Consider the following scenario:

Marcus recalls the beginning of his career, when he started as a nurse at Grand View Hospital. He had heard the organization was soliciting proposals from various companies so they could weigh the pros and cons associated with adopting a new health information technology system. He has been curious about the request for proposal (RFP) process ever since. Now, as he looks forward to new professional opportunities, he would like to ensure that he develops the skills and expertise needed to formulate an RFP.

What are your professional aims? How can you apply what you have learned in your coursework to your practicum setting? How will you leverage your experiences in the practicum to facilitate your development as a nurse leader-manager or informaticist?

In this Discussion, you reflect on your aspirations and consider the transitions that may be required to achieve them. You identify professional development objectives and evaluate opportunities for achieving them through your experiences in the practicum.

• Think about the professional role changes you have been undergoing or that you may undertake following completion of this MSN program.
• Review the information related to professional development and role change in the Learning Resources, and conduct additional research as necessary to address any questions or concerns you may have.
• Consider the following questions:
  • What types of professional positions interest you? Are they significantly different from the types of positions you have held in the past? If so, how?
  • What challenges are you likely to encounter as you transition into a new role?
  • What resources could help you to manage this change? Consider your inner resources (e.g., drawing on previous experiences, stress management), resources available to you through your relationships with others, and institutional supports.
• Consider how you could use this Practicum Experience to apply what you have learned and enhance or acquire specialization skills and knowledge, regardless of whether you intend to change roles or stay in your current position for the time being.
• Review the NURS 6600 Course Outcomes listed in the Syllabus. Determine how your experiences in the practicum could help you to achieve one or more of these outcomes.
• Review the information in the Introduction to the Practicum (in this week’s Practicum area) and the School of Nursing Practicum Manual as necessary to ensure you have a clear understanding of the practicum requirements.
• Review the suggestions for developing effective learning objectives provided in the Learning Resources.
• Think of two or three objectives that could help guide your professional development during your practicum. These objectives, referred to as your practicum professional development objectives, must be:
  • Specific
  • Measurable
  • Attainable
  • Results-focused
  • Time-focused
  • Reflective of the higher-order domains of Bloom’s Taxonomy (i.e., Application level and above)
• Select one or more practicum professional development objectives to focus on for this Discussion. (You may continue to hone these objectives as you work on this week’s Application Assignment.)
• Reflect on how you could achieve each objective through your Practicum Experience.

By Day 3

Post an explanation of your professional aspirations and how you intend to use the Practicum Experience to promote career change and/or enhance your performance. Describe at least one objective to facilitate your professional growth, and explain the steps you could take to achieve the objective(s) during your Practicum Experience. Support your response with examples from the literature.

• Review the information on just culture presented in the Learning Resources.
• For this discussion, you will use the Regulatory Decision Pathway found in Russell, K. A. & Radtke, B. K. (2014).
• Examine an adverse event at the unit level in your organization or one with which you are familiar and apply the Regulatory Decision Pathway.
• Compare the findings of the Regulatory Decision Pathway  to what actually happened at the unit in your organization. Was the event deemed: bad intent, reckless, at risk, or human error? According to the pathway, do you now think it was the correct action?
• Think about how a nurse leader–manager may use just culture as a framework to create or maintain a focus on accountability and outcomes throughout a group. What actions could be taken if a systems–related error was made or if an error resulted from risky behavior?
• How might role conflict and/or ambiguity have contributed to the situation?

By Day 3

Post a description of an adverse event in your organization and your analysis of the issue using the Regulatory Decision Pathway. Explain how role conflict or ambiguity might have influenced this situation. Apply the principles of just culture as you explain how you, as the group’s manager, would handle the situation.

As with your prior weekly posts, you need to organize your responses under the heading of each question. Please carefully read the questions and fully answer all aspects of each question. 

Fred is an 83-year-old male who is being admitted to the medical-surgical unit status post fall. He is alert and oriented and reports that while visiting a local casino with his wife Margaret earlier this evening, he tripped over a curb and fell landing on his right side. After receiving morphine in the emergency room prior to transfer to your unit, Fred is rating his pain at 6/10. He has multiple bruises from his jawbone to his knee as well as a slight rotation of his right leg.

Past medical history includes: myocardial infarction (MI) x 2, peripheral vascular disease (PVD) with bilateral iliac stents, non-insulin-dependent diabetes mellitus (NIDDM), sleep apnea, and degenerative joint disease.

Medications include: aspirin, Plavix, Lopressor, Lisinopril, and Metformin.

After reviewing the above scenario please answer the following questions.

1. Based on the information provided, how will you prioritize your care, what assessments will you include and in what order? Please provide rationale for your response.
2. Considering this patient’s age, injury, past medical history, and list of current medications, what, if any, concerns do you have related to his potential need for surgery?
3. Should surgery to repair his right femur be required; what type of clearance and pre-op orders would you anticipate receiving related to his diet, meds, lab work, and so on?

Review the following case study and complete the questions that follow. For this assignment, write your responses to each question as one narrative rather than separating your responses by question number. Include an introduction and a conclusion. Submit your answers using APA format, well-written sentences, and detailed explanations. Your analysis must be scientifically sound, necessary, and sufficient.

You must also include a bibliography of at least 3 sources (with at least one non Internet source). Your textbook may not be included as a source for this assignment. Refer to the rubric for more information on how your assignment will be graded.

Case Study 

M.K. is a 45-year-old female, measuring 5’5” and weighs 225 lbs. M.K. has a history of smoking about 22 years along with a poor diet. She has a history of Type II diabetes mellitusalong with primary hypertension. M.K. has recently been diagnosed with chronic bronchitis. Her current symptoms include chronic cough, more severe in the mornings with sputum, light-headedness, distended neck veins, excessive peripheral edema, and increase urination at night. Her current medications include Lotensin and Lasix for the hypertension along with Glucophage for the Type II diabetes mellitus.

The following are lab findings that are pertinent to this case:

Vitals

BP

158/98 mm Hg

CBC

Hematocrit

57%

Glycosylated hemoglobin (HbA1c)

7.3 %

Arterial Blood Gas Assessment

PaCO₂

52 mm Hg

PaO₂

48 mm Hg

Lipid Panel

Cholesterol

242 mg/dL

HDL

32 mg/dL

LDL

173 mg/dL

Triglycerides

1000 mg/dL

1. What clinical findings correlate with M.K.’s chronic bronchitis? What type of treatment and recommendations would be appropriate for M.K.’s chronic bronchitis? 
2. Which type of heart failure would you suspect with M.K.? Explain the pathogenesis of how this type of heart failure develops. 
3. According to the B.P. value, what stage of hypertension is M. K. experiencing? Explain the rationale for her current medications for her hypertension. Also, discuss the impact of this disease in the U.S. population. 
4. According to the lipid panel, what other condition is M.K. at risk for? According to this case study, what other medications should be given and why? What additional findings correlate for both hypertension and Type II diabetes mellitus? 
5. Interpret the lab value for HbA1c and explain the rationale for this value in relation to normal/abnormal body function?