Respond with a paragraph, citations and references
Explain the role of the community health nurse in partnership with community stakeholders for population health promotion. Explain why it is important to appraise community resources (nonprofit, spiritual/religious, etc.) as part of a community assessment and why these resources are important in population health promotion.(minimum 200 words)
Part 3 Paragraph 1 Hearth Failure
Please write a paragraph responding to the discussion bellow. Add citations and references in alphabetical order.
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The American Heart Association describes Heart Failure as “Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen.” (American Heart Association, 2019). Heart Failure is a definite threat to morbidity and mortality of the patient. Mrs. J needs much help in terms of medical and nursing interventions in light of her current situation.
As far as nursing interventions, oxygen is definitely warranted for this patient and may even benefit from BiPAP to aide with the pulmonary edema as evidenced by the pulmonary crackles and frothy blood-tinged sputum. Along with this, the patient should be sat up in a high-fowler’s position and vital signs, ECG and oxygen saturation all need to be monitored closely to watch for further decompensation. Diuretics such as Lasix are effective in reducing the volume or preload coming into the heart which can help the heart contract more effectively and improve cardiac output. ACE Inhibitors such as Vasotec “are the primary drug of choice for blocking the RAAS system in HF patients with systolic dysfunction…The conversion of angiotensin I to the potent vasoconstrictor angiotensin II requires the presence of ACE. ACE Inhibitors also decrease the development of ventricular remodeling by inhibiting ventricular hypertrophy.” (Lewis et al, 2011). Beta-adrenergic blockers can decrease the heart rate by blocking the effects of the sympathetic nervous system on the heart’s beta receptors. Lastly, Morphine reduces preload and afterload by dilating “pulmonary and systemic blood vessels, a goal in decreasing pulmonary pressures and improving the gas exchange.” (Lewis et al, 2015). Four cardiovascular conditions that may lead to heart failure include coronary artery disease, hypertension, valvular diseases such as stenosis, and congenital heart defects. Coronary artery disease can be aided by exercise and nutritional diet and may also helped by stenting of coronary arteries when precipitated by angina or MI. Hypertension can also be helped by exercise and nutritional diet and antihypertensive medications. Valvular diseases such as stenosis can be repaired or replaced by mechanical or bioprosthetic valves. Lastly, congenital heart defects can be surgically repaired.
Four interventions to prevent drug interactions for older adults include:
Encourage older adults to check with their PCP or pharmacist before taking any OTC, herbal or prescription medications to make sure that there are no interactions between the medications. Secondly, have a system to properly identify medications and take them in the appropriate doses and right medication, these can include a clearly labeled weekly pill organizer. This can prevent taking wrong medications at wrong times or overdosing. Thirdly, set alarms or reminders to reinforce taking medications at the right times. Some medications need to be spaced out to prevent adverse events or complications. Lastly, promptly report adverse effects to the PCP or pharmacist or seek medical treatment, whichever is warranted by the gravity and urgency of the adverse effect.
Paragraph 2
Please write a paragraph responding to the discussion bellow. Add citations and references in alphabetical order.
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Looking at Mrs. J’s objective and subjective data a plan of care can be initiated for left sided heart failure. For the patient’s respiratory status, the patient’s sp02 is 82%, decreased breath sounds in the right lower lobe and coughing with frothy blood tinged sputum, oxygen therapy should be administered. Also, the patient’s crackles indicates congestion and fluid overload as well as the JVD. IV diuretics would treat this symptom. Placing a Foley catheter to ensure strict I&Os and possible fluid restriction will be considered. Daily weights would also be initiated to monitor the effectiveness of treatment and patient’s status. A chest x-ray would be performed to evaluate for any infection. Tylenol would be administered to treat the low grade temperature. The patient would be on 24hr telemetry monitoring. Medications would be administered to treat the AFIB to control the ventricular rate and for anticoagulation therapy.
Part B
IV furosemide (Lasix) – Lasix is a loop diuretic. It is used to treat edema due to heart failure. It causes diuresis and mobilization of the excess fluid caused by heart failure. It also helps decrease blood pressure.
Enalapril (Vasotec) – Enalapril is an ACE inhibitor. It is used to treat blood pressure. It is also used for CHF in conjunction with diuretics
Metoprolol (Lopressor) – Lopressor is a beta-blocker that affects the heart and circulation. It can also help treat the patients Afib.
IV morphine sulphate (Morphine) – IV morphine is a narcotic that is used many times in cardiac events such as chest pain. It helps open up the blood vessels and helps improve cardiac workload, reduce anxiety and pain.
Part C
1. Smoking- smoking is a major risk factor for the development of coronary heart disease (CAD). CAD is a major cause of heart failure. Nursing interventions to manage this are to educate patient on the importance of smoking cessation and the risk factors associated with not doing so. Getting respiratory therapy or other resources to help quit smoking. Get nicotine patches or other prescribed medication regimen to help quit smoking.
2. High blood pressure- Uncontrolled BP is a high risk factor for developing CHF. When pressure is blood vessels is too high the heart has to pump harder than normal to keep up and over time this causes the heart to get weaker. Nursing interventions to help manage this is ensuring all home medications are on the MAR. Check the BP per protocol and ensure that it is within the parameters set by the MD. Order PRN or adjust medication for BP per MD orders. Educate on taking BP medicine regardless if the BP is normal or the patient is not having any symptoms
3. Obesity- Being overweight can cause the heart to work harder than normal and can cause sleep apnea. Nursing interventions that can help manage obesity are ensuring proper diet is ordered in the hospital. Educating on the long term effects of obesity and some ways to help with weight loss. Encourage an exercise routine.
4. Sleep apnea- Pauses in breathing can contribute to fatigue and cause high blood pressure and heart failure, diabetes, stroke. Nursing interventions for sleep apnea are to ensure a sleep study is completed or ordered. Ensure all prescribed regimens are available such as CPAP at night. Educate on the importance of being compliant with CPAP and risks of failure to do so.
Part D
1. Help and educate the patient on keeping an accurate log and list of all medications and herbal medication that the patient is on. In order to reduce the chances of the physician ordering medications that may have drug interactions.
2. Educate the patient on the importance of choosing one primary care physician in order to reduce polypharmacy.
3. Help and educate the patient on ensuring proper dosage and frequency are followed by using a medication organizer.
4. Educate the patient on possible interactions of herbal medication and the need to inform the physician of all herbal medication.
5. Ensure the patient is educated on all new medications, indications, education, potential side effects and potential interactions.
References
American Nurses Association. (2010). Preventing polypharmacy in older adults. Retrieved from https://www.americannursetoday.com/preventing-poly…
Professional Development of Nursing Professionals
Review the Institute of Medicine’s 2010 report “The Future of Nursing: Leading Change, Advancing Health.” Write a
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750-1,000 word paper discussing the influence of the IOM report on nursing practice. Include the following:
Summarize the four messages outlined in the IOM report and explain why these are significant to nursing practice.
Discuss the direct influence the IOM report has on nursing education and nursing leadership. Describe the benefits and opportunities for BSN-prepared nurses.
Explain why it is important that a nurse’s role and education evolve to meet the needs of an aging and increasingly diverse population.
Discuss the significance of professional development, or lifelong learning, and its relevance in caring for diverse populations across the life span and within the health-illness continuum.
Discuss how nurses can assist in effectively managing patient care within an evolving health care system.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
Stress and Immunity Paper Assignment
Your written assignment for this module should be a 1-2 page paper (not including title page and reference page) that describes the following:
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What are the different types of immunities and give an example of each
Describe how stress impacts the immunity of a person
You should include a minimum of 3 scholarly references. Include a title page, in-text citations, and a reference page in APA format.
Importance of effective communication in healthcare
1. Discuss the importance of effective communication in the personal relationship, the therapeutic relationship, and the relationship within the interprofessional health-care team.
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2. What similarities and differences can you identify among the above interactions?
3. Explain the concept of congruence between verbal and nonverbal communication.
4. There are many pitfalls to electronic communication. Identify a situation in which an electronic form of communication may result in a miscommunication. What other method of communication would have been more effective?
5. How have you seen SBAR used during your clinical experiences?
6- Develop a hand-off report for yourself. Include items that you believe are pertinent for safe and effective nursing care. Refer to the information in the chapter for creating this report form. Using the information from the chapter, determine the effectiveness of the system currently in use on your unit for communicating shift-to-shift reports.
7-Dr. Roberts comes into the nurses’ station demanding, “Where are Mr. Adams’s lab reports? I ordered these stat, and they’re not here! Who’s responsible for this patient?” How would you, as the nurse, respond?
8-Explain the concept of accountability in delegation. What are the legal ramifications of accountability in delegation?
9. Dennie and Elias arrive in the unit for the 7:00 p.m. to 7:00 a.m. shift. Both nurses completed orientation 4 weeks ago. They find that they will be the only two RNs on the floor that night. There is a census of 48 clients. The remaining staff consists of two NAPs/UAPs and one LPN. What are the responsibilities of the RN, NAP/UAP, and LPN? Can Dennie and Elias effectively delegate client care tasks and care safely for all 48 clients? Use the Delegation Tree to make your decisions.
10. Discuss the differences between direct delegation and indirect delegation.
1. You have to observe delegation procedures in your assigned unit:
A-What considerations does the RN take into account when delegating patient care?
2-You have to look at the unit census and prioritize the patient care:
A- Give the rationale for your choices.
3.Answer the following questions during your clinical experiences:
a. What specific tasks did your patients require that you might have been able to delegate?
b. How effective was your nurse/preceptor in delegating tasks to others?
c. How did your nurse/preceptor ensure that the tasks were completed safely and appropriately?
clinical thinking
One of the most important skills a nurse needs is clinical judgment. This is a skill that can be learned. Reflect on your own ability to critically think and the reading for this module.
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When see yourself as a nurse and giving care, discuss what qualities and behaviors you possess that make you a person that would have good clinical judgment. What three strategies can you use to develop better clinical judgment? As a nurse, what areas of the nursing process do you think might be more challenging to you given the critical thinking and clinical judgment skills you have now?
Most of us don’t think about how we think. Thinking is a skill. In the reading critical thinking is defined as “your ability to focus your thinking to get the results you need in various situations.” This means that you are able to use your thinking abilities to clarify goals, examine assumptions, evaluate evidence, accomplish actions, and evaluate decisions or conclusions. And, it is when you are able to do this consciously you are “critically thinking.”
In nursing it is essential that we think critically because the decisions we make influence the care and health outcomes of others. Critical thinking also leads to clinical reasoning and then to making clinical judgments. It is when we are able to make informed and conscious clinical judgments we are able to provide safe quality nursing care.
View – “What is Critical Thinking?”
Critical thinking skills include reflection, interpretation, analysis, inference, and evaluation. Critical thinkers are open-minded, systematic, and have self-confidence. In your reading there are critical thinking indicators. Review these behaviors, qualities, and attitudes to see which you possess.
As described in your reading there area barriers to critical thinking. Just a few are age/maturity, one’s self confidence, past experiences, dislikes, prejudices and biases, one’s anxiety and fears, negativity, motivation. These potential barriers need to be in full awareness as a nurse can the can negatively affect clinical judgment.
When comparing critical thinking, clinical judgment, and clinical reasoning, you will find in your reading that the differences are critical thinking, and clinical reasoning are considered processes and clinical judgment is the result of the process. These are purposeful and end in outcomes.
One way nurses used critical thinking, reasoning and judgment is through the nursing process.
Nursing Process
The nursing process is a clinical reasoning tool. The phases of the nursing process are dynamic and organized steps that lead to clinical decision making. The nursing process includes assessment, analysis and identification of the problem, planning, implementation, and evaluation. When applied to client situations, the nursing process offers a way to organize information to make the best possible clinical decisions. The review of the nursing process in the textbook provides detailed information for each of the phases. You will be learning more about the nursing process in later courses. For now you want to think about it as an organized way of assessing and evaluating information and making informed decisions.
In this module the key emphasis is understanding the differences between critical thinking, clinical reasoning, and clinical judgment and your abilities in each of these areas.
NUR699 Nursing Evaluation Plan For EBP Project
Course Code NUR-699 Class Code NUR-699-O500 Criteria Percentage Evaluation 100.0% Develop a
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n evaluation plan. Describe the rationale for the methods used in collecting the outcome data, the ways in which the outcome measures evaluate the extent to which the project objectives were achieved, and how the outcomes will be measured and evaluated based 100.0% Total Weightage 100% Evidence-Based Practice Proposal: Section G: Evaluation of Process Unsatisfactory (0.00%) Evaluation plan presents the method used in the measurement of the outcomes but does not align the project objectives and/or evidence. The rationale is missing. Modification strategies as well as the impact to future research may or may not be present with minimal details. Subject matter is absent, inappropriate, and/or irrelevant. 60.0 Less than Satisfactory (80.00%) Evaluation plan presents the methods used in the measurement of the outcomes according to the project objectives and/or evidence. The rationale is missing. The information presented is ambiguous. Modification strategies as well as the impact to future research may or may not be present with minimal details. A lack of comprehension is Satisfactory (88.00%) Evaluation plan presents the rationale for and the methods used in the measurement of the outcomes according to the project objectives and evidence. The information presented may lack cohesiveness and details. Possible project modifications when outcomes do not provide expected results are listed. The implications for practice and future Good (92.00%) Evaluation plan presents the rationale for and the methods used in the measurement of the outcomes according to the project objectives and evidence. Validity, reliability, and applicability are briefly addressed. Strategies for project modification when outcomes do not provide expected results are outlined. Implications for practice and future research are Excellent (100.00%) Comments Evaluation plan presents the rationale and the methods used in the measurement of the outcomes according to the project objectives and evidence. The information presented is aligned, comprehensive, and addresses validity, reliability, and applicability. The plan formulates clear and precise strategies for project modification when outcomes do not Points Earned
Purchase answer to see full attachment
NURS317 Week5 Appendicitis Teaching Plan Pediatric Nursing Project
Robert Im going to post the questions for the week 5 assessment there are 3 paper to do for week 5 .
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For the teaching project my topic is appendicitis/appendectomy for a 7 years old child. You can access to the rubric and see all the instructions .
The community experience is in this place
2nd House Daycare & Preschool. they have kids from 2month to 5 years
and the last paper is care plan you can do it from Kawasaki disease for a child of 20month?
Critical medical action discussion
Please write a paragraph responding to the discussion bellow. Add citations and references in alphabetical order.
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Nursing interventions to help Mrs. J would be increase head of bed, place oxygen with nasal canula, monitor I&O, order low sodium diet, obtain a bed side commode, start an IV, and do a medication reconciliation. Start her medications as ordered.
Lasix is a diuretic and is used to ease swelling and congestion in the lungs, by getting rid of unneeded water and salt through urine. The result is it makes it easier for the heart to pump and decreases congestion in the lungs to help breathing, (WebMD, 2019).
Vasotec is an ACE inhibitor which allows blood vessels to relax and widen making it easier for the heart to pump blood and prevent hypertension; it also helps the body to release water and salt, so the Lasix can get rid of them, (Cardio Smart, 2015).
Lopressor is a beta-blocker that is used in conjunction with the Lasix and Vasotec to reduce mortality in CHF caused by left ventricular systolic dysfunction, by decreasing the work load of the heart, (Neher & Saframek, 2003).
Morphine is an opiate that is used in CHF to “reduce preload, heart rate, and afterload, the net effect of which is a reduction in myocardial oxygen demand. Morphine also has a sedative property to decrease anxiety, pulse restlessness, dyspnea, and chest pain” (Coons, McGraw, & Murali, 2011).
Four cardiovascular conditions that can lead to heart failure include: hypertension, the extra exertion can make the heart muscle stiff and to weak to pump blood; coronary heart disease, is plaque buildup in the arteries reducing blood flow and can lead to a heart attack; cardiomyopathy, heart muscle damage caused by infections, alcohol abuse or certain medications/drug abuse; heart arrhythmias, heart beats to fast or to slow cause extra work on the heart. Nurses can help prevent these by educating the patient and care givers to take medication as prescribed, exercise, stop using tobacco products, limit alcohol consumption, eat a well-balanced diet with limited salt intake and low fat, maintain a healthy weight, and reduce stress. (MayoClinic, 2019)
A problem facing older adults is polypharmacy, taking multiple amounts of medications. Nurses can help patients that are taking multiple medications by: encouraging them to use one pharmacy, this way all the medications will come from one place and the pharmacist can oversee the medication regimen and interactions; provide medication education, teach patients and caregivers about the reason for the drug, side effects and interactions; organize medications for the patient, write out a medication schedule with time medications are to be taken, name of the medicine, and how to take the medicine; instruct the patient not to take any OTC medication or herbal supplements without consulting the doctor or pharmacist first, many OTC meds and supplements can interact with prescription medication either by elevating the effects to cause adverse reactions or to decrease the absorption. (Woodruff, 2010).
CardioSmart, (2019). Heart Failure: ACE Inhibitor. American College of Cardiology. Healthwise Inc.
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