical challenges or implications for patients and families with disabilities or with chronic illnesses, trying to achieve comprehensive self-management.
  3. Identify and state two (2) actions the RN can implement to help the patient and family achieve comprehensive self-management with a disability or with a chronic illness.

Base your initial post on your readings and research of this topic. Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.

 Lubkin’s Chronic Illness Impact and Intervention by Pamela Larsen (Chapter 14, Self-Management) may be of assistance with this topic.  Click on link to access.

LeBlanc, R., & Jacelon, C. (2016). Self-management. In P. Larsen (Ed.),   Lubkin’s chronic illness: Impact and intervention (9th ed.). Retrieved from ovidsp.tx.ovid.com

Creating a Plan of Care

Creating a Plan of Care

Utilizing the information you have gathered over the weeks regarding the specific illness group you identified, this week, you will create a plan of care for your chronic illness group.

Create the plan in a 4- to 6-page Microsoft Word document (the 4–6 pages include the holistic care plan). Include the following in your plan:

  • Start the paper with a brief introduction describing the chronically ill group you selected and provide rationale for selecting this illness and the participants. Clearly identify the Healthy People 2020 topic chosen and why this topic was chosen.
  • You will want to compile the information gathered from Weeks 1–4 over 2 to 3 pages. This should be in APA format and paragraph form. This is not to be copied and pasted from previous assignments. It is to be a summary of each week. 
  • The paper should include the care plan for your chronic illness group organized under the following headings:
    • Nursing Diagnoses
    • Assessment Data (objective and subjective)
    • Interview Results
    • Desired Outcomes
    • Evaluation Criteria
    • Actions and Interventions
    • Evaluation of Patient Outcomes
  • You will need to ensure that the care plan is holistic and includes at least 3 nursing diagnoses related to the topic and interview results from the previous weeks.
  • Include strategies for the family or caregiver in the care plan and provide your rationale on how they will work.
  • Include a reference page to provide reference for all citations for the paper as well as the care plan.

Making healthy food choices initiative

In 2011 the United States Department of Agriculture (USDA) introduced the “My Plate” initiative, to help Americans make healthy food choices and to be active every day. Recently, new guidelines were released, and the initiative was updated to include, “MyPlateMyWins!”

Initial Discussion Post:

Review the following resource: United States Department of Agriculture: ChooseMyPlate.gov. (2015). Older adults. Retrieved from http://www.choosemyplate.gov/older-adults

Mrs. Jenkins is a 70-year-old patient at the primary care provider for a routine visit. As you are gathering data prior to showing her into an examination room, you note her height and weight, of 65 inches and 101 pounds.

  • Calculate Mrs. Jenkins’ BMI and interpret the result.
  • Discuss two additional specific assessments you would perform, and why the information you obtain in these assessments might be a concern to the RN.
  • Based on these assessments:
    1. What education would you provide related to this concern?
    2. Identify a member of the health care team with whom you would collaborate about this concern.

Be sure to use evidence from the assigned text or website, or other professional sources in your answer.

Base your initial post on your readings and research

Statistical Analysis of Community Health Problem

Module One (Week One): Part One Windshield Survey and Key Informant Interviews

Please complete the following information on this template about the community you have selected. If you do not use this template there will be a 10- point grade penalty per assignment, and you will be required to resubmit within 48 hrs. You may increase the size of the block by continuing to type.  Use as much space as necessary to provide your answers

Reference Module 2 (Week 2) Part Two: Statistical Analysis of Community Health Problem

Please complete the following information on this template. If you do not use this template there will be a 10-point grade penalty per assignment, and you will be required to resubmit within 48 hrs. You may increase the size of the block by continuing to type. Use as much space as necessary to provide your answers

Name of Community or Zip Code:

Instructions:  Enter your response in each category marked below.  Provide objective, statistical support for your subjective findings. 

● Include all the data listed in the Objective Data Criteria listed below.  

● Add supplemental data as needed for your community.

● All statistical data must be reported in NARRATIVE form only. Tables and graphs will not be accepted. 

● Compare objective data for your community with local (city), state, and national data.

You may increase the size of the block by continuing to type.  Use as much space as necessary to provide your answers

General Objective Data Criteria for the Community-at-Large

1.    Demographics:  Total population; age distribution; gender distribution; family characteristics (single parent, multi-family, etc.). Remember compare objective data for your community with local (city), state, and national data. Remember to cite sources as appropriate.

  1. Racial/Ethnic Characteristics: Remember compare objective data for your community with local (city), state, and national data. Remember to cite sources as appropriate.
  2. Economy: poverty rate, unemployment rates, median income. Remember compare objective data for your community with local (city), state, and national data. Remember to cite sources as appropriate.

4.    Education: High school completion rates; higher education statistics. Remember compare objective data for your community with local (city), state, and national data. Remember to cite sources as appropriate.                                                                                                                                                                                                                                                                                                                                                                                                                                                    

5.    Identify two Morbidity and Mortality/Risk Problems: (Based on your observations from Week 1 subjective assignment, windshield survey and key informants provide Morbidity, Mortality (M&M) and risk data for your community… Example 1: if you observed obesity in your community then present obesity rates and health conditions associated with obesity [i.e. CVD, HD, Depression, etc.). Example 2: smoking/drinking rates and health conditions associated with smoking [i.e. Lung Cancer, COPD, etc]. These variables may include the following: gender (who does this problem affect the most, men or women); age distribution; ethnicity or racial group(s) mostly-affected; morbidity and mortality rates; any data related to life-expectancy in light of the health issues; is there a geographic area where the health problems mainly exist; is there a relationship between the health issue(s) and environmental health hazards; are these life-threatening health issues? Remember compare objective data for your community with local (city), state, and national data. Remember to cite sources as appropriate.

6.    Other data as needed (air, water quality, crimes rates). Remember compare objective data for your community with local (city), state, and national data. Remember to cite sources as appropriate.

Analysis of Data

1.    Based on your subjective and objective review of your findings, what conclusions have you arrived at? Remember to cite sources as appropriate.

·         What impressions from your subjective observations were unfounded/invalid?

·         Given the objective data, what impressions were validated/substantiated?

·         What cause-and-effect relationships did you discover/identify?

2.    Problem Analysis for Community/Zip Code:

Problem: List two (2) problems within your community (for example, Infant Malnutrition, CVD, Lung Cancer, Obesity, Alcoholism, Violence) NOTE: These problems need to be something the Community Health Nurse can impact(for example, a CHN cannot build a sidewalk, repair a street, implement a new bus route, etc.). Remember to cite sources as appropriate.

1.    ____________________________________________

2.    ____________________________________________

    Select one of these problems and complete the Problem Analysis chart

*These are factors that contribute to problem and outcomes.

+ Refer to appropriate sections of the database and relevant research of the findings in current literature.  Data in the third column could be local, state, or national statistics.

Refer to text (pg. 420-423) for additional examples.

3.    Community Health Nursing Diagnoses:

Based on your subjective and objective assessment findings above for both Weeks 1 and 2, write TWO priority community health nursing diagnoses.

You must use this format as outlined in your text page 413 (do NOT use NANDA):

Health Risk/problem of (specific injury, illness, or potential of, complication of, etc) among (specific population) related to (supporting evidence from your assessment findings). 

Ø  Your CHN Diagnoses MUST be something that a community/public health nurse can do something about. See example below.

Ø  Note: Poverty is NOT a CHN diagnosis.

Ø  Remember do NOT use NANDA Nursing Diagnoses.

For example: Risk of asthma complications among children in SE Dallas County related to observations of overcrowded living conditions, lack of public transportation (may result in inability to access health care), high number of animals observed living in homes, poverty indications (may result in lack of access to medications).

Community Health Nursing Diagnosis #1

Community Health Nursing Diagnosis #2

Ethical principles in conflict for the RN in end of life care and withdrawal of life support

Scenario:

A 70 year-old patient has experienced a devastating stroke and is comatose in the intensive care unit on a ventilator. A family meeting was held. The hospital physician explained the irreversible damage to the brain, and discussed end of life care and withdrawal of life support. Family members acknowledge understanding and return to the patient’s room. As the RN was preparing to enter the room a family member is overheard to say, “Mom always said she didn’t want to be attached to a bunch of machines.” Another family member replies, “Don’t tell anyone she signed forms on the last admission, I don’t think we should take her off life support.”

Initial Discussion Post:

Address the following:

  • Describe two (2) ethical principles in conflict for the RN in the scenario.
  • What should the RN do in this scenario?
  • Refer to the 2015 American Nurses Association (ANA) Code of Ethics to resolve this dilemma. Provide a rationale that goes beyond your personal opinion.

Base your initial post on your readings and research of this topic. Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.

Ethical principles in conflict for the RN in end of life care and withdrawal of life support

Scenario:

A 70 year-old patient has experienced a devastating stroke and is comatose in the intensive care unit on a ventilator. A family meeting was held. The hospital physician explained the irreversible damage to the brain, and discussed end of life care and withdrawal of life support. Family members acknowledge understanding and return to the patient’s room. As the RN was preparing to enter the room a family member is overheard to say, “Mom always said she didn’t want to be attached to a bunch of machines.” Another family member replies, “Don’t tell anyone she signed forms on the last admission, I don’t think we should take her off life support.”

Initial Discussion Post:

Address the following:

  • Describe two (2) ethical principles in conflict for the RN in the scenario.
  • What should the RN do in this scenario?
  • Refer to the 2015 American Nurses Association (ANA) Code of Ethics to resolve this dilemma. Provide a rationale that goes beyond your personal opinion.

Base your initial post on your readings and research of this topic. Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.

The significant trends in long-term care likely to impact the operation of the various programs

Choose two long-term care facilities—one from nursing facilities, assisted living, or subacute care and another from adult day care, home health care, or hospice care—on which you would want to base your research work. Research Internet to read about your chosen long-term care facilities.

Assume you are responsible for the management and administration of the two facilities. You have to orient the newly appointed manager by providing an overview on managing long-term care. You also need to discuss the programs of the two facilities. From this perspective and based on your research about the facilities, prepare a Microsoft PowerPoint presentation of 10–15 slides including the following:

What are the various multidisciplinary departments (teams) included in your facilities?

Who comprise the target population being served by the various programs provided by your chosen facilities?

What are the major staffing and human resource issues faced by your chosen facilities?

What are the significant trends in long-term care likely to impact the operation of the various programs provided by your chosen facilities, and what is your plan of action to overcome them?

What are the various forms of cooperation and integration existing in your chosen facilities? Discuss the nature of management, financing, and quality issues related to integration and cooperation in the facilities?

Support your responses with examples.

Use the Notes section of the slides to provide additional information.

Cite any sources in APA format.

Activities related to health promotion and disease prevention

Scenario:

As a community health nurse, you are working in an outpatient clinic in a community that serves mainly elderly clients.

This year, you noted that 85 percent of the visits resulting in hospitalization resulted from bronchitis, asthma, pneumonia, and influenza as compared to last year. At that time; the visits weredue to  colds, sore throats, influenza, bronchitis, and pneumonia, in order of frequency.

Maria Perez, a 73-year-old Cuban American woman has been referred for community health nursing services following her discharge from the hospital. She smokes two packs of cigarettes per day. She was recently hospitalized as a result of a severe shortness of breath due to an asthma attack. The primary care provider prescribed respiratory treatments using Albuterol via jet nebulizer every 4-6 hours as needed. Mrs. Perez lives alone and has three cats to take care of.

Instructions:

  1. Read the scenario above and answer the following questions: 
  • What are the biophysical, psychological, physical environmental, sociocultural, behavioral, and health system factors influencing Mrs. Perez’s health?
  • Describe at least three primary, secondary, and tertiary prevention strategies that would be appropriate in resolving Mrs. Perez’s health problems. Why would they be appropriate?
  • What activities related to health promotion and disease prevention would you plan for the late fall?
  • How would you evaluate your nursing interventions? What criteria would you use to evaluate care?
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The analysis used Determining the electrolyte imbalance

A useful resource related to this discussion: Overview of the Nursing Process [PDF, File Size 331 KB].

A 19-year-old female college student who is pledging a sorority arrives at the Emergency Department (ED) after participating in a contest to drink the most water. She drank 5 liters of water in about 2 hours. The sorority sisters called 911 when the student reported a headache and was confused. Upon arrival to the ED, a nursing assessment was performed and laboratory tests ordered by the MD were obtained. The patient reports a headache, abdominal cramping, and has orthostatic hypotension. The following laboratory results are reported:

Sodium: 122 mEq/L

Potassium: 3.6 mEq/L

Calcium: 10 mg/dL

Magnesium: 2 mg/dL

Chloride: 100 mEq/L

Phosphate: 2 mEq/L

Initial Discussion Post:

Cluster and analyze the data in the scenario.

  • Determine the electrolyte imbalance.
  • As the RN monitoring this patient, what assessments will you perform for early recognition of potential problems?
  • Identify a nursing diagnosis with related factors, and defining characteristics (if appropriate).
  • Describe the analysis used and rationale for your choice.

Base your initial post on your readings and research of this topic.Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.