Grand Canyon University Concept in Community and Public Health Questions

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Grand Canyon University Concept in Community and Public Health Questions

complete question:

Select a global health issue affecting the international health community. Briefly describe the global health issue and its impact on the larger public health care systems (i.e., continents, regions, countries, states, and health departments). Discuss how health care delivery systems work collaboratively to address global health concerns and some of the stakeholders that work on these issues.

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Resources within your text covering international/global health, and the websites in the topic materials, will assist you in answering this discussion question.

UWF Myocardial Infarction and Acute Coronary Syndrome Discussion

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UWF Myocardial Infarction and Acute Coronary Syndrome Discussion

Discuss Myocardial Infarction and Acute Coronary Syndrome.

2. Describe the differences between and signs and symptoms of STEMI’s and NonSTEMI’s. 1. Discuss Myocardial Infarction and Acute Coronary Syndrome.

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2. Describe the differences between and signs and symptoms of STEMI’s and NonSTEMI’s.

3. Describe the pathophysiology of each condition (ACS and MI).

4. For both ACS and MI please address the following questions:

how common the occurrence is, diagnostics for each condition, and the treatment for each condition.

Describe atypical presentations, occurrence rate, and what groups have atypical presentations. (Which patients present with atypical signs and symptoms?)

Minimum 3 references no longer than 5 years old

University of West Florida Leishmaniasis Skin Condition Discussion

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University of West Florida Leishmaniasis Skin Condition Discussion

A. From your chapter readings and study, discuss Leishmaniasis, its presentation (how it looks), the etiology (what causes it), treatment, and insert a photo (screenshot) of the skin condition. (You can copy and paste the photo into your discussion or take a screen shot). Write an informative, scholarly summary of the skin topic (Good grammar, citations, references. Post directly into discussion space (no attachments). Two (2) required citations from either:

  • CINAHL e-library or PubMed e-journal article (with link to pdf or e-journal abstract), and/or
  • link to reliable (i.e. no “.com”): only .gov, .edu, .org, .net) websites. (MedlinePlus is acceptable .gov website)
  • textbook

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Include details such as: What is the skin problem? When assessing, where are lesions usually located? What are the physical exam findings? Are lesions single or grouped? What are preventive measures? Include other important information that will inform your classmates when assessing this skin condition.

If the skin condition is contagious, What is the method of transmission? Incubation? Life cycle? Symptoms? When assessing, what are the physical/clinical highlight? What are preventive measures?

Minimum 750 words

NSG4067 UWF Ch 36 End of Life Care Gerontological Nursing Discussion

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NSG4067 UWF Ch 36 End of Life Care Gerontological Nursing Discussion

Initial post : you are to thoroughly discuss the topic of End of Life Care (Chapter 36) thoughtfully and thoroughly with a minimum of 500 words From book

1. Eliopoulos, C. (2018). Gerontological nursing (9th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins

Include 2 scholarly peer reviewed article citations

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Include a personal nursing experience where you have addressed this issue

NSG6103 South University BSN Program and Curriculum Reviews Paper

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NSG6103 South University BSN Program and Curriculum Reviews Paper

  • You mentioned curriculum reviews. How would you assess if the textbooks for courses are adequate or need changing? What criteria would you use in selecting textbooks for the program? This is a timely question since everyone will be choosing textbooks for their BSN program assignment.ORDER A PLAGIARISM FREE PAPER NOW

This is the question from my teacher?

Medgar Evers College Ethical Decision Making Worksheet Questions

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Medgar Evers College Ethical Decision Making Worksheet Questions

The learning objectives for this assignment are stated in the beginning of each chapter assigned (Textbook-Yoder-Wise, 6th edition)

Instructions:

Read the following case studies. Answer all the questions below related to each chapter assigned. Submit your response in the designated “drop box” in Blackboard no later than June 26th, 2019 at 11:59 PM.

Chapter 4: Legal and Ethical Issues

Ethical and Critical Decision Making – Ethical and critical decision making requires the

ability to make distinctions between competing choices. The thinking process involved in

making such decisions can follow many formats, but in all cases, it is a deep-thinking process– sometimes called critical thinking. In complicated cases the use of ethical decision-making models can help clarify what the competing ethical principles are, and what information should be thinking about.

What goes into ethical decision making? Consider these five steps:

1. Is It an Ethical Issue? Being ethical does not always mean following the law. And just because something is possible doesn’t mean it is ethical, hence the global debates about biotechnology advances such as cloning. And ethics and religion do not always concur. This is perhaps the trickiest stage in ethical decision making, as sometimes the subtleties of the issue are above and beyond our knowledge and experience. Listen to your instincts – if it feels uncomfortable making the decision on your own, get others involved and use their collective knowledge and experience to make a more considered decision.

2. Get the Facts. What do you know, and just as importantly, what don’t you know? Who are the people affected by your decision? Have they been consulted? What are your options? Have you reviewed your options with someone you respect?

3. Evaluate Alternative Actions. There are different ethical approaches which may help you make the most ethical decision.

a. Utilitarian Approach – which action results in the most good and least harm?

b. Rights Based Approach – which action respects the rights of everyone involved?

c. Fairness or Justice Approach- which action treats people fairly?

d. Common Good Approach – which action contributes most to the quality of life of the people affected?

e. Virtue Approach – which action embodies the character strengths you value?

4. Test Your Decision. Could you comfortably explain your decision to your mother? To man in the street? On television? If not, you may have to re-think your decision before you take action.

5. Just Do It – Make a Decision and Go. Once you’ve made the decision, then don’t waste time in implementing it. Set a date to review your decision and make adjustments if necessary. Often decisions are made with the best information to hand at the time, but things change, and your decision making needs to be flexible enough to change too. Even a complete about face may be the most appropriate action further down the track.

Case Study 1

Nurse Smith has been working in the Critical Care Unit for 18 months. One evening John, a 40-year-old male patient, was admitted with a serious head injury. He has a history of mental illness and has been living with his 80-year-old parents for the last 15 years. After being on life support for 3 days his parents came to the Unit and stated they wanted everything stopped and to have him removed from life support. After taking the appropriate measures, the team began to remove the life supporting equipment. After removing his breathing tube, John opened his eyes and looked at his family. He said to them “Why are you trying to kill me?” As the nurse assigned to John, what would you do?T

DECISIONETHICAL DECISION MAKING WORKSHEET

Answer these questions:

Using the Ethical Decision-Making Framework as a guide above, think through the ethical issues in the scenario identified and determine what decision you would make.

1. Is It an Ethical Issue?

2. Get the Facts.

3. Evaluate Alternative Actions.

4. Test Your Decision.

5. Just Do It – Make a Decision. What did you decide and what did you learn?

Case Study 2

Mrs. M is a 75-year-old widow who lives alone in a small house that she and her husband built during the first few years of their marriage. Before his death 2 years earlier, Mrs. M had cared for him at home with the assistance of a home health aide. The community health nurse who visited her husband also taught Mrs. M how to be more independent in the management of her own chronic illnesses. Since her husband’ s death, the community health nurse and Mrs. M have remained friends, and they see each other once or twice a month.

Mrs. M was doing well until 4 months ago, when she experienced an episode of dizziness and fell. She was examined by her physician, who could find no physical injury but hospitalized her for further evaluation of the dizziness and a possible altered mental state. In the hospital, Mrs. M fell while being ambulated with the assistance of two certified nursing assistants. The fall caused both her left hip and left arm to be broken, and Mrs. M underwent surgery for a left hip replacement. Her left arm was set. She also underwent a full rehabilitation program after the hip replacement surgery and was admitted to a skilled nursing home for a short time. When Mrs. M was discharged, a referral was made to the community health nursing agency to provide services so that Mrs. M could safely remain at home.

Mrs. M has been capable and independent all her life, so she has found it difficult to acknowledge the changes that have come with aging and the increasing limitations imposed by her chronic illnesses. Since her return home, she has responded positively to nursing counseling about her functional health status and has participated actively in a plan to meet her changing daily living needs. She has developed a stronger and more therapeutic nurse-client relationship with the community health nurse, as the same nurse who had cared for Mr. M was assigned to Mrs. M’s care.

Mrs. M has also responded well to the services of a home health aide who visits weekly to provide personal care and light housekeeping. The community health nurse visits once a month. Neighbors help with shopping, occasional meal preparation, and general monitoring. Mrs. M’s sole family member is a married daughter who lives with her family in a distant state. Although they talk frequently by phone, the daughter has not visited since her father’s funeral 2 years earlier.

Recently, Mrs. M’s long-time physician retired, and she is now seeing a different physician. After Mrs. M’s second office visit with this new physician, the community health nurse received a call from the physician. The physician said he had told Mrs. M that she must sell her house and move into a nursing home permanently. He gave this advice because, “She is an old woman. Her health will not improve, and she is at risk for falling or having an acute exacerbation of her primary illnesses that will probably lead to disability or death. She should not live alone.” The physician then added, “Mrs. M became confused and emotional. She refused to listen to me. We must do what is best for her, as she is incapable of a rational decision. You need to tell her that she must go to a nursing home, as she said she would talk with you.” The primary community health nurse acknowledged that Mrs. M does have known health risks, but when she tried to describe Mrs. M’s safe-care abilities, the safe home environment, and the community services, the physician replied, “Just follow orders,” and abruptly ended the phone conversation.

Questions:

1. What legal and ethical issues are presented?

2. As a nurse manager, what advice would you give the staff nurse regarding this client?

Chapter 9: Cultural Diversity in Health Care (Please select 2 out of 3 Case Studies below)

Case Study 1

Mr. A is a 70-year-old Egyptian male who speaks only Arabic. He was diagnosed with a meningioma by means of magnetic resonance imaging (MRI) in Egypt. Mr. A and his family came to the United States for better treatment of his meningioma. A craniotomy was performed for the removal of the tumor. The surgery produced no complications, and Mr. A was moved to the surgical intensive care unit (SICU) for observation. The SICU does not have open hours for visiting. The RN assigned to Mr. A does not speak Arabic, nor does the patient’s wife speak or understand English. Mr. A’s son speaks some English and was able to translate some words. It was reported to the oncoming day shift that Mr. A had had a very restless first postoperative night. When the assigned male RN came on at 7 AM, Mr. A was trying to tell him something that seemed urgent. Mr. A’s family was unable to be located in the SICU waiting room, and an Arabic translator was not available at the time.

Mr. A appeared agitated as he repeatedly pointed to his head, making a circle with his fingers. The male RN had difficulty with verbal and nonverbal communication with Mr. A. The RN did a neurological assessment and took his vital signs, which were within normal limits. The RN expressed his need to the nurse manager to have the patient’s son available to translate for Mr. A so as to determine his level of pain. However, the RN did not want to give Mr. A pain medication because of a scheduled MRI.

Questions:

1. What might be some nonverbal cues for assessing Mr. A’s pain?

2. What could Mr. A’s son and the RN staff have done to prevent communication barriers from occurring?

3. If the SICU does not have a policy for open visiting or a specific hospital translator, is it fair to let a family member remain at the patient’s bedside for the purpose of communication? Provide pros and cons for your answer.

4. What ethical values and legal principles should be considered in this situation?

Case Study 2

Mrs. C, an 87-year-old, frail, widowed, African-American female is a patient in a skilled nursing unit in a healthcare center that has a culturally diverse staff. Mrs. C has moderate multi-infarct dementia and a history of bronchiectasis. Following her breakfast and while morning care is being given, Mrs. C suddenly starts coughing and producing a moderate amount of bright red blood. The patient does not have a signed advance directive in her chart; however, there is a written do not resuscitate (DNR) order on the physician order form. Mrs. C’s only living child, a daughter, resides in another city about 1000 miles away.

Questions:

1. What immediate nursing action should be taken by the licensed or unlicensed nursing staff on duty?

2. What nursing action should be taken by the nurse manager or the licensed nurse designate?

3. What are your state’s laws concerning advance directives (living wills)? What are its laws concerning directions to physicians, family, and surrogates? What is to be done if none of these are in effect for a patient?

4. Consider this situation: What if AND (allow natural death) had been written on the patient’s chart by the physician? Does AND have the same meaning as DNR to you and other unit staff members? Discuss why or why not. Are there any cultural implications or values to be considered in caring for this patient?

Case Study 3

A neurological intensive care nurse is assigned to care for a 16-year-old married Hispanic male patient who the physician has determined is brain-dead as the result of a severe head trauma. His mother’s and stepfather’s requests are that his organs not be donated for transplantation.

Questions:

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1. What actions should the nurse consider while taking care of this patient?

2. What knowledge does the licensed nurse need to have about advance directives in this situation?

3. What rights does the patient’s wife have in this situation?

4. What ethical values and legal principles should be considered

responding to classmates discussion answers

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responding to classmates discussion answers

Discussion 1 1) Yosniel The roadmap to the full realization of the mandate of the patients to control their health has dramatically changed, owing to the number of policies surrounding ethical and legal perspectives. In the traditional times, often the physicians and doctors strongly control what kind of medications the patient should be put under as their primary focus was to act responsibly and safeguard the lives of the people (Vahdat et al.,

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2014). There were relatively few restrictions and legal recourse that permitted nurses and health care to recommend the kind of medication that should be administered to cure particular ailments of the patients. Therefore, the contemporary healthcare settings allow the patients to have a full mandate over the control of their health as they can participate in any decision making that involves their treatment and medication. Legally, the patients are supposed to have control over their health and exercise their duty to disclose any health-related information that will help the healthcare professionals be able to diagnose the kind of ailments they are suffering from for medical remedies. For example, the active participation of patients on matters to do with their well-being and health has welcomed tremendous changes concerning improved patient outcomes regard to the more responsible treatment they receive from nurses and healthcare professionals (Vahdat et al., 2014). Another health care change that has been necessitated by the control as seen from the patient’s side is the requirement that nurses and health care professionals utilize the evidencebased practice in their nursing roles. As a result, patient involvement in their healthcare, which implies exercising their control over the kind of medical services they should receive is one of the essential ingredients in the evidence-based practice in the course of nursing practice. Thus, this implies that the act of patience, exercising the full mandate of controlling the type of medication they get from nurses, and healthcare professionals have immensely changed since time immemorial. 2)Rachel In the past, it was expected that patients would follow the advice, recommendations, and treatment plans created by their doctors without fail. They were never expected to ask questions, play an active role in their treatment or negotiate with their doctors over other options and differing medical opinions (Falvo, 2019). Today patients have access to more information available online and are more knowledgeable about their healthcare and the options that they have to play an active part in their care. Technology and communication advancements allow for patients to do their own research online about medication, treatments, and diagnosis. Patients now have access to their own medical charts through their own doctors and have a number of medical professionals and apps at their disposal. On one hand, this helps to better educate the patient and provide tutorials and other teaching materials that are easy to understand; however, it also can propose a challenge when the material found online is inconsistent with the medical advice or incorrect as it applies to the patient. This can cause confusion, frustration, and even resentment for the patient (Falvo, 2019). In terms of insurance, individuals now have an opportunity usually to choose their own provider and plan that best suits their individual or family needs. In the past, an individual from a particular company would go to a specific hospital where everyone was treated in the same fashion. Having access to different hospitals and networks allows the patient to find the best care option for themselves and also requires that they have more ownership of their care plan (Falvo, 2019). Likewise, this opens up access to different people at different facilities and allows for differences of opinions and treatment. 3) Carla According to Sherman and Hilton (2014), health care has evolved over the years to become consumer-driven. Patient satisfaction has become a measure of the quality of health care alongside clinical outcomes. As such, health care providers have taken the long term initiative in involve patients in their care. Additionally, more emphasis is being put into health and wellness as opposed to treatment of diseases, thus necessitating patient education. In the traditional practice of medicine health practitioners were seen as experts while patients were seen not to know anything whatsoever in health care. The practitioners, therefore, made all the decisions because the notion was that patients could not give any meaningful contribution. Patients took little to no responsibility for their health and only relied on what their care providers instructed (Sherman & Hilton, 2014). However, research has proved that patients have a role to play in ensuring their recovery as well as preventing illness. Adherence to care plans, quality of care, and patient safety are all related to patient engagement. Patient education is also responsible for reduced readmission rates and healthier communities. Moreover, empowered healthcare users can manage their health conditions and avoid hospitalization. The Affordable Care Act, enacted in 2010, further made patient engagement imperative by linking reimbursement to patient outcomes. Health care providers rely on their ability to achieve the intended health outcomes for reimbursement, which causes patient experience crucial (Sherman & Hilton, 2014). In this way, patients are given control over their health, a previously non-existent phenomenon. Many agencies, including the National Alliance for Quality Care and the Agency for Healthcare Research and Quality, have even become involved through providing health organizations with guidelines on patient involvement. Therefore, in present-day patients are part of the care team and have a say in deciding their care plans. Discussion 2 1) Katreina The model of negotiation, or the mutual participation model, “assumes both patient and health professional to be equal members of the interaction” (Falvo, pg. 226, 2011). This concept requires that both the health care professional and the patient work together to come to a mutual agreement for goals regarding treatment. In the patient education aspect, it requires that the health care professional and the patient form a bond that ensures the patient is an active participant in their learning, and that they are effectively absorbing the information. In all aspects of patient care, it means that the health care professional and the patient will work out problems together so that the solutions they come up with best meet the patient’s needs. A trusting and open relationship is necessary for the cooperation in all areas of patient care, which will require the health care professional to be culturally competent and unbiased (or aware of their biases) in order to take into account the patient’s desires. Whether the health care provider agrees with any or all of the patient’s wishes that deviate from the health care provider’s suggestions is irrelevant. The health care provider will negotiate with the patient to see if they can come to a mutual decision that achieves both their goals. For example, if the provider wants a new patient to begin chemotherapy immediately after the discovery of a late stage cancer in a new patient, and the patient does not want to be sick with the side effects, they need to find a solution. This may be that the patient takes a 3 week vacation with their family before returning to begin chemotherapy. It may not be ideal but the provider gets the patient to begin treatment and the patient gets a few last weeks of their “normal life” before starting a treatment that could save their life. 2) Therese The role of negotiation in patient education is to allow the patient and the health care professional participate in shared decision making to reach a compromise in order to meet a common goal. The role of the health care professional is to provide the patient with information, education, risks, and benefits in order to empower the patient to make an informed decision. With negotiation, the patient’s values, beliefs, background and attitudes are taken into consideration by the health care professional (Falvo, pp.232, 2011). It is considered patient-centered care because its ensures that the patient consider recommendations that they are agreeable to and receives treatment that they choose. However, when the patient chooses not to adhere to the recommendations, the health care professional must remain non judgmental and should keep channels of communication open to allow future opportunities for patient teaching and negotiation (Falvo, pp.234, 2011). 3) Tenzing Negotiation refers to a patient-centered type of physician-patient communication which combines the patient’s beliefs, values and circumstances with the doctor’s advice so that the result is shared decision-making. Gone are the old days of patriarchal relationship between physician and patient where all health treatment decisions were made by the physicians alone and the patients would just follow it. Nowadays with the use of modern technology like the internet the patients come in much prepared and aware of their medical issues, resulting often in negotiation between the provider and patient. Negotiation is seen as an effective treatment plan where the patient is willing and comfortable in following the treatment process as incorporated by both their decisions. The healthcare providers need to understand that if the patient is unwilling or the recommendations provided are unattainable/difficult for the patient without consulting with them or knowing their background conditions no matter how many times the patient is provided education it would be ineffective completely (Falvo, 2019). Therefore, better than not getting any improvement from the patient, being able to get the patient involved in his treatment plan, knowing his opinions and negotiating a treatment plan is so much effective while providing patient education in an effective communication.
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NUR799 Capella Preoperative Education Using One-On-One Counseling Peer Review

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NUR799 Capella Preoperative Education Using One-On-One Counseling Peer Review

Running head: PREOPERATIVE EDUCATION 1 PREOPERATIVE EDUCATION USING ONE-ON-ONE COUNSELING by Annie Daniel, MSN NP-BC Capstone Paper submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice Chatham University Date Signature Faculty Reader Date Signature Program Director Date PREOPERATIVE EDUCATION 2 Acknowledgments I would like to first acknowledge GOD for his grace, mercy, and blessings. I know that without GOD I would not have or be able to accomplish anything. I would like to acknowledge my faithful family and friends that were patient with me during this journey. To my beloved husband Daniel and my kids Rhema, Rebecca and Ryan, thank you all for being understanding of my tight time constraints due to school and work obligations. I would like to acknowledge my mom and dad for praying for me everyday and encouraging me all the time. I would like to acknowledge Dr. Sandra, for taking the time to precept me and always being available to meet and talk with me during this journey. Thank you, Chatham University staff, for being do helpful and willing to give me your time so I can truly understand the process. PREOPERATIVE EDUCATION 3 Abstract Start typing here…. Key words: PREOPERATIVE EDUCATION 4 Table of Contents

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Acknowledgments……………………………………………………………………………………………………X Dedication ………………………………………………………………………………………………………………X Abstract ………………………………………………………………………………………………………………….X Chapter One: Overview of the Problem of Interest ……………………………………………………..X Background Information ………………………………………………………………………………..X Significance of the Problem ……………………………………………………………………………X Question Guiding Inquiry (PICO) …………………………………………………………………..X Variables of the PICO question ……………………………………………………………X Summary ……………………………………………………………………………………………………..X Chapter Two: Review of the Literature/Evidence ……………………………………………………….X Methodology ………………………………………………………………………………………………..X Sampling strategies …………………………………………………………………………….X Inclusion/Exclusion criteria …………………………………………………………………X Literature Review Findings…………………………………………………………………………….X Discussion ……………………………………………………………………………………………………X Limitation of literature review. …………………………………………………………….X Conclusions of findings ………………………………………………………………………X Potential practice change …………………………………………………………………….X Summary ……………………………………………………………………………………………………..X Chapter Three: Theory and Model for Evidence-based Practice ……………………………………X Theory …………………………………………………………………………………………………………X Application to practice change……………………………………………………………..X PREOPERATIVE EDUCATION 5 Model for Evidence-Based Practice ………………………………………………………………..X Application to practice change……………………………………………………………..X Summary ……………………………………………………………………………………………………..X Chapter Four: Pre-implementation Plan …………………………………………………………………….X Project Purpose …………………………………………………………………………………………….X Project Management ……………………………………………………………………………………..X Organizational readiness for change ……………………………………………………..X Inter-professional collaboration ……………………………………………………………X Risk management assessment ………………………………………………………………X Organizational approval process …………………………………………………………..X Use of information technology …………………………………………………………….X Materials Needed for Project ………………………………………………………………………….X Plans for Institutional Review Board Approval …………………………………………………X Plan for Project Evaluation …………………………………………………………………………….X Plan for demographic data collection ……………………………………………………X Plan for outcome data collection and measurement ………………………………..X Plan for evaluation tool ………………………………………………………………X Plan for data analysis …………………………………………………………………X Plan for data management ……………………………………………………………………X Summary ……………………………………………………………………………………………………..X Chapter Five: Implementation Process ………………………………………………………………………X Setting …………………………………………………………………………………………………………X Participants …………………………………………………………………………………………………..X PREOPERATIVE EDUCATION 6 Recruitment ………………………………………………………………………………………………….X Implementation Process …………………………………………………………………………………X Plan Variation ………………………………………………………………………………………………X Summary ……………………………………………………………………………………………………..X Chapter Six: Evaluation and Outcomes of the Practice Change …………………………………….X Participant Demographics ………………………………………………………………………………X Table or Figure X ……………………………………………………………………………….X Table or Figure X ……………………………………………………………………………….X Outcome Findings …………………………………………………………………………………………X Outcome One …………………………………………………………………………………….X Table or Figure X ……………………………………………………………………………….X Table or Figure X ……………………………………………………………………………….X Summary ……………………………………………………………………………………………………..X Chapter Seven: Discussion ………………………………………………………………………………………X Recommendations for Site to Sustain Change …………………………………………………X Plans for Dissemination of Project ………………………………………………………………..X Project Links to Health Promotion/Population Health ……………………………………..X Role of DNP-Prepared Nurse Leader in EBP ………………………………………………….X Future Projects Related to Problem ……………………………………………………………….X Implications for Policy and Advocacy at All Levels ………………………………………..X Summary ……………………………………………………………………………………………………X Chapter Eight: Final Conclusion ……………………………………………………………………………….X Clinical Problem …………………………………………………………………………………………..X PREOPERATIVE EDUCATION 7 Evidence Base ………………………………………………………………………………………………X Theory and Model for Evidence-based Practice ………………………………………………..X Project Management ……………………………………………………………………………………..X Project Implementation ………………………………………………………………………………….X Outcome Findings …………………………………………………………………………………………X Discussion Summary …………………………………………………………………………………….X Final Conclusions…………………………………………………………………………………………………….X References ………………………………………………………………………………………………………………X Appendix A: XXXXXX ………………………………………………………………………………………….X Appendix B: XXXXXX …………………………………………………………………………………………..X Appendix C: XXXXXX…………………………………………………………………………………………..X Appendix D: XXXXXX ………………………………………………………………………………………….X Appendix E: XXXXXX …………………………………………………………………………………………..X Appendix F: XXXXXX …………………………………………………………………………………………..X Appendix G: XXXXXX ………………………………………………………………………………………….X Running head: PREOPERATIVE EDUCATION 8 Chapter One: Overview of the Problem of Interest Surgery is an important event in an individual’s life, impairing physical functioning thereby fear, anxiety and depression may be experienced by the patient (Ramesh et al., 2017), In 2008, more than 22 million surgeries were performed over 5,000 Ambulatory Surgery Centers in the United States. Surgery can be a significant and potential danger to the patient’s health and may cause psychological reactions such as anxiety (Gezer & Arslan, 2019). With thousands of patients having elective surgery on a daily basis, it is essential that these patients are adequately prepared prior to their surgery (Kruzik, 2009). Preoperative education is widely used by healthcare professionals all over the world to help patients prepare for their impending surgery and postoperative needs (Spalding, 2004). Preoperative education is a key element of the Enhanced Recovery After Surgery (ERAS) protocols and guidelines (Foss, 2011). Preoperative education leads to significant improvements in patient satisfaction, surgical outcomes, and reduction in patient’s anxiety. Background Information Each year, an estimated 234 million major surgical procedures are conducted worldwide (Fink et al., 2013). Evidence suggests that postsurgical complications occur in at least seven million cases annually, resulting in up to one million deaths. These figures illustrate the tremendous socio-economic burden associated with postoperative morbidity and mortality (Fink et al., 2013). Patients suffer needlessly due to inadequate preoperative preparation and lack of information regarding their postoperative course as indicated by reports of unexpected pain, fatigue, and the inability to care for themselves (Fink et al., 2013). The prevention of these postoperative complications is of the highest medical interest and importance. The impact of well drafted standardized preoperative patient education will result in positive postoperative outcomes PREOPERATIVE EDUCATION 9 (Fink et al., 2013). This suggests that there is a need for improved efforts from all healthcare providers to step up and design preoperative educational interventions for better patient preparedness, reduce their anxiety and post-operative complications. In late 2016, the American College of Surgeons (ACS) became the national home for Strong for Surgery which is a pre-surgical health optimization program (American College of Surgeons, 2016). The ACS has begun administering and promoting STRONG as a quality initiative aimed at identifying and evaluating evidence-based practices to prepare and optimize the health of patients before their operations. Strong for Surgery was developed by surgeons and empowers hospitals and clinics to integrate checklists into the preoperative phase of clinical practice for elective operations. These checklists are used to screen patients for potential risk factors that can lead to surgical complications, and to provide appropriate interventions to ensure better surgical outcomes (American College of Surgeons, 2016). The project implementer’s clinical practice site is an inpatient facility which conducts approximately 40 surgeries a day, including same-day surgery and inpatients. In the project implementer’s clinical practice site only about 50 % of the patients are told by their surgeons to come to the pre-surgical testing area prior to their elective surgery. The preoperative surgical patients either come 1 to 2 days before their surgery, but the majority of them arrive on the day of their surgery. As a result, these patients are not be given the adequate preoperative counseling. Even if they receive preoperative counseling, there is less time for them to be prepared; for example, proper preoperative diet, exercise, medication management, smoking cessation, and comorbidities such as diabetes and hypertension to be under control. The key principles of the ERAS protocol include preoperative counseling, preoperative nutrition, avoidance of perioperative fasting and clear liquids up to 2 hours preop. But according PREOPERATIVE EDUCATION 10 to traditional surgical doctrine patients are instructed to take nothing by mouth (NPO) from mid night by the surgeons to avoid pulmonary aspiration after elective surgery; however, there is no evidence to support this. Melnyk, Casey, Black and Koupparis (2011) stated that, preoperative fasting actually increases the metabolic stress, hyperglycemia and insulin resistance, which the body is already prone to during the surgical process. Despite the significant body of evidence indicating that ERAS protocols lead to improved outcomes, the ERAS protocols challenge traditional surgical doctrine, and as a result, their implementation has been slow (Melnyk, Casey, Black and Koupparis, 2011). Significance of Clinical Problem Patients must be appropriately educated before any surgical procedure to ensure they understand the complete process and to improve surgical outcomes (Wunderle, Bena & McClelland, 2017). When patients are not adequately prepared for surgery, there is a high chance that their surgery can be canceled on the day of surgery. Surgery cancelations on the operative day cause a huge impact on the organizational effectiveness and the patient satisfaction. Further, preoperative education plays a major role in prevention of post operative complications. Complications such as Surgical Site Infection (SSI) increase the length of the patient’s stay. The Center for Disease Control (CDC) health care – associated infection (HAI) prevalence survey found that there were an estimated 157,500 surgical site infections (1.9%) in 2008 among the inpatient surgical patients (CDC, 2018). Surgical site infections remain a substantial cause of morbidity, prolonged hospitalization and mortality of the patients. The implementer’s clinical practice site’s SSI task force data showed that the SSI rates among surgical patients was 2.2% in 2017. The preoperative education provides information to patients regarding the measures that can be used to prevent post-operative complications. A well- PREOPERATIVE EDUCATION 11 designed preoperative education with emphasis on SSI prevention measures such as usage of Hibiclens showering prior to surgery, hand hygiene and wound care may result in decrease rate of SSIs. Other postoperative complications such as venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) affects an estimated 300,000600,000 individuals in the U.S each year causing significant mortality and morbidity (Beckman et al., 2010). VTE is a leading cause of preventable hospital death in the Unites Stated (CDC, 2015). VTE is the fifth most frequent reason for unplanned hospital readmissions after surgery (CDC, 2015). A recent study of almost 500,000 surgeries performed at Department of Affairs (VA) hospitals found that about 4 in 10 patients developed VTE after surgery while they were still in hospital and approximately 6 in 10 surgical patients developed VTE up to 90 days after discharge from hospital (CDC, 2015). The implementer’s clinical practice site performance improvement (PI) data reported a significant increase in VTE rates in 2017. Preoperative education plays a major role in educating patients in prevention of such complications. Preoperative education regarding the early ambulation after surgery helps the patient to be more compliant, thereby reducing the risk of VTE. In addition, Oshodi (2007) suggested that preoperative information about surgical procedures and outcomes alleviates patient anxieties, lessens the need for postoperative analgesia, and allows the patient to be discharged earlier. The patients when educated before surgery know what to expect after their procedure, such as pain. Through preoperative education, the capability of patients to take care of themselves improves through meeting their postoperative self-care needs at home (Oshodi, 2007). For example, information about PREOPERATIVE EDUCATION 12 appropriate behavior after discharge (mobility, exercise, relaxation, appropriate diet or adequate pain control) will facilitate full recovery and prevents postoperative complications. Question guiding inquiry (PICO). A clinical question needs to be relevant to the patient or problem in the current practice, it should facilitate the search for the solution. PICO makes the search process easier. The formulation of a question used to challenge a current practice and provide evidence for new practice change is called a “PICO” question. The “P” stands for patient or problem, “I” for intervention, “C” for control/comparison and “O” for outcome. (Melnyk & Fineout-Overholt, 2015). The PICO question that guided a literature inquiry for the problem of surgical patients is: In pre-surgical patients, does individualized one-on-one pre-operative counseling decrease the post-operative complications? Variables of the PICO question Population. The population of interest was individuals eighteen years of age and older located in New Jersey. Patients who participated were scheduled for ortho-spine procedures and was not limited by gender, education, nationality, religion, ethnicity, or race. The targeted population of interest that participated in the EBP change project were 18 years of age and older. Intervention. The intervention for this project was the implementation of individualized one-on-one pre-operative counseling. Educational materials and a question and answer session were offered during the educational session. Comparison. There was no comparison group, but a comparison was made to assess the fear and anxiety of pre-surgical patients. There was a pre-test given before the start of the educational session. Immediately after the educational session, the participant was given a surgical fear post- test to determine if there were a decrease in fear and anxiety. PREOPERATIVE EDUCATION 13 Outcomes. Knowledge is the first step of prevention; therefore, the intended outcome of the EBP change project is to reveal if an increase in knowledge and decrease in fear occurred by comparing the pre-test and post-test scores after the educational sessions. Summary Preoperative education provides the surgical patients with the pertinent information concerning the surgical process and the intended surgical procedures, as well as anticipated patient behaviors (e.g., anxiety, fear); expected sensations; and probable surgical outcomes (Kruzik, 2009). Preoperative teaching plays a vital role in preoperative, intraoperative and postoperative management of patient. The preoperative education can help patients to be prepared for surgery, to decrease post-operative pain, reduce length of stay, decrease anxiety and increase patient satisfaction (Garretson, 2004). Lack of preoperative education can lead to postoperative complications such as DVT, SSI. PREOPERATIVE EDUCATION 14 Chapter Two: Review of the Literature Preoperative education includes instruction about the preoperative period, the surgery itself, and the postoperative period. Patients who undergo surgical procedures experience a high level of stress and anxiety, which could have negative consequences on post-operative outcomes. Patient education appears to be effective in improving knowledge and reducing days of stay at the hospital (Chevillon, Hellyar, Madani, Kerr and Chae, 2015). The goal of preoperative education is to not only prepare the patient for their surgery, but also to prepare them for what to expect following the surgery. Patient preparedness for surgery has important implications for patient satisfaction and the perception of improvement after surgery (Greene et al., 2017). Anxiety has been noted among patients who have been waiting for scheduled procedures ( Harkness, Morrow, Smith, Kiczula, and Arthur, 2003). Nurse-initiated preoperational education and counseling was associated with a reduced rate of perioperative complications and a reduced level of anxiety following surgery (Ji et al., 2012). Therefore, it is crucial that the patients are adequately educated and prepared for their surgery. To this end, various types of preoperative education have been evaluated to help reduce patient’s anxiety and complications after surgery. The purpose of this paper is to provide an overview of the literature regarding preoperative education. This chapter will review the literature regarding specific interventions utilized in preoperative education. Methodology In order to study the concept of preoperative education and its importance in patient preparedness, a comprehensive literature review was performed. After considering the concept and perusing several articles through the online library and databases, the decision was made on the possible search terms that will be covered to find scholarly articles on preoperative education PREOPERATIVE EDUCATION 15 and its importance in preparing the patients. The selection of the literature was based on the level of evidence and the relevancy to the EBP change project. Sampling strategies. The databases searched for the literature review were as follows: ProMED , CINAHL Complete, the allied and complementary medicine database (AMED), EBSCO Host, PyscINFO, the Cochrane Database of Systematic Reviews on preoperative education. The key terms included preoperative teaching, preoperative education, preoperative preparation, surgery preparedness, preoperative teaching and anxiety, preoperative education and surgery, preoperative teaching and surgical site infection, preoperative education and postoperative complications using the Boolean operator AND. Google scholar search was also performed to include possible additional literature. Please see Appendix A for the Literature Search Strategy Log. Inclusion /Exclusion Criteria. After performing a literature review, titles were reviewed for relevance. If the title was unclear, the abstract was reviewed. Articles were included for further review if they related to preoperative education and preoperative teaching. Exclusion criteria included articles not in English and published prior to 2012. A hierarchical rating system for evaluation of strength of the evidence was used in evaluating articles for inclusion or exclusion. As part of the EBP process, assessing individual articles for strength of the evidence is appropriate to ensure that findings are “best evidence” (Melnyk & Fineout-Overholt, 2015, p. 11). Articles were ranked according to the following Rating System for the Hierarchy of Evidence for Intervention/Treatment Questions: Level I: Evidence from a systematic review or meta-analysis of all relevant RCTs Level II: Evidence from well-designed RCTs Level III: Evidence obtained from well-designed controlled trials without randomization PREOPERATIVE EDUCATION 16 Level IV: Evidence from well-designed case-control and cohort studies Level V: Evidence from systematic reviews of descriptive and qualitative studies Level VI: Evidence from single descriptive or qualitative studies Level VII: Evidence from the opinion of authorities and/or reports of expert committees (Melnyk & Fineout-Overholt, 2015, p. 11). Articles from Level I through Level VI were considered for inclusion. The total number of articles reviewed was 695. Of those, the total number kept for inclusion was 30. Literature Review Findings In many institutions, when a patient is scheduled for surgery, the patient is contacted before the procedure and given instructions as to how to prepare for the surgery. Preoperative anxiety is a common occurrence leading up to procedures in a hospital setting, owing to fear of the unknown and loss of control, and may cause an array of detrimental physiological effects (Chevillon, Hellyar, Madani, Kerr, and Son Chae, 2015). Preoperative education may be done by staff from the surgeon’s office or staff at the institution where the surgery will be performed. Some institutions also send written instructions. Often the patient is anxious and may have difficulty understanding or remembering the instructions. It has been repeatedly proven a well instituted preoperative education reduces anxiety, and post-operative complications (Greene et al., 2017). It is essential in helping presurgical patients cope with these changes and to recover quickly after surgery. Surgical patients who perceive they did not receive proper preoperative education experience more dissatisfaction after surgery and have greater difficulty understanding the changes they face (Guo, 2015). According to Chevillion et al. (2015) patient education appeared to be effective in improving knowledge and reducing days of mechanical ventilation. Preoperative pain PREOPERATIVE EDUCATION 17 neuroscience education (NE) for lumbar radiculopathy resulted in significant behavior change. Despite a similar pain and functional trajectory during the 1-year trial, patients with LS who received NE viewed their surgical experience more favorably and used less health care facility in the form of medical tests and treatments (Louw, Diener, Landers and Puentedura 2014) Preoperative education is a broad term that encompasses many modalities. Common preoperative teaching techniques include a) instructional printed material, b)one-on-one sessions, c) group classes, d) seminars, e) counseling, f) video tapes, g) picture guides, h) online apps, and i)YouTube videos. The amount of pre-surgical information and education to which a patient is exposed has shown to improve the patient’s overall anxiety and stress levels (Gadler, 2016; Liebner 2015). It also highlights the need for incorporating education into all phases of the perioperative process, beginning in the preoperative period. Perioperative educators should address all learning styles that provide education in a simple and cost-effective way to appeal to all patients and help to reduce postoperative complications and increase patient satisfaction. One-on-one education and individual teaching can decrease their anxiety and gain reassurance while allowing patients to obtain specific information more pertinent to them. According to Kalogianni et al. (2016), preoperative education delivered by the nurses reduced anxiety and postoperative complications of patients undergoing surgery. By providing preoperative education by inpatient urology RN decreased patients’ anxiety, answered their questions, and introduced the urinary catheter and leg bag. This helps patients develop confidence and autonomy after hospital discharge (Delano, 2017). According to Guo et al. (2012) Chinese patients undergoing cardiac surgery who received preoperative education experienced a greater decrease in anxiety score (mean difference −3.6 points, 95% confidence interval −4.62 to −2.57; P
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SUNY Upstate Weeks 3 & 4 Legal and Ethical Issues Case Studies Questions

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SUNY Upstate Weeks 3 & 4 Legal and Ethical Issues Case Studies Questions

Weeks 3 & 4 Content Online Assignment

Summer 2019

The learning objectives for this assignment are stated in the beginning of each chapter assigned (Textbook-Yoder-Wise, 6th edition)

Instructions:

Read the following case studies. Answer all the questions below related to each chapter assigned.

Chapter 4: Legal and Ethical Issues

Ethical and Critical Decision Making – Ethical and critical decision making requires the

ability to make distinctions between competing choices. The thinking process involved in

making such decisions can follow many formats, but in all cases, it is a deep-thinking process– sometimes called critical thinking. In complicated cases the use of ethical decision-making models can help clarify what the competing ethical principles are, and what information should be thinking about.

What goes into ethical decision making? Consider these five steps:

1. Is It an Ethical Issue? Being ethical does not always mean following the law. And just because something is possible doesn’t mean it is ethical, hence the global debates about biotechnology advances such as cloning. And ethics and religion do not always concur. This is perhaps the trickiest stage in ethical decision making, as sometimes the subtleties of the issue are above and beyond our knowledge and experience. Listen to your instincts – if it feels uncomfortable making the decision on your own, get others involved and use their collective knowledge and experience to make a more considered decision.

2. Get the Facts. What do you know, and just as importantly, what don’t you know? Who are the people affected by your decision? Have they been consulted? What are your options? Have you reviewed your options with someone you respect?

3. Evaluate Alternative Actions. There are different ethical approaches which may help you make the most ethical decision.

a. Utilitarian Approach – which action results in the most good and least harm?

b. Rights Based Approach – which action respects the rights of everyone involved?

c. Fairness or Justice Approach– which action treats people fairly?

d. Common Good Approach – which action contributes most to the quality of life of the people affected?

e. Virtue Approach – which action embodies the character strengths you value?

4. Test Your Decision. Could you comfortably explain your decision to your mother? To man in the street? On television? If not, you may have to re-think your decision before you take action.

5. Just Do It – Make a Decision and Go. Once you’ve made the decision, then don’t waste time in implementing it. Set a date to review your decision and make adjustments if necessary. Often decisions are made with the best information to hand at the time, but things change, and your decision making needs to be flexible enough to change too. Even a complete about face may be the most appropriate action further down the track.

Case Study 1

Nurse Smith has been working in the Critical Care Unit for 18 months. One evening John, a 40-year-old male patient, was admitted with a serious head injury. He has a history of mental illness and has been living with his 80-year-old parents for the last 15 years. After being on life support for 3 days his parents came to the Unit and stated they wanted everything stopped and to have him removed from life support. After taking the appropriate measures, the team began to remove the life supporting equipment. After removing his breathing tube, John opened his eyes and looked at his family. He said to them “Why are you trying to kill me?” As the nurse assigned to John, what would you do?T

DECISIONETHICAL DECISION MAKING WORKSHEET

Answer these questions:

Using the Ethical Decision-Making Framework as a guide above, think through the ethical issues in the scenario identified and determine what decision you would make.

Is It an Ethical Issue?

2. Get the Facts.

3. Evaluate Alternative Actions.

4. Test Your Decision.

5. Just Do It – Make a Decision. What did you decide and what did you learn?

Case Study 2

Mrs. M is a 75-year-old widow who lives alone in a small house that she and her husband built during the first few years of their marriage. Before his death 2 years earlier, Mrs. M had cared for him at home with the assistance of a home health aide. The community health nurse who visited her husband also taught Mrs. M how to be more independent in the management of her own chronic illnesses. Since her husband’ s death, the community health nurse and Mrs. M have remained friends, and they see each other once or twice a month.

Mrs. M was doing well until 4 months ago, when she experienced an episode of dizziness and fell. She was examined by her physician, who could find no physical injury but hospitalized her for further evaluation of the dizziness and a possible altered mental state. In the hospital, Mrs. M fell while being ambulated with the assistance of two certified nursing assistants. The fall caused both her left hip and left arm to be broken, and Mrs. M underwent surgery for a left hip replacement. Her left arm was set. She also underwent a full rehabilitation program after the hip replacement surgery and was admitted to a skilled nursing home for a short time. When Mrs. M was discharged, a referral was made to the community health nursing agency to provide services so that Mrs. M could safely remain at home.

Mrs. M has been capable and independent all her life, so she has found it difficult to acknowledge the changes that have come with aging and the increasing limitations imposed by her chronic illnesses. Since her return home, she has responded positively to nursing counseling about her functional health status and has participated actively in a plan to meet her changing daily living needs. She has developed a stronger and more therapeutic nurse-client relationship with the community health nurse, as the same nurse who had cared for Mr. M was assigned to Mrs. M’s care.

Mrs. M has also responded well to the services of a home health aide who visits weekly to provide personal care and light housekeeping. The community health nurse visits once a month. Neighbors help with shopping, occasional meal preparation, and general monitoring. Mrs. M’s sole family member is a married daughter who lives with her family in a distant state. Although they talk frequently by phone, the daughter has not visited since her father’s funeral 2 years earlier.

Recently, Mrs. M’s long-time physician retired, and she is now seeing a different physician. After Mrs. M’s second office visit with this new physician, the community health nurse received a call from the physician. The physician said he had told Mrs. M that she must sell her house and move into a nursing home permanently. He gave this advice because, “She is an old woman. Her health will not improve, and she is at risk for falling or having an acute exacerbation of her primary illnesses that will probably lead to disability or death. She should not live alone.” The physician then added, “Mrs. M became confused and emotional. She refused to listen to me. We must do what is best for her, as she is incapable of a rational decision. You need to tell her that she must go to a nursing home, as she said she would talk with you.” The primary community health nurse acknowledged that Mrs. M does have known health risks, but when she tried to describe Mrs. M’s safe-care abilities, the safe home environment, and the community services, the physician replied, “Just follow orders,” and abruptly ended the phone conversation.

Questions:

What legal and ethical issues are presented?

As a nurse manager, what advice would you give the staff nurse regarding this client?

Chapter 9: Cultural Diversity in Health Care (Please select 2 out of 3 Case Studies below)

Case Study 1

Mr. A is a 70-year-old Egyptian male who speaks only Arabic. He was diagnosed with a meningioma by means of magnetic resonance imaging (MRI) in Egypt. Mr. A and his family came to the United States for better treatment of his meningioma. A craniotomy was performed for the removal of the tumor. The surgery produced no complications, and Mr. A was moved to the surgical intensive care unit (SICU) for observation. The SICU does not have open hours for visiting. The RN assigned to Mr. A does not speak Arabic, nor does the patient’s wife speak or understand English. Mr. A’s son speaks some English and was able to translate some words. It was reported to the oncoming day shift that Mr. A had had a very restless first postoperative night. When the assigned male RN came on at 7 am, Mr. A was trying to tell him something that seemed urgent. Mr. A’s family was unable to be located in the SICU waiting room, and an Arabic translator was not available at the time.

Mr. A appeared agitated as he repeatedly pointed to his head, making a circle with his fingers. The male RN had difficulty with verbal and nonverbal communication with Mr. A. The RN did a neurological assessment and took his vital signs, which were within normal limits. The RN expressed his need to the nurse manager to have the patient’s son available to translate for Mr. A so as to determine his level of pain. However, the RN did not want to give Mr. A pain medication because of a scheduled MRI.

Questions:

What might be some nonverbal cues for assessing Mr. A’s pain?

What could Mr. A’s son and the RN staff have done to prevent communication barriers from occurring?

If the SICU does not have a policy for open visiting or a specific hospital translator, is it fair to let a family member remain at the patient’s bedside for the purpose of communication? Provide pros and cons for your answer.

What ethical values and legal principles should be considered in this situation?

Case Study 2

Mrs. C, an 87-year-old, frail, widowed, African-American female is a patient in a skilled nursing unit in a healthcare center that has a culturally diverse staff. Mrs. C has moderate multi-infarct dementia and a history of bronchiectasis. Following her breakfast and while morning care is being given, Mrs. C suddenly starts coughing and producing a moderate amount of bright red blood. The patient does not have a signed advance directive in her chart; however, there is a written do not resuscitate (DNR) order on the physician order form. Mrs. C’s only living child, a daughter, resides in another city about 1000 miles away.

Questions:

What immediate nursing action should be taken by the licensed or unlicensed nursing staff on duty?

What nursing action should be taken by the nurse manager or the licensed nurse designate?

What are your state’s laws concerning advance directives (living wills)? What are its laws concerning directions to physicians, family, and surrogates? What is to be done if none of these are in effect for a patient?

Consider this situation: What if AND (allow natural death) had been written on the patient’s chart by the physician? Does AND have the same meaning as DNR to you and other unit staff members? Discuss why or why not. Are there any cultural implications or values to be considered in caring for this patient?

Case Study 3

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A neurological intensive care nurse is assigned to care for a 16-year-old married Hispanic male patient who the physician has determined is brain-dead as the result of a severe head trauma. His mother’s and stepfather’s requests are that his organs not be donated for transplantation.

Questions:

What actions should the nurse consider while taking care of this patient?

What knowledge does the licensed nurse need to have about advance directives in this situation?

What rights does the patient’s wife have in this situation?

What ethical values and legal principles should be considered in this patient’s situation?

NURS6551 Walden Womens Health Prenatal Care Case Study Paper

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NURS6551 Walden Womens Health Prenatal Care Case Study Paper

3 references within 7 years, apa

After confirming and dating a pregnancy, you must collaborate with patients to develop a personalized care plan. These pregnancy care plans are integral to prenatal care as they help to ensure the mother and child’s well-being throughout the entire pregnancy. Pregnancy can be a wonderful, yet difficult time for women as a woman’s body goes through many physical, mental, and emotional changes that might be challenging or even overwhelming for some. Whether or not these women share their concerns, as the advanced practice nurse, you must routinely watch for signs and symptoms of any developing physical or mental health issues. By collaborating with patients and discussing concerns, you can modify care plans and often address potential issues before they become a significant health problem. For this Discussion, consider pregnancy care plans for the women in the following case studies:

CASE STUDY 1:

On 1-15-13, you are seeing a 25-year-old Caucasian female in the clinic because she believes she’s pregnant. Her LMP was 12-1-12. Her home pregnancy test was positive, and she has been having nausea and breast tenderness.

  • Review and select one of the two provided case studies. Analyze the patient information.
  • Consider how to date the pregnancy and estimate the date of delivery for the patient in the case study you selected.
  • Based on the dating of the pregnancy, reflect on the appropriate clinical guidelines for procedures and screenings. Think about the implications of any missed procedures or screenings.
  • Determine a plan of care for the patient. Identify procedures, screenings, diagnostic testing, pharmacologic and nonpharmacologic treatments (if appropriate), management strategies, and patient education.

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BY DAY 3

Post the estimated date of delivery for the patient in the case study you selected. Include an explanation of how you dated a pregnancy and which of the patient’s factors led to your estimated date of delivery. Then, based on the dating of the patient’s pregnancy, explain the appropriate clinical guidelines for procedures and screenings. Explain implications of any missed procedures and/or screenings. Finally, explain a plan of care for the patient, including procedures, screenings, diagnostic testing, pharmacologic and nonpharmacologic treatments, management strategies, and patient education.