Part 2 paragraph 2 MR C Discussion

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Part 2 paragraph 2 MR C Discussion

Please write a paragraph responding to the discussion bellow. Add citations and references in alphabetical order.

After reviewing the assessment data this nurse found that Mr. C’s BMI

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After reviewing the assessment data this nurse found that Mr. C’s BMI is 46 which indicates morbid obesity. Morbid obesity is defined as having a BMI > than 30 (Copstead-Kirkhorn, & Banasik, 2014). Given his BMI of 46 along with a FBS of 146, suggests that Mr. C has diabetes. He admits to having HTN. He mentions that he tries to control his BP with a low sodium diet, however his BP remains high at 172/96 which suggest that he has uncontrolled HTN. His lipid panel is elevated, confirming high cholesterol and he has been diagnosed with sleep apnea.aving a BMI > than 30 (Copstead-Kirkhorn, & Banasik, 2014). Given his BMI of 46 along with a FBS of 146, suggests that Mr. C has diabetes. He admits to having HTN. He mentions that he tries to control his BP with a low sodium diet, however his BP remains high at 172/96 which suggest that he has uncontrolled HTN. His lipid panel is elevated, confirming high cholesterol and he has been diagnosed with sleep apnea.

Mr. C would be a candidate for bariatric surgery only after he lost weight and with the new diagnosis of peptic ulcer, and a high chance of type 2 diabetes diagnosis (A1c needs to be checked) would need to be managed. Typically, surgery could be performed until all appropriate non-surgical measures have been tried but the person has not achieved or maintained clinically beneficial weight loss and only after a person had received intensive treatment for weight loss (Schroeder, Garrison, & Johnson, 2011). With bariatric surgery, Mr. C. may have better control of his diabetes. “In a systematic review, metabolic surgery has been shown to be superior to medical treatment for short-term remission of type 2 diabetes and comorbidities” (Schroeder, Garrison, & Johnson, 2011).

Health care providers should be sure to educate patients that bariatric surgery is not a weight loss technique, rather it is a tool that is used congruently with medical guidance, psychological support and lifestyle changes by Mr. C. to ensure positive outcomes.

Treatment for peptic ulcers depends on the cause (Mayo Clinic, n.d). Usually treatment will involve killing the H. pylori bacterium, if present, eliminating or reducing use of NSAIDs, if possible, and helping your ulcer to heal with medication (Mayo Clinic, n.d.). Proton pump inhibitors (PPIs) reduce stomach acid by blocking the action of the parts of cells that produce acid (Mayo Clinic, n.d.). Mr. C’s current medication regime could be simplified by adding a PPI continuing with Zantac and Carafate and removing Mylanta (Mayo Clinic, n.d.).

PPI: Commonly, these medicines are taken 30 minutes before the first meal of the day.

Carafate: take this medicine by mouth, usually 2 to 4 times daily, on an empty stomach at least 1 hour before a meal, or as directed by your doctor.

Zantac: It does not matter if you take it before, with or after food. If it is prescribed twice a day, the best time to take it is in the morning and at bedtime. If it is prescribed once daily, the best time to take it is at bedtime.

Schedule

6 am-Carafate

630 am- PPI

7am- Breakfast

11am- Carafate

12pm- Lunch

5pm- Carafate

6pm- Dinner

10pm- snack

Bedtime -Zantac

Functional Health Patterns

Health perception and health management – Mr. C. is aware of his obesity and seems motivated to ask bariatric surgery and take control of his health. It is not clear whether he has attempted lifestyle changes or weight loss programs in the past.

Nutritional / Metabolic Pattern – These patterns are evident with Mr. C’s morbid obesity, uncontrolled HTN, undiagnosed diabetes and PUD. The DM and HTN have not been addressed medically since there are no medications prescribed that we know of. He would benefit with a nutritional consult to assist with meal planning and food choices.

Elimination- no information is given about his elimination patterns.

Activity / Exercise – Mr. C has a sedentary job at a catalog phone center. Given his weight one can only assume that he has limited activity and exercise since there is no other information given.

Cognitive / Perceptual – Mr. C recognizes that his obesity is a problem. He shows motivation to ask about a surgical intervention to address this issue. He perceives his obesity as a medical concern and is worried about his health from his statement about his weight always having been a difficulty since childhood.

Sleep / Rest – He has documented sleep apnea, which contributes to poor quality of sleep.

Self – Perception / Self Concept- He perceives that he has a weight problem. This is supported by his statement that his weight has been a problem since childhood. He probably has a low self-esteem, but this needs further support.

Sexuality / Reproductive – no information given other than he is single.

Coping / Stress – He admits to gaining 100 pounds in the last 2-3 years. This could support the possibility that Mr. C uses food as a coping mechanism so these patterns need to be explored further.

Value / Belief – He is seeking information about a lifestyle change and bariatric surgery, so this supports the fact that he values his life. No information given about his beliefs.

Problems

Altered nutritional/metabolic pattern: BMI of 46, HTN- BP 172/96, Hyperlipidemia – elevated lipid panel, DM FBS 146, and PUD
Altered Sleep/ Rest -Diagnosed with sleep apnea: “Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain” (American Sleep Apnea Association, n.d.).
Altered Health Perception/ Health Management Pattern: Non-compliance in weight management and low sodium diet, lack of follow-up in the past with weight management and HTN
Altered Self-Perception / Self Concept : “I have always been heavy, even as a child.”
Altered Coping/Stress Tolerance: Possible decompensation of coping mechanisms as evidenced by recent significant weight gain.
Copstead-Kirkhorn, L., Banasik, J. L. (2014). Pathophysiology, 5th Edition.[Pageburstl]. Retrieved from https://pageburstls.elsevier.com/#/books/978-1-455…

Non verbal communication discussion questions

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Non verbal communication discussion questions

describe how you typically communicate nonverbally?

Do you have particular or unique patterns of nonverbal communication?
What have others said to you about your non-verbal communication?
How do you think your non-verbal communication impacts your effectiveness as a communicator?
In what ways do you think your non-verbal communication patterns will influence your ability to provide client-centered care

Tags: psychology

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Emotional Intelligence Essay Paper

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Emotional Intelligence Essay Paper

The patient in 4D had been admitted for multidrug resistant pneumonia. Given her advanced age and a host of other medical problems, the outlook was dire. Over the weeks she and the night nurse had struck up something of a friendship. Other than that she had no visitors, not a soul listed to notify in case of death, and no known friends or relatives. As he dropped by on his night rounds, the nurse was her only visitor, and the visits were limited to the short conversations she could manage. Now her vital signs were failing, and the nurse recognized that the patient in 4D was near death. So he tried to spend every spare minute on his shift in her room, just being present. He was there to hold her hand during her last moments of life. How did his supervisor respond to this gesture of human kindness? Emotional Intelligence Essay Paper
—Goleman, 2006, p. 252

How do aspects of emotional intelligence relate to leadership and management success? Does an effective leader-manager have to be emotionally sensitive and literate? Why or why not?

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Reference:
Goleman, D. (2006). Social intelligence: The revolutionary new science of human relationships. New York, NY: Bantam Dell.

To prepare:

  • Following the passage above, Goldman continues on to explain that the nurse supervisor reprimanded the nurse. Does this line up with what you were expecting? Why or why not?
  • Based on the information in the Learning Resources, think of a recent experience in your organization and consider how a nursing administrator demonstrated or failed to demonstrate emotional intelligence. How did this impact the outcome of the situation? Emotional Intelligence Essay Paper
  • Reflect on your identified strengths and opportunities for growth related to emotional intelligence from the information in the Learning Resources. What surprises you about the concept of emotional intelligence? How would you rate your own emotional intelligence?

By Day 3

Post a description of a situation in which a nursing administrator demonstrated or did not demonstrate emotional intelligence when managing a situation. Explain how this may have impacted the outcome of the situation. Describe how you would handle the situation differently based on your own identified emotional intelligence strengths.

 

Required Readings

Review the information found at Mind Tools: http://www.mindtools.com/pages/article/newCDV_59.htm

Trivella, P., Gerogiannis, V., & Svarna, S. (2013). Exploring Workplace Implications of Emotional Intelligence (WLEIS) in Hospitals: Job Satisfaction and Turnover Intentions. Procedia–Social and Behavioral Sciences 73(27). 701–709.
Retrieved from the Walden Library databases.

Van der Linden, D., Tsaousis, I., & Petrides, K. V. (2012). Overlap between General Factors of Personality in the Big Five, Giant Three, and trait emotional intelligence. Personality and Individual Differences, 53(3), 175–179.
Retrieved from the Walden Library databases.

Greater Good. (2012). Body language quiz: Test your emotional intelligence. Retrieved from http://greatergood.berkeley.edu/ei_quiz/

Take this free online assessment, and note your results for this week’s Discussion.

Institute for Health and Human Potential. (2015). Emotional Intelligence Quiz. Retrieved from http://www.ihhp.com/free–eq–quiz/ Emotional Intelligence Essay Paper

Need diet plan for a patient with COPD with references

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Need diet plan for a patient with COPD with references

Create a one-day meal plan (breakfast, lunch, dinner, and snacks) appropriate for a patient with COPD. Discuss needed nutrients and food choices. Include ways to increase calories and protein.

Tags: diet nursing copd

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Discussion Forum 4

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Discussion Forum 4

D. D. is a 66 year-old female suffering from shortness of breath. She smoked 2 packs a day until she quit 2 years ago.

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She has a history of bronchiolitis, hyperinflated lungs, pulmonary edema, and syncope. Her primary care practitioner suspects she also has pulmonary hypertension (PH). After examination, D. D. has a PAP of 35mmHg and mild CHF.

Citing scholarly resources, answer the following questions:

What is pulmonary hypertension and how could D. D. have developed PH?
How does her history fit in with her new diagnosis?
In addition to the two questions above, select ONE other question from the list below to complete your discussion post. Be sure to cite the sources of your information and clearly identify which supplemental question you chose to answer.

How many patients are suffering from COPD in the United States? Do COPD sufferers die of respiratory causes or other causes? (Be sure to cite the data.)
What two separate diseases are the main COPD diseases? Give background on each disease.
How does COPD correlate with left ventricular pressure and primary heart failure?
What are the three types of bronchodilators, and how do they function to alleviate the symptoms of COPD? What are other possible treatments for COPD?
Through which mechanism does bronchiolitis cause destruction of alveoli? Is emphysema genetic? Can environmental factors increase the risk of emphysema? Why or why not?
Is lung transplantation a solution for emphysema? Can new technology be useful in the treatment of emphysema? Why or why not?

Evidence-Based Practice In Nursing Discussion Help

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Evidence-Based Practice In Nursing Discussion Help

Identify two areas of nursing practice, which evidence-based practice has improved patient outcomes. State the study and its impact on patient care. How have these findings changed your nursing practice? Please support your response with a minimum of two supporting peer reviewed articles.

500words, No pliagarism

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Implementation Plan paper

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Implementation Plan paper

The chosen evidenced-based practice proposal will be conducted at a 111-bed psychiatric institution. The rate of medication errors in the population will be evaluated before the implementation of electronic health records and 6 months after its implementation Implementation Plan paper. The goal of this proposal is to ascertain whether or not electronic health records decrease medication errors, thereby improving outcomes. For this to occur, a change in the current workflow has to be implemented. The institution is currently on paper charting, therefore a change process will be required to illicit the desired effect. Implementation Plan paper

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For change to be successful, strategic planning is of utmost importance. The implementation team should be identified; the goals, budget and time-frame should also be clearly communicated (Agency for Healthcare Research and Quality, 2014). The project member should clearly outline the team members, the tasks, the background literature, the needs assessment and time-frame for the proposal. A communication plan, risk management plan and change management plan are necessary components to guide a successful change. In order to execute a successful change, the implementation team should support and guide the implementation throughout the pilot (Agency for Healthcare Research and Quality, 2014). The project manager should outline milestones to ensure deliverables are met in accordance to the goals, time-frame and scope of the project. Regular meeting should be conducted at scheduled intervals to ensure the project is functioning as expected, or to implement mitigation strategies. A Model for Change by Rosswurm and Larrabee (1999), is the model of choice to guide the proposal. The steps required for this change is highlighted in the table below: Implementation Plan paper

Evidenced Based Plan Implementation Project
PICOT In patients admitted to a psychiatric institution that converted from paper charting to electronic health records (P) , does the implementation of electronic health records (I) compared to paper charting ( C) decrease medication errors (O) within 6 months of its implementation (T).
Evidence Based Model to Guide Implementation A Model for Change by Rosswurm and Larrabee (1999) is a model based on theoretical literature related as it relates to evidence‐based practice, research utilization, standardized language, and change theory. This model guides practitioners through the change process through steps 6 steps: assess, link, synthesize, design, implement/evaluate and integrate/maintain (Rosswurn & Larrabee, 1999). These steps will be implemented in the chosen proposal to guide change and evaluate outcomes.
Project Stakeholders · The project stakeholders will be clearly identified. The project manager, project sponsor and all team members (active and supportive) will be highlighted. Implementation Plan paper
· All necessary human and physical resources will be gathered (including approvals and budget). Implementation Plan paper

Milestone One (Checkpoint)- Assess · Assess the need for change (needs assessment: the inefficiencies of paper-charting to the desired effect of a computerized system. Also, the high rate of medication errors, to the desired effect of a low/ no rate of medication errors)
· Review of quality reports regarding medication error events

· Assess knowledge of the implementation team in relations to the PICOT, goals, evidenced based knowledge and skills.

Milestone Two (Checkpoint)-Link · Link problems with interventions and outcomes; Link medication errors to the intervention of electronic health records implementation.
· Conduct background research

.

Milestone Three (Checkpoint)-Synthesize · Synthesize literature to support stance.
· Define the purpose of the project.

· Define the key quality indicators to determine if the project is successful

· Communicate information and address concerns with implementation team.

 

Milestone Four (Checkpoint)-Design · Formulate plan for the implementation of the electronic system with hospital administration. Identify the vendor and project sponsors responsible for the computerized system implementation project. Get communication of the time-frame in which system should be implemented in order to formulate a timeframe for the post implementation evaluation.
· Delegate to relevant team member/s to gather current data as it relates to medication errors in the hospital. Implementation Plan paper

· Formulate plan on evaluating outcomes after the implementation of the electronic system.

· Design a communication and risk management plan.

· Create a poster to disseminate of initiation of project information.

Milestone Five (Checkpoint)-Implement/Evaluate · Implementation of electronic health records.
· Make adjustments to poster as necessary.

· Launch the pilot study.

· Evaluate medication error rates monthly post implementation.

· Review progress of project during meetings, using the previously defined key quality indicators as guidance.

· Compare medication error findings to the pre electronic health records implementation phase.

· Analyze findings

· Celebrate project’s success

 

Milestone Six (Checkpoint)- Integrate &Maintain · Formulate a report of the medication error data before electronic health records implementation and 6 months after its implementation
· Close the project- review lesson learned and make recommendations. Implementation Plan paper

 

References

 

Agency for Healthcare Research and Quality, . (2014, October). How Do We Implement Best Practices in Our Organization? (continued). In AHRQ. Retrieved from https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu4a.html

 

Rosswurm, M., & Larrabee, J. (1999). A Model for Change to Evidence-Based Practice. The Journal of Nursing Scholarships, 31(4), 317-322. doi:file:///C:/Users/vpw63478/Downloads/A_Model_for_Change_to_Evidence_Based_Pra.pdf Implementation Plan paper

Paragraph 3

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Paragraph 3

Please write a paragraph responding to the discussion bellow. Add citations and references in alphabetical order.

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Based on the data provided, there are many health risks associated with being obese. According to the National Institute of Health (NIH, nd), based on his weight and height his body mass index (BMI) is a close assessment of how much body fat an individual is carrying around. The higher your BMI is, puts you at greater risk for developing health risks. Mr C. is 5ft 6in and weighs 296lb which calculates his BMI at 47.8. This scores puts Mr. C. in the category of obese. Mr. C. health risk due to his obesity includes the following: High blood pressure. Uncontrolled blood pressure puts him at multiple health risks such as, stroke, heart attack/failure, kidney failure, vision loss, peripheral artery disease, angina and sexual dysfunction (American Heart Association, 2017). Obstructive sleep apnea is associated with obesity. The upper airway closes due to loss of muscle tone causing more frequent closing of the airway (American Heart Association, 2017). Mr. C is also at risk for diabetes and hyperlipidemia.

Mr. C. has been struggling with weight his entire life up to know. Information regarding past attempts to diet and exercise is not provided. According to the National Institute of Diabetes and Digestive and Kidney Disease, (2016). Mr. C. is a potential candidate for gastric band only based on his BMI of > 40 and having a serious health problem of type 2 diabetes and sleep apnea. The National Institute for Care and Health Excellence, (2016) also states that adults with a BMI >30 and have had type 2 diabetes for less than 10 years should receive a bariatric surgical assessment without any prior attempts to reduce weight through diet and lifestyle changes.

Medication Schedules

6 am-Carafate

7am- Breakfast

11am- Carafate

12pm- Lunch

5pm- Carafate

6pm- Dinner

10pm- snack

Bedtime -Zantac

Ranitidine and Carafate should be taken 2 hours apart from each other for best absorption.

Assessment of Mr. C’s functional health patterns:

Health Perception- He realizes that his weight has gotten out of control due to him seeking information on weight reduction surgery. He is trying to manage his HTN with dietary modification and does not seek out expert opinion for proper management.

Nutritional/Metabolic- He weighs 296lb which put him in the obese category. His BMI is 47 with HTN and Diabetes. He consumes three meals and a snack.

Activity/Exercise- Works at a telephone center where he very likely sits for eight hours in a day at minimum. No mention of any daily activity.

Sleep/Rest- Has sleep apnea which does not allow a good night’s rest due to frequent awakening from apneic episodes. States he sleeps at 10pm and is up by 6 am this would potentially give him approximately eight hours of sleep, but not in the presence of sleep apnea which never allows you to fall into the deep sleep in order to feel and get adequate rest.

Cognitive Pattern- Is able to maintain a job. Can communicate clearly based on the duties of his job at a telephone center. Understands his need to seek help for his weight.

Self-Perception- He is definitely not comfortable with his weight and has not been since childhood based on his self-report of considering himself “heavy” as a child. He may have body image issues and low self-esteem.

Role relationship- His is 32 years old and single. There is no mention of him being in a relationship and may feel as though he is not wanted by the opposite sex based on his appearance.

Sexuality/Reproductive- Does not have any children. He is single.

Elimination-No information provided.

Coping/Stress tolerance- He looks as though he may be coping with stress through food and using food as an outlet putting him in a vicious unhealthy pattern.

The following are five actual or potential problems identified:

Ineffective health maintenance as evidenced by multiple chronic conditions and lack of appropriate health seeking behaviors.

At risk for delayed surgical recovery due to high levels of blood glucose and insulin resistance.

Imbalanced nutrition more than body requirements as evidence by a BMI of 47.8, putting him at a dangerously level of obesity that requires immediate action.

Activity intolerance as evidenced by being obese and sedentary lifestyle that includes working in an environment that requires sitting for majority of the work day.

At risk for non-compliance with heart healthy diet and exercise regimen. If Mr. C. gets obesity surgery he will need extensive education and teaching on an appropriate diet and exercise program. He has been overweight as a child and has either never been educated on or was never able to comply with dietary restrictions to induce weight loss or has incorporated levels of activity that promotes a healthy heart and healthy weight.

References

American Heart Association. (2016). HDL (Good), LDL (Bad) Cholesterol and Triglycerides. Retrieved from http://www.heart.org/HEARTORG/Conditions/Cholester…

Must be 100% perfect. Its bout nursing

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Must be 100% perfect. Its bout nursing

In the third stage of labor, what is the effect of cord cutting within the first three minutes on placenta separation?
Do teenagers with Type 1 diabetes who receive phone tweet reminders maintain lower blood sugars than those who do not?
Do the elderly diagnosed with dementia experience pain?
How can siblings’ risk of depression be predicted after the death of a child?
How can cachexia be prevented in cancer patients receiving aggressive protocols involving radiation and chemotherapy?

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Mucor Definition and Infection Assignment

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Mucor Definition and Infection Assignment

Mucor Definition and Infection

Explain what Mucor is and how a patient is likely to become infected with Mucor.

Mucormycosis or zygomycosis is a rare and serious fungal infection. It is caused by a group of molds called mucormycetes. Patients is likely to be infected by coming in contact with fungal spores found in the environment. People at risk are patients with a weak immune system. They may become infected by simply inhaling the spores or through any type of skin trauma.

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Describe the pathophysiologic progression of the infection into pneumonia and at least two medical/nursing interventions that would be helpful in treating the patient.

Pulmonary mucormycosis happends when spores may reach all the way to the alveolar spaces, most stay in the nasal turbinates causing sinusitis. Two nursing interventions would be watching closely for respiratory problems, monitoring vital signs specially pulse oximetry levels, chest pains and fever.  Lastly, giving medications as prescribed by physician.

Examine the laboratory blood test results and arterial blood gases provided in “Discussion Question Resource: Laboratory Blood Test Results.” What laboratory values are considered abnormal? Explain each abnormality and discuss the probable causes from a pathophysiologic perspective. Mucor Definition and Infection Assignment

WBC’s are abnormally high due to infection; Lymph are abnormally low due to infection; HCO and PH suggests metabolic alkalosis. Decreased Pa02/PC02 suggests alkalotic and compensated. High glucose levels indicate that the body is trying to compensate due to the infection.

What medications and medical treatments are likely to be prescribed by the attending physician on this case? List at least three medications and three treatments. Provide rationale for each of the medications and treatments you suggest.

Mucor must be treated with antifungal medications. Amphotericin B,Posaconazole, Isavuconazole. Ibuprofen and Tylenol might be used for fever/pain. O2 per doctor’s orders might be needed as well.

Treatments: If needed, mucromycisis might require surgery to remove infected tissue. Educating the patient on how to prevent this infection from occurring again like wearing appropriate clothing when working outside with soil. Mucor Definition and Infection Assignment