Nursing change project

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Nursing change project

Identify the change project topic and identify why it is a problem (provide details). i.e. something to change in

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nursing , like reduce falls or something like that. Identify the stakeholders (both internal and external) and summarize the benefits of the change project as well as the benefits and challenges associated with internal and external stakeholders.

All submissions must have a minimum of two scholarly references to support your work.

Examples of work to show mastery:

1-2 page paper – APA format

Nursing Pathophysiology Case Study on Neuro/Endocrine

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Nursing Pathophysiology Case Study on Neuro/Endocrine

A fifty-nine (59) year old black American with hypertension and hypercholesterolemia is brought

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to the emergency department. She has a history of tobacco use for 25 year; quit ten years ago.

Husband smoked one pack per day. She has a positive family history of heart disease.

Occasionally takes walks in the neighborhood with friends, but does not have a regular

exercise regimen.

In the emergency department, Mrs. Johnson is alert and oriented. Her vital signs are

temperature 98.2 F (36.7C), blood pressure 148/97, pulse 81, and respiratory rate 14. An

electrocardiogram (EEG, EKG) monitor shows a normal sinus rhythm. Mrs. Johnson is still

complaining of “numbness” of the right side of her face and down her right arm. Her mouth is

noted to divert to the right side with a slight facial droop when she smiles. Her speech is clear.

She is able to move all of her extremities and follow commands. Her pupils are round, equal,

and reactive to light (4mm to 2 mm) and accommodation. There is no nystagmus noted. Her

right hand grasp is weaker than her left. Mrs. Johnson does not have a headache and denies

any nausea, vomiting, chest pain, diaphoresis, or visual complaints. She is not experiencing

any significant weakness, has a steady gait, and is able to swallow without difficulty.

Laboratory blood test results are as follows: white blood cell count (WBC) 8,000 cells/mm,

hemoglobin (Hgb) 14 G/dL , hematocrit (Hct) 44%, platelets = 294,000 mm, erythrocyte

sedimentation rate (ESR) 15 mm/hr, prothrombin time (PT) 12.9 seconds, international

normalized ratio (INR) 1.10, sodium (Na) 149 mEq/L, Potassium (K) 4.5 mEq/L, glucose 105

mg/dL, calcium (ca) 9.5 mg/dL, blood urea nitrogen (BUN) 15 mg/dL, and creatinine (creat) 0.08

mg/dL. A head computed tomography (CT) scan is done which shows no acute intracranial

change and magnetic resonance imagery (MRI) is within normal limits. Mrs. Johnson is started

on an intravenous heparin drip of 25,000 units in 500cc of D5W at 18 ml per hour (900 units per

hour). Mrs. Johnson is admitted for a neurology evaluation, magnetic resonance angiography

(MRA) of the brain, a fasting serum cholesterol, and blood pressure monitoring. Upon

admission to the nursing unit, her symptoms have resolved. There is no facial asymmetry and

her complaint of numbness has subsided.

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A comprehensive health assessment in a geriatric patient is conducted to help identify potential abnormal findings (Grand Canyon University, 2012). The assessment should include a physical examination, family history, evaluation of cognition, sensory loss, nutrition, mental health, and a determination of any advance care plan for end of life.

When the nurse first encounters the patient, there are clinical signs that can be observed by paying close attention to the client’s general appearance and behavior. Close observation is important in conducting a thorough assessment, and observation begins from the first moment of contact with the client. Important factors to notice include the steadiness of the patient’s gait and balance, and the general appearance of self-care and hygiene. Also, it is important to note if the elderly client is wearing corrective lenses or hearing aids. These findings are indications of a sensory deficit, and they should trigger the nurse to speak slowly and clearly, making direct interactions in close proximity.

Assessment of family history is important in assessing risk factors and heritable disease, and, especially with the elderly, it has the added benefit of helping the nurse address living conditions and the existence of a support system, which might be beneficial when evaluating a patient’s ability to manage care. Cognition is a critical factor in determining patient’s ability to manage care. A patient with a neurodegenerative disorder, such as dementia, may have a severely diminished capacity to comply with medical recommendations, follow-up care, self-care, and nutrition.

Assessment of nutrition should include examination of the hair, nails, and teeth. This can provide important clues about the state of a patient’s nutrition. Patient’s with diminished nutrition may not be as resilient after sickness or injury, and they are more vulnerable to pathogens and hospital-acquired infections.

The assessment of advanced directives and end-of-life plans is another crucial element in providing care for the elderly. This portion of the assessment is important because many of these directives are legally binding, and they can provide a large amount of information and direction to healthcare providers in the event of death or incapacitation.

References

Health assessment of the older adult (2012). Grand Canyon University. Retrieved from https://lc-ugrad3.gcu.edu/learningPlatform/user/users.html?

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Physical Health

The medical history focuses special attention on medication use and the risk for malnutrition, falling, incontinence, and immobility. The nurse examination seeks to identify specific diseases or conditions for which curative, restorative, palliative, or preventive treatment may be available. Special attention is directed towardvisual or hearing impairment, nutritional status, and conditions that may contribute to frailty and falling or difficulty in ambulation.

Mental Health

Cognitive, behavioral, and emotional statuses are evaluated, paying close attention to detecting dementia, delirium, and depression.

Social and Economic Status

The social support network includes the accessibility and capability of caregivers, the elderly person’s economic resources, and other bases of support such as cultural, ethnic, and spiritual resources. It also includes the individual’s own assessment of their quality of life.

Functional Status

Functional status is measured by the ability to accomplish basic activities of daily living (ADLs) and to participate in behavioral and social activities referred to as instrumental activities of daily living (IADLs). ADLs include bathing, dressing, toileting, transferring, continence, and feeding. IADLs require a higher level of cognition and judgment than physical activities and include preparation of meals, shopping, light housework, financial management, medication management, use of transportation, and use of the telephone.

Environmental Characteristics

Evaluating the patient’s physical environment regulates the safety of the living environment. It also assesses the patient’s availability and use to essential services, such as shopping, pharmacy, and transportation.

What special considerations should the nurse keep in mind while performing this assessment?

It might take a little more time to complete the assessment and need to make sure that we are doing it at an optimal time, They might tire easier and when they take and what medications that they are taking. We need to make sure that we have them use any assistive devices that they normally use such as glasses, hearing aids, pocket talkers, walkers, and provide written explanations if needed. Be prepared to use interpreters instead of family members for non-English speaking patients. Make sure that when testing for mobility to have a safe clear and enough room. Be respectful of their environment and their things as well as the need for pain relief.

Reference:

Jarvis, C., (2016), Physical Examination and Health Assessment, Seventh Edition, Elsevier., MO.

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The comprehensive health assessment of the geriatric patient requires knowledge of normal aging changes, the effects of chronic diseases, genetic makeup, and lifestyle. It is multidimensional and incorporates the physical exam and assessment of mental status, functional status, social and economic status, pain and exam of the environment for safety concerns (Jarvis, 2016). Some of the special considerations the nurse must keep in mind is the presence of “geriatric syndromes” such as urinary incontinence fragile skin, confusion, eating problems or feeding problems, falls and sleep disorders. The goal of the functional assessment of the geriatric patient is to identify the geriatric patient’s strengths and limitations and to be able to come up with interventions to promote independence and prevent functional decline.

Reference:

Jarvis, C. (2016). Physical Examination and Health Assessment

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Studies have shown that about 80% of Americans would prefer to die in their own home, if possible. In spite of this, 60% of Americans pass away in acute care hospitals, 20% in nursing homes and only 20% at home. A smaller number of dying patients uses hospice care and even those patients are often referred to hospice only in the last 3-4 weeks of life. However, not every patient will want to die at home. Dying at home is taboo in certain cultures and some patients may wish not to die at home, out of concern that they might be a burden on the family. Still, it is clear that fewer patients are dying at home than want to do so. (Stanford school of medicine 2018)

End-of-life care is almost 30% of Medicare’s annual budget over the last year of life. Dying at home is much cheaper rather than in the Hospital or nursing home. Family caregivers have the heavy burden of caring for their loved ones which could be too much at times. Hospice care at home is helpful, but the family might not be ready for the emotional response of losing your loved one. Patient might get more sick and unable to maintain pain control forcing them into the Emergency Room for care and possibly a hospital admission. Also the caregivers might be fatigued and need a little break, to reset.

As Nurses we need to be supportive and non-judgmental. The family caregivers might be trying to overcome their guilt of not being able to live up to their loved ones last wishes. We can be understanding and offer pastoral help for the family. We as nurses can reassure the family that we will maintain their loved ones wishes with dignity.

Reference:

Brenoff, A. (2017). When Loved Ones Die At Home, Family Caregivers Pay The Price. HuffPost

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references in alphabetical order in case of another source.

I see this first hand from working in hospice where patients have been relocated into their children’s homes because they can no longer take care of themselves or bel eft alone for that matter. Prior to them moving into their children’s homes, there were already pending medical issues that prompted the final move in such as reoccurring falls, fractures, forgetfulness/cognitive decline, poor vision, constant hospitalizations, failure to thrive and failed cancer treatments/interventions. I even see this on admission with elderly patients and not just my hospice patients. So sometimes the child has to basically be the more responsible one when it comes to the safety and health of the elderly parent since sometimes the parent can be in denial of need or unaware of how severe their condition is.

Assessment 2 Legal and Ethical Considerations

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Assessment 2 Legal and Ethical Considerations

Assessment Instructions

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Note: Complete the assessments in this course in the order in which they are presented.

PREPARATION
For this assessment, you will develop a presentation to support an educational session that you plan to conduct for your clinical team that addresses the ethical and legal implications typically associated with the provision of coordinated care. Because you do not expect to be able to assemble all of your team members, in person, for this session, you have decided to add detailed speaker’s notes to your slides, record a voice-over track, and make the presentation available for team members to review at their earliest opportunity.

Before you begin developing your presentation:

Complete the Vila Health: Overseeing the Legal Process exercise, linked in the Required Resources. This interactive simulation will enable you to gather the information needed as the basis for your educational session.
Consider creating a Care Coordination Legal Responsibility table to help organize your thoughts about the legal implications of the issues associated with the patient you interviewed in the Vila Health simulation. A table is not required, but if you choose to create one, you may use the Care Coordination Legal Responsibility Table Template provided in the Suggested Resources or devise one of your own.
Note: Remember that you can submit all, or a portion of, your draft presentation to Smarthinking for feedback, before you submit the final version for this assessment. However, be mindful of the turnaround time of 24–48 hours for receiving feedback, if you plan on using this free service.

Presentation Tools
You may use Microsoft PowerPoint or any other suitable presentation software to create your slides. If you elect to use an application other than PowerPoint, check with your instructor to avoid potential file compatibility issues.

Use the speaker’s notes section of each slide to develop your talking points and cite your sources, as appropriate. If you need help designing your presentation, you are encouraged to review the various presentation resources provided for this assessment. These resources will help you to design an effective presentation, whether you choose to use PowerPoint or other presentation design software.

You have the option of either recording a voice-over track for your presentation or creating a video. In either case, you may use Kaltura Media, Adobe Connect, or other technology of your choice for your audio or video recording

If using Kaltura Media, refer to the Using Kaltura tutorial for directions on recording and uploading your video in the courseroom.
If using Adobe Connect, refer to the instructions and tutorials available from the Using Adobe Connect support page.
Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact Disability Services to request accommodations.

REQUIREMENTS
Develop a presentation to support an educational session for your clinical team.

Presentation Format and Length
At a minimum, your presentation must include the following slides:
Title.
Purpose (the reasons for your presentation).
References (at the end of your presentation).
Your slide deck should consist of 15–18 slides, not including the title, purpose, and references slides.
Supporting Evidence
Cite 5–7 sources of credible, scholarly or professional evidence to support your analysis and recommendations.
List your sources on the references slide.
Developing the Presentation
Note: The requirements outlined below correspond to the grading criteria in the scoring guide. Be sure that your presentation addresses each point, at a minimum. You may also want to read the Ethical and Legal Considerations Scoring Guide to better understand how each criterion will be assessed.

Explain the concept of informed consent in care coordination.
What is informed consent?
What circumstances require the patient’s consent for a medical intervention?
How much, and what, information should be communicated to the patient to be considered adequate?
Describe three ways in which legal and ethical concerns can be minimized through collaboration with caregivers in situations where clients have minimal or absent ability to communicate.
Summarize the responsibilities and expectations of the nurse for collaborating with clinical team members, when ethical issues emerge.
Consider possible underlying assumptions or biases that could influence your perspective.
Consider areas of uncertainty, knowledge gaps, and additional information that would be needed in order to gain a more complete understanding of the responsibilities.
Describe interrelationships among the legal, ethical, and professional responsibilities of the care coordinator.
Consider possible assumptions underlying your analysis.
Consider areas of uncertainty, knowledge gaps, and additional information that would be needed in order to gain a more complete understanding of the responsibilities.
Explain how diversity is supported through state and federal statutes.
What legislation can you cite that addresses diversity issues in health care?
Articulate the importance of adhering to applicable laws on the local, state, and federal level that govern the practice of care coordination and nursing care management.
Present main points, arguments, and conclusions to a clinical team clearly and accurately.
Address the anticipated needs and concerns of your audience.
What questions or alternative points of view might you expect? How will you respond?
Express your main points, arguments, and conclusions coherently.
Proofread your slides to minimize errors that could distract the audience and make it more difficult to focus on the substance of your presentation.
Support main points, arguments, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style.
Is your supporting evidence clear and explicit?
How or why does particular evidence support a claim?
Will your audience see the connection?
Additional Requirements
Be sure that:

Your slide deck consists of approximately 15–18 slides, not including the title, purpose, and references slide.
You have cited 5–7 sources of relevant and credible scholarly or professional evidence to support your presentation.
You have listed your sources on the references slide at the end of your presentation.
Portfolio Prompt: You may choose to save your presentation to your ePortfolio.

Creating a theory in nursing

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Creating a theory in nursing

Description
Fundamentals of Nursing Models, Theories, and Practice discusses the theory-practice gap in detail in many

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chapters. As you’ve read throughout the course, there is ongoing discussion about the connection between theory and practice, and the application in day-to-day nursing activities. This assignment is designed to illustrate that although there may be a gap, other factors play an important role in decision-making and each aspect of theory, research, and practice experience are integral to well-rounded patient care.

Click the Paper tab for a link to Fundamentals of Nursing Models, Theories, and Practice and review Figure 1.4 Correlation: education, science and practice.

Think of a scenario in which theory, research, and practice interact to create good patient outcomes.

Create a visual representation of the theory-practice relationship or gap by replacing the text in the Theory-Practice Gap diagram template.

Write a minimum of 525- to 700-word narrative explanation of your visual representation following the diagram.

Describe the chosen theory, research, and practice guideline or standard.
Explain the relationship between the three and discuss the role each plays in quality patient care in the scenario.
Explain any gaps, such as a lack of research, no practice standard, or no useable theory.
Determine the best course of action for making decisions in the absence of one aspect.
Include documentation of the practice guideline or standard, and your corres

Respond to Power Point with a Comment

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Respond to Power Point with a Comment

Presented by Idongesit Akazue Grand Canyon University NRS-434VN July 9, 2018 Overview of Presentation

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➢Background of Movie and character. ➢Functional Assessment ➢Analysis of health Assessment ➢Nursing Diagnosis ➢Cancer Resources Background of Movie and Character ➢ ➢ ➢ ➢ ➢ ➢ Kate Fitzgerald diagnosed with Acute Myeloid leukemia ➢ ➢ ➢ Anna Fitzgerald (Kate’s sister genetic donor match) ➢ ➢ Dysfunctional family 15 years old female 90lbs Penicillin allergy Renal Failure-undergoing dialysis On chemotherapy 11 years old Conceived thru in vitro Made unorthodox decisions Functional Assessments ➢ Health Perception/Health Management ▪ Kate is well aware of her disease and outcome ▪ Follows treatment plan and medication regimen ▪ She knows her family has insurance and she is covered ➢ Nutrition/Metabolic ▪ ▪ ▪ ▪ Organic and steamed food prepared by mother Nausea and vomiting Loss of appetite Weight loss ➢ Pattern of Elimination ▪ ▪ Hemodialysis fluid removal Diarrhea Assessments Continued ➢ Pattern of Activity/Exercise ▪ ▪ ▪ Kate has decreased physical activity She is often weak and tired Loves spending time at the beach ➢ Conceptual/Perceptual Pattern ▪ ▪ ▪ Pain from medical procedures Helpless Depressed ➢ Pattern of Sleep and Rest ▪ ▪ ▪ Sleep pattern is irregular Wakes up at night frequently Encouraged to sleep at night Assessments Continued ➢ Pattern of Self Perception and Self Concept • • • • • Kate accepts her disease Understands her body Wants to make her own choices She feels like a burden to the family Ok with dying ➢ Role/Relationship Patterns ▪ ▪ ▪ She is a daughter Sister to Anna Dating Taylor ➢ Sexuality/Reproductive Patterns ▪ ▪ ▪ A girlfriend to Taylor Experiences sex for the first time Falls in love Assessments Continued ➢ Pattern of Coping and Stress Tolerance ▪ Supported by family-mom shaves her own hair ▪ ▪ keeps a scrapbook Encouraged by boyfriend Taylor ➢ Pattern of Values and Beliefs ▪ The family love, support and encouragement one another ▪ ▪ No religious preference in this movie Life is not taken for granted Analysis of Health Assessment ➢ Normal assessment findings ▪ ▪ ▪ ▪ ▪ Appropriate skin color Increased activity Pain free No bruising Within normal limits CBC ➢ Abnormal or risk-based findings ▪ ▪ ▪ Anemia Bleeding Infection Additional Observations ➢ Cultural ▪ ▪ ▪ Middle class American family Great family bond Family willing to sacrifice everything to save Kate ➢ Geographical ▪ Family lives in California ➢ Religious ▪ No religious preference ➢ Ethnic ▪ Caucasian, non Hispanic white ➢ Spiritual • Believes she will see her family again in heaven Nursing Considerations ➢ Nursing Diagnosis ▪ ▪ Activity intolerance r/t generalized weakness ▪ Risk for infection r/t inadequate secondary defense(immunosuppression) ➢ Interventions ▪ ▪ Encourage patients to keep a dairy detailing daily routines and energy level ▪ Place patient in a private room with limited visitors Acute pain r/t physical agents e.g. enlarged organs/lymph nodes, bone marrow filled with leukemic cells Administer pain medications as needed. Monitor vital signs and watch for non verbal cues such as restlessness and muscle tensions Conclusion ➢ Family dealing with sensitive health issues ➢ Overcoming family struggles ➢ Moral and ethical decisions ➢ Coping with dying and death Resources ➢ Leukemia & Lymphoma Society ▪ ▪ ▪ ▪ Research on finding cures Advocacy Provide information Support www.lls.org ➢ Childhood Leukemia Foundation ▪ ▪ ▪ ▪ Patient education Advocacy Programs Build self-esteem www.clf4kids.org ➢ Cancer Care ▪ ▪ ▪ ▪ Counseling Support Groups Education Financial Assistance www.cancercare.org References Gordon, M. Nursing Diagnosis: Process and application, Third Edition. St. Louis: Mosby, 1994. Leukemia. (2018). Retrieved from CancerCare: http://www.cancercare.org/diagnosis/leukemia CMN4100. (2010). A Film Analysis… My Sister’s Keeper. Retrieved from http://cmn4100msk.blogspot.in / Gradishar, D., Muzio, L., Filipski, A., & Klopp, A. (n.d). Leukemia and Lymphoma Society.org: https://www.lls.org/support/other-helpful-organizations/patient-andcaregiver-resources-support-and-counseling/children-and-families Making Smiles Happen Everday. (n.d.). Retrieved from Childhood Leukemia Foundation: https://www.clf4kids.org/whatwedo.php Childhood AML Treatment. (n.d.). Retrieved from National Cancer Institue: https://www.cancer.gov/types/leukemia/patient/child-aml-treatment-pdq Matt Vera, R. (2014, Feburary 27). 5 Leukemia Nursing Care Plans. Retrieved from NursesLabs: https://nurseslabs.com/5-leukemia-nursing-care-plans/ Images of My Sister’s Keeper. Retrieved from bing.com/images
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