Nursing homework help

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Nursing homework help

Patrick Realon

Posted Date

Mar 31, 2022, 8:25 AM

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Postoperative cerebrospinal fluid (CSF) leak is a well-known complication following transsphenoidal surgery for sellar lesions, with a reported incidence in the range of 8.6%–15.9%. Its occurrence may result in meningitis, and prolonged treatment or reparative surgery are required in some patients. Following transsphenoidal surgery, patients are at risk for developing a variety of neuroendocrine or other postoperative complications, which can potentially be minimized or prevented by maintaining a high degree of awareness for such issues on the part of the neurosurgical team and nursing staff. Serial clinical monitoring of a patient’s neurological and visual status is imperative following transsphenoidal surgery, as patients may develop untoward complications such as postoperative hematomas, epistaxis, ischemic events, hydrocephalus, CSF leaks, or meningitis. Maintaining a constant state of vigilance for these uncommon, but serious, events in all patients is absolutely critical. If a CSF leak is suspected in the postoperative period, a noncontrast CT scan of the head is a useful study that may demonstrate the presence of intracranial air in the event of a CSF leak. Although the majority of patients do not require insertion of nasal packing at the time of surgery, some patients (especially those with or intraoperative CSF leaks requiring sellar floor reconstruction, Cushing’s Disease, and acromegaly) may benefit from their insertion. If used, nasal packing can typically be removed on postoperative day one. Postoperative epistaxis infrequently develops following transsphenoidal surgery and can typically be treated successfully with routine nasal packing for 2-3 days. In rare refractory cases of epistaxis, reoperation or endovascular embolization of an arterial bleeder may be required (Sun et al., 2018). Nursing homework help

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Aberrancies of fluid homeostasis and serum electrolytes occur quite commonly following transsphenoidal surgery. An understanding of the underlying physiology, coupled with monitoring of a patient’s volume status, as well as serum and urine laboratory studies, may make a significant difference in a patient’s postoperative course. Although a foley catheter is not inserted at the time of surgery in the majority of patients at our institution, strict measurement of a patient’s intake, output, and daily weight should be carried out in order to provide a continuous assessment of volume status.  Patients with preoperative evidence of hypopituitarism should be maintained on sufficient stress doses of hormonal replacement during the initial perioperative period, and then kept on physiological maintenance doses of replacement agents until it is appropriate to assess their pituitary function in a controlled manner. Patients with evidence of hormonal excess typically undergo appropriate lab testing during the first few days following surgery to assess for evidence of early endocrinological remission (Sun et al., 2018).

Primary reconstruction techniques use autologous grafts (e.g., fascia lata) or a pedicled nasoseptal flap to reconstruct the skull base when a CSF leak occurs during or after surgery. However, due to the unpopularity of endoscopy and unfamiliarity with this reconstruction method in surgery department, we used alternative repair methods and also obtained excellent results. Most patients chose conservative methods for CSF rhinorrhoea repair, with surgical repair used only if conservative treatment failed. Our strategies often eliminated the need for additional surgery; however, conservative treatment may increase the risk of infection, duration of hospitalization and economic and psychological burden on the patient. Surgical repair should be performed as soon as general clinical conditions allow if diagnostic assessments have detected CSF rhinorrhoea and identified the exact site of the leak. They concluded that clinical presentation and office-based endoscopic nasal exam were of primary importance to evaluate suspected CSF leaks. Prospective randomised controlled studies are needed to clarify the optimal approach and time window for surgical repair of CSF rhinorrhoea (Zhang et al., 2017).

Endoscopic endonasal pituitary surgery differs from the transsphenoidal microsurgery in the following aspects: plane vision, close-up view, no nasal speculum, endonasal approach and ample vision field. Microscopy features a three-dimensional visualisation, wider view and use of a transnasal speculum. Use of the endoscope during TSS is important in that it allows maximum tumoural excision and better visualisation of a small CSF fistula. Because of the enhanced illumination and visualisation of lesions, endoscopic surgery for CSF rhinorrhoea is more reliable and convenient than traditional TSS. In addition, we found that the endoscopic approach enables precise confirmation of the leakage site, sufficient exposure, minimal invasiveness and high rate of success. Although endoscopy was underutilised initially in our department, we subsequently used endoscopy to repair CSF leakage with excellent results. We therefore strongly recommend endoscopy for surgical repair as well as tumour removal (Zhang et al., 2017).

Following discharge, patients are usually seen in the clinic for routine follow-up one week after surgery, then again at the 6-week postoperative time point for routine endocrine and postoperative evaluation, to account for equilibration of the hypothalamic-pituitary-adrenal axis as well as the longer half-life of thyroid hormone. Postoperative MR imaging is obtained 3 months following the operation, to allow sufficient resolution of postoperative changes prior to any meaningful assessment regarding the extent of tumor resection. Routine imaging studies may then be obtained annually, or more often as indicated. Patients with sellar pathology may have delayed tumor recurrences occurring up to several years after successful remission, therefore mandating continued endocrinological and imaging surveillance, even beyond a decade following initial remission (Sun et al., 2018).

References:

Sun, I., Lim, J. X., Goh, C. P., Low, S. W., Kirollos, R. W., Tan, C. S., Lwin, S., & Yeo, T. T. (2018). Body mass index and the risk of postoperative cerebrospinal fluid leak following transsphenoidal surgery in an asian population. Singapore medical journal, 59(5), 257–263. https://doi.org/10.11622/smedj.2016159

Zhang, C., Ding, X., Lu, Y., Hu, L., & Hu, G. (2017). Cerebrospinal fluid rhinorrhoea following transsphenoidal surgery for pituitary adenoma: Experience in a Chinese centre. Rinoliquorrea dopo chirurgiadell’adenomaipofisario con approcciotransfenoidale: esperienza in un centrocinese. Acta otorhinolaryngologicaItalica : organoufficialedellaSocietaitaliana di otorinolaringologia e chirurgiacervico-facciale, 37(4), 303–307. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584102/

 

Nursing homework help

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Nursing homework help

Transsphenoidal surgery is the approach of choice for pituitary adenomas and is indicated when the mass impacts the function of other surrounding structures (Melmed & Jameson, 2018, p. 2672).  The common symptoms from a local mass effect of a pituitary tumor are headache and visual disturbances; and other symptoms that vary by adenoma type (Melmed & Jameson, 2018, p. 2671). Postoperative central diabetes insipidus (CDI) is a result of damage to the pituitary stalk, hypothalamic injury, or a disruption in the hypothalamic-neurohypophyseal connections (Elisaus & Ball, 2021). This results in a deficiency of AHD and prevents concentration of urine in the renal collecting tubule. DI can be classified into three different types: nephrogenic, central, and dipsogenic (Elisaus & Ball, 2021). Nephrogenic occurs when there is a lack of renal response to ADH and dipsogenic occurs secondary excess fluid intake. To determine which etiology of DI is present; a water restriction test is performed. If urine concentrates with water restriction, then there is no DI; next desmopressin (dDAVP) is given and if urine concentrates then it is CDI; in nephrogenic DI, urine will not concentrate with either intervention (Elisaus & Ball, 2021). In this scenario, we know the patient is manifesting CDI secondary to a pituitary adenoma resection. CDI occurs transiently in 10-20% of transsphenoidal pituitary surgeries and is permanent in 2-7% of patients (Swearingen, 2021). Thus, post-operative transsphenoidal surgical patient should be closely monitored for CDI by monitoring urine output. Polyuria (3L/d) and polydipsia are hallmark symptoms of DI (Elisaus & Ball, 2021). A diagnosis can be made by a low urine osmolality (<250mosmol/kg) with high serum osmolality (>290mosmol/kg) and no hyperglycemia (Elisaus & Ball, 2021). Treatment for CDI is with DDAVP 5-20mcg/day and fluid replacement. Serum sodium, urine osmolality, and urine output help guide the continued need for dDAVP and fluid therapy (Swearingen, 2021). Typically, only one or two doses of dDAVP are needed (Elisaus & Ball, 2021). CDI can vary from mild to severe with the major concern of life-threatening hypernatremia and dehydration. Hypernatremia can manifest with neurologic symptoms of: confusion, restlessness, lethargy, seizures, and death. Severe volume depletion can cause circulatory collapse. For these reasons, post-op transsphenoidal patients are typically monitored in the ICU for the first 48 hours to monitor for the development of DI.  Nursing homework help

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References

Elisaus, P., & Ball, S. (2021). Diabetes insipidus. Medicine, 49(8), 495–497. https://doi.org/10.1016/j.mpmed.2021.05.009

Melmed, S., & Jameson, J. L. (2018). Pituitary tumor syndromes. In Harrison’s principles and practice of hospital medicine (20th ed.). McGraw Hill.

Swearingen, B. (2021). Transsphenoidal surgery for pituitary adenomas and other sellar masses. UpToDate. Retrieved March 31, 2022, from https://www.uptodate.com/contents/transsphenoidal-surgery-for-pituitary-adenomas-and-other-sellar-masses?search=transsphenoidal%20surgery&source=search_result&selectedTitle=1~35&usage_type=default&display_rank=1#H21307966

REPLYRLRommel Lantajo

Posted Date

Mar 31, 2022, 1:53 AM

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Diabetes insipidus (DI) is an uncommon neurological condition that accounts for 1 in every 25,000-patient population (Christ-Crain et al., 2021). The underlying clinical issue with DI comes as part of the polydipsia-polyuria syndrome, which is characterized by hypotonic urine and excessive polydipsia (Christ-Crain et al., 2021; Christ-Crain, 2020). The postoperative neurosurgical patient is prone to developing the central form of DI (Christ-Crain et al., 2021; Christ-Crain, 2020). The pathophysiological underpinning of central DI is the lack or inability of the posterior pituitary to secrete arginine vasopressin (Christ-Crain et al., 2021; Christ-Crain, 2020). The insufficient synthesis of arginine vasopressin in the hypothalamic neurohypophyseal system causes this inappropriate osmotic stimulation (Christ-Crain et al., 2021; Christ-Crain, 2020).  Nursing homework help

The clinical manifestation of Di is excessive urinary excretion, usually more than 50 mL per kilogram in 24 hours, and increased oral intake of water (Christ-Crain & Gaisl, 2021). The patient with DI will also present with serum hyperosmolar and hypernatremia associated with urinary hypo osmolar (Christ-Crain & Gaisl, 2021). Some patients may or may not present with fever, excessive sense of thirst, irritability, etc. (Christ-Crain & Gaisl, 2021). The main treatment in DI is to identify the primary cause, postoperative neurosurgery in this case (Christ-Crain & Gaisl, 2021). Therefore, it is vital that the provider must keep in mind that severe hyperosmolality from dehydration should be managed promptly (Christ-Crain & Gaisl, 2021). The water should be replaced by at least 50 % of the calculated free water deficit within 24 hours (Christ-Crain & Gaisl, 2021). The overcorrection of water can lead to unwanted neurological consequences such as cerebral edema, seizures (Christ-Crain & Gaisl, 2021). Furthermore, the management of diabetes insipidus should be focused on the prevention of secondary complications of excessive water intake, which can further cause severe fluid and electrolyte imbalances (Christ-Crain & Gaisl, 2021). In addition, a single dose of desmopressin is sufficient to treat neurosurgery-related DI (Christ-Crain & Gaisl, 2021).

References

Christ-Crain, M, Winzeler, B, Refardt, J. (2021). (University Hospital Basel, University of Basel, Basel, Switzerland). Diagnosis and management of diabetes insipidus for the internist: an update (Review). J Intern Med.,290(1), 73– 87. https://doi.org/10.1111/joim.13261

Christ-Crain M: Diabetes Insipidus: New Concepts for Diagnosis. Neuroendocrinology 2020;110:859-867. doi: 10.1159/000505548

Christ-Crain, M. & Gaisl, O. (2021). Diabetes insipidus. La Presse Médicale, 50 (4), 104093. https://doi.org/10.1016/j.lpm.2021.104093.

Nursing homework help

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Nursing homework help

For this assignment, you will develop a presentation on a realistic clinical case on a topic that is of interest to you. And then, use Canvas Studio’s Screen Capture feature to record (voice-over) your presentation. Develop your presentation based on a clinical case that was seen during your experience or a topic that is of interest to you. How do I record a Canvas Studio video with a webcam in a course?

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Content Requirements You will create a PowerPoint presentation with a realistic case study and include appropriate and pertinent clinical information that will be covering the following: Nursing homework help

  1. Subjective data: Demographics; Chief Complaint; History of the Present Illness (HPI) that includes the presenting problem and the 8 dimensions of the problem; Medications; Allergies; Past medical history; Family history; Past surgical history; Social history;  Review of Systems (ROS)
  2. Objective data: Vital signs; Physical exam, Labs (reviewed from the patient’s medical records, if no lab/diagnostic tests were done recently to review, you must indicate that to receive credit). Nursing homework help
  3. Assessment: Differential diagnosis; Primary Diagnosis
  4. Plan: Laboratory and diagnostic tests; Pharmacologic treatment plan; Non-pharmacologic treatment plan; Anticipatory guidance (primary prevention strategies); Follow up plan. Nursing homework help
  5. Other: Incorporation of current clinical guidelines; Integration of research articles; Role of the Nurse practitioner

Submission Instructions:

  • The presentation is original work and logically organized, formatted, and cited in the current APA style, including citation of references.
  • The presentation should consist of 10-15 slides and less than 5 minutes in length.  Nursing homework help
  • Incorporate a minimum of 4 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles and books should be referenced according to APA style (the library has a copy of the APA Manual). Nursing homework help

 

PICOT Question and Literature Research

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PICOT Question and Literature Research

 

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Clinic issue: pressure ulcer (pressure injury)

An Ulcer of Pressure is a localized injury to the skin and underlying tissue, usually over a bony prominence, as a result of pressure alone or pressure in conjunction with shear (Dorner et al., 2009). Today, pressure ulcers rank third in terms of cost after cancers and cardiovascular diseases. This disease has a mortality rate of two to six times higher than most other diseases, with 60,000 deaths occurring every year due to this complication(Schindler et al., 2011). Inpatients are more susceptible to pressure ulcers in the tissues of the extremities and in bony extensions such as the sacrum and heel. Pressure ulcers are most often caused by low physical activity, decreased consciousness, urinary and fecal incontinence, malnutrition, and advanced age (Afzali Borojeny et al., 2011). PICOT Question and Literature Research

In the United States, pressure ulcers are estimated to cause about 2.5 million hospitalizations (Kottner & Dassen, 2010). Pressure ulcers can result in pain, reduced autonomy, increased infection and sepsis risks, more surgical procedures, long hospital stays, and higher costs for patients, families, and health care systems (Stinson et al., 2013). In addition to physical-social and self-care dysfunction, pressure ulcer patients may also experience several complications such as depression, pain, topical infection, osteomyelitis, sepsis, and even death (Senmar et al., 2017).

Despite advances in medicine, pressure ulcers remain one of the most common medical problems. There is currently no consensus on the risk factors of pressure ulcers, so identifying them is the first step in preventing an increase in their incidence (Donnelly et al., 2011). The development of counseling and prevention systems for pressure ulcers in the USA and Europe has become so important because pressure ulcers pose a major concern for patients and healthcare providers(Reddy, Gill, & Rochon, 2006). PICOT Question and Literature Research

PICOT Question 

Population: patients who have developed pressure ulcer

The intervention of interest: patients who utilize pressure ulcer prevention strategies

Comparison: patients who are not been used pressure ulcer strategyies

Outcome: better or faster wound healing

Time: in the monitoring phase.

 

Are those pressure ulcer prevention strategies such as use use of specialty beds, turn and re-position, urinary catheter , nutritional consult better or faster for wound healing and prevention Compare patients who not been used pressure ulcer strategies.

 

 

 

Criteria Article 1 Article 2 Article 3
APA-Formatted Article Citation with Permalink Reddy, M., Gill, S. S., & Rochon, P. A. (2006). Preventing Pressure Ulcers: A Systematic Review. JAMA, 296(8), 974.doi:10.1001/jama.296.8.974 McInnes, E., Jammali-Blasi, A., Bell-Syer, S. E., Dumville, J. C., Middleton, V., & Cullum, N. (2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews.doi:10.1002/14651858.cd001735 Schindler, C. A., Mikhailov, T. A., Kuhn, E. M., Christopher, J., Conway, P., Ridling, D., … Simpson, V. S. (2010). Protecting Fragile Skin: Nursing Interventions to Decrease Development of Pressure Ulcers in Pediatric Intensive Care. American Journal of Critical Care, 20(1), 26–35.doi:10.4037/ajcc2011754

 

 
How Does the Article Relate to the PICOT Question? This article is relevant to general pressure ulcer prevention strategyies among patients who suffer pressure ulcers The aim of this systematic review is to determine the extent to which pressure-relieving support surfaces reduce the incidence of pressure ulcers compared to standard support surfaces, as well as their comparative effectiveness in ulcer prevention. This article is relevant to determine nursing strategies associated with a lower incidence of pressure ulcers.

 

 

 

 

 
Quantitative, Qualitative (How do you know?)                          methodological quality of randomized control trial                          Randomised controlled trials (RCTs) and quasi-randomised trials

 

  

Randomized clinical trial                                     multivariate logistic regression models

 

 

 

 
Purpose Statement To systematically review the evidence examining interventions to pre- vent pressure ulcers. To review which material of mattress or supportive surface can help relieve pressure ulcer To determine effective interventions associated with low pressure ulcer incident
Research Question Studies assessed three categories of interventions, namely those that addressed impairments of mobility, nutrition, and skin health.

 

 People at high risk of developing pressure ulcers should use higher-specification foam mattresses rather than standard hospital foam mattresses.

 

 

 

 Effective nursing care with targeted interven- tions can reduce the incidence of pressure ulcers.

 

 

 

 

 
Outcome Examed difference approaches: reposition on the special mattress, incontinence care, skin care, nutritional supplement all benefit for decrease or prevention  pressure ulcer

 

 higher-specification foam mattresses show more evidence to prevent pressure injury In this multisite study, we focused on determining the incidence of pressure ulcers among critically ill and injured infants and children, comparing the characteristics of patients with and without pressure ulcers, and identifying prevention strategies associated with fewer pressure ulcers.

 
Setting

(Where did the study take place?)

 Participants  from acute care, long term care,  rehab, and mixed setting

 

 

 Participants who have hight risk of pressure ulcer or some of them have pressure ulcer In PEDs ICU
Sample The 59 selected studies enrolled a total of 13 845 patients: 9397 (67.9%) in acute care, 2367 (17.1%) in LTC, 333 (2.4%) in re- habilitation, and 1748 (12.6%) in mixed settings People receiving health care who were deemed to be at risk of developing pressure ulcers, in any setting, total of included trials to 59 , in comparison 1, participant including

2407

 

 

 

 

 

 

 

 5346 patients in pediatric inten- sive care units in whom pressure ulcers did and did not develop were compared
Method Based on whether the intervention being evaluated addressed mobility, nutrition, or skin health impairments, RCTs were divided into three categories.

 

 Randomised controlled trials (RCTs) and quasi-randomised trials .

Trials that evaluated the following interventions included:

1. “Low-tech” CLP support surfaces

2. “High-tech” support surfaces

3. Other support surfaces

 

 

 The 29 separate preventive measures evaluated in this way were entered into the multivariate logistic regression models described above in order to determine which preventive measures had the greatest influence on pressure ulcer development..

 
Key Findings of the Study  Re-position on the special mattress, skincare, nutritional supple all affectively reduce incident happen High special supportive surface show show more benefit for preventing pressure ulcer Infants and chil- dren sink into low–air loss beds and specialty beds in turning mode, increasing occipital friction and shearing. Pressure ulcers were more likely in children who remained in the pediatric intensive care unit at least 4 days

Some of the pressure ulcers in our patients were related to devices.

Strategies associated with less frequent development of pressure ulcers included use of specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable under-pads, body lotion, nutrition consultations, change in body position every 2 to 4 hours, blanket rolls, foam wedges, pillows, and draw sheets
Recommendations of the Researcher The in-complete reporting in the RCTs may have influenced our assessment.  In future studies, the interventions required to prevent pressure ulcers specifically among high-risk populations should be defined. There are several risk factors for pressure ulcers, including being bedridden or chairbound, being unable to reposition without assistance, difficulty ambulating, history of stroke, fecal incontinence (which is highly related to immobility), low body weight, lymphopenia, difficulty feeding independently, impaired nutritional intake, nonblanchable erythema of intact skin (ie, stage 1 pressure ulcer), and dry sacrum. The study also found that people who used sheepskin overlays for their mattresses tended to develop fewer pressure ulcers. In contrast to high-specification constant low-pressure or alternating-pressure support surfaces, there is little evidence that alternating-pressure mattresses can prevent pressure ulcers more effectively than alternating-pressure overlays. These patients may benefit from targeted nursing interventions to reduce pressure ulcers. We plan to conduct a prospective randomized clinical trial to confirm that specific nursing interventions improve outcomes.  During the study, critical care nurses will have access to a set of interventions that can significantly reduce pressure ulcer risk in critically ill children and infants

 

Criteria Article 4 Article 5 Article 6
APA-Formatted Article Citation with Permalink Medical Advisory Secretariat (2009). Community-based care for chronic wound management: an evidence-based analysis. Ontario health technology assessment series, 9(18), 1–24. Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2019). Preventing pressure ulcers in nursing homes using a care bundle: A feasibility study. Health & social care in the community, 27(4), e417–e427. https://doi.org/10.1111/hsc.12742 Soban, L. M., Kim, L., Yuan, A. H., & Miltner, R. S. (2017). Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey. Journal of nursing management, 25(6), 457–467. https://doi.org/10.1111/jonm.12416
How Does the Article Relate to the PICOT Question? Managing pressure ulcers with a multidisciplinary wound care team significantly increases wound healing Assessed pressure ulcer prevention strategies in nursing home Programs designed to prevent pressure ulcers include nursing interventions such as risk assessments, as well as organizational strategies such as policies and performance monitoring to embed these interventions into routine care.
Quantitative, Qualitative (How do you know?) Randomized controlled trials and Controlled clinical Trials Quantitative and qualitative data were analyzed using descriptive statistics A cross-sectional survey ,Descriptive statistics
Purpose Statement To determine the effectiveness of a multidisciplinary wound care team for the management of chronic wounds.  To determine, the implementation bundle effective on pressure ulcer To describe the presence and operationalization of organizational strategies to support implementation of pressure ulcer prevention programs across acute care hospitals in a large, integrated healthcare system.

 

 
Research Question  Multidisciplinary team can help manage Chronic wounds assessed the feasibility of implementing our pressure ulcer prevention care bundle in a nursing home setting.

 

 Assess the presence and operationalization of organizational strategies to support implementation of pressure ulcer
Outcome The percentage of persons and/or wounds completely healed. Reduction in healing time, improved quality of life, and pain management.

 

 

 According to this study, a pressure ulcer prevention bundle is acceptable to nursing home staff and can improve care provision. Participants reported an increase in their motivation to provide more comprehensive care.

 

 Organizational strategies that support pressure ulcer prevention program implementation (policy, oversight committee, wound care specialist, staff education, performance data, and performance improvement activities) were reported at high levels
Setting

(Where did the study take place?)

 Nursing home Nursing home hospitals

 

 
Sample Population includes persons with pressure ulcers (anywhere) and/or leg and foot ulcers

In 2007, control Group 119, experimental  127.

Harrison et al, 2005: before 78, after 180

Vu et al, 2007 : 176 residents (342 wounds)

 

 collected data for 462 resident bed days prior to implementing the bundle; collected data for 1,181 resident bed days during the intervention phase achieved 97% response rate (N=116/120)

 

 
Method Randomized controlled trials and Controlled Clinical Trials (CCT), The intervention includes a multidisciplinary (two or more disciplines) wound care team, The control group does not receive care by a wound care team

 

 

 For 5 weeks before implementing the bundle, we collected quantitative data on nursing home staff pressure ulcer prevention behaviors, as well as pressure ulcer incidence rates. After implementation, we collected data for an additional 9 weeks.

The bundle comprised three evidence-based elements: support surfaces,skininspection,repositioning

 

 A cross-sectional survey of key informants at all VHA acute care hospitals was conducted via email to assess pressure ulcer prevention programs. Surveys were sent to 124 nurse leaders
Key Findings of the Study Using a multidisciplinary wound care team, we’ve been able to reduce the pain and the need for daily wound care. And significantly increases wound healing Before the implementation of this period, five new pressure ulcers were recorded, and repositioning was the only documented way to prevent pressure ulcers.

Following implementation, no new pressure ulcers developed. Documented prevention strategies included repositioning, skin inspection, and checking support surfaces.

 For the year October 1, 2013 to September 31, 2014, the aggregated mean HAPU rate for acute care hospital medical/surgical units was 1.02% (range 0–3.1%)

 

 

 

 
Recommendations of the Researcher Evidence for these outcomes is low to very low, so further research will likely have a big impact on how confident we are in the estimate of effect. Further research is needed to enhance adherence and/or documentation to further investigate a bundle’s potential for preventing pressure ulcers in nursing homes.In spite of low completion rates of the bundle (or the documentation of this), feedback from participants indicates that the bundle was easy to follow, facilitated continuity of care, and resulted in comprehensive pressure ulcer prevention. Nurse leaders and committees and quality improvement teams play important roles in operationalizing patient safety initiatives such as pressure ulcer prevention.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reference

Afzali Borojeny, L., Albatineh, A. N., Hasanpour Dehkordi, A., & Ghanei Gheshlagh, R. (2020). The Incidence of Pressure Ulcers and its Associations in Different Wards of the Hospital: A Systematic Review and Meta-Analysis. International journal of preventive medicine, 11, 171. https://doi.org/10.4103/ijpvm.IJPVM_182_19

Dorner BD, Posthauer ME, Thomas D. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Role of Nutrition in Pressure Ulcer Healing Clinical Practice Guideline. 2009

Donnelly, J., Winder, J., Kernohan, W. G., & Stevenson, M. (2011). An RCT to determine the effect of a heel elevation device in pressure ulcer prevention post-hip fracture. Journal of wound care, 20(7), 309–318. https://doi.org/10.12968/jowc.2011.20.7.309

Kottner, J., & Dassen, T. (2010). Pressure ulcer risk assessment in critical care: interrater reliability and validity studies of the Braden and Waterlow scales and subjective ratings in two intensive care units. International journal of nursing studies, 47(6), 671–677. https://doi.org/10.1016/j.ijnurstu.2009.11.005

Reddy, M., Gill, S. S., & Rochon, P. A. (2006). Preventing pressure ulcers: a systematic review. JAMA, 296(8), 974–984. https://doi.org/10.1001/jama.296.8.974

Schindler CA, Mikhailov TA, Kuhn EM, Christopher J, Conway P, Ridling D, Scott AM, Simpson VS Am J Crit Care. 2011 Jan; 20(1):26-34; quiz 35.

Stinson, M., Gillian, C., & Porter-Armstrong, A. (2013). A literature review of pressure ulcer prevention: weight shift activity, cost of pressure care and role of the OT. British Journal of Occupational Therapy, 76(4), 1-10.

 

 

Senmar, M., Azimian, J., Rafiei, H., Habibollahpour, M., & Yousefi, F. (2017). The incidence of pressure ulcer in old patients undergoing open heart surgery and the relevant factors. Journal of Preventive Epidemiology, 2(2), e15-e15.

 

 

 

 

Nursing homework help

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Nursing homework help

Practice Question: In adult patients aged 18 years and older with a diagnosis of depression, will implementing the National Institute for Health and Care Excellence (NICE) Guidelines for exercising impact depression scores over 8-10 weeks? Nursing homework help

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            Information technology is an integral component of quality, safe, and efficient healthcare delivery (Bergey et al., 2019). As the foundation of the future, IT plays an important role in nursing practice (Farokhzadian et al., 2020). Using IT, the DNP student can educate the staff, patients, and families about health-related issues to expand knowledge and improve patient outcomes.

My practicum site is faced with a knowledge-practice gap. To address this practice gap of a non-pharmacological approach to the management of depression affecting patients, the organization as well as the Doctor of Nursing Practice (DNP) student must leverage innovative strategies and the use of information technology (IT) to improve patient care, outcomes, and provide quality care (Role et al., 2021). IT skills are required to identify the extent of the practice gap, its incidence, significance, and cost to the patients as well as the facility and how to provide the solution to the problem.

The DNP student must use IT skills to capture data that will be used in the planning, implementation, and evaluation of the Project. IT skills are required to map out how the project will be implemented, where and how the participants will document their activities, track the activities as well as evaluate the effectiveness of the project.

How important will IT competencies be to the role/position that you aspire to after completion of your DNP degree? What IT skills do you need to develop? Share your plan for professional development to develop these skills.

IT skills are essential to the role I perform and aspire to perform in the future. My goal is to use evidence-based practice to continue to advocate for patients’ safety and improve patient outcomes. This process requires an extensive literature search using IT. IT will be required to gather and store data needed as well as to educate the patients and staff to expand their knowledge. I will continue to expand on my IT skills, learning how to navigate library searches more efficiently, how to create tables, and embed documents.

Provide your instructor and student colleagues with an update on your implementation plans for your DNP Project. Share any successes, challenges, or barriers you experienced this week Nursing homework help

I continue to make corrections to my synthesis of the literature paper as highlighted by the instructor. This will help ensure smoother project implementation.

References

Bergey, Goldsack, J. C., & Robinson, E. J. (2019). Invisible work and changing roles: Health information technology implementation and reorganization of work practices for the inpatient nursing team. Social Science & Medicine (1982), 235, 112387–112387. https://doi.org/10.1016/j.socscimed.2019.112387 (Links to an external site.)

Farokhzadian, Khajouei, R., Hasman, A., &Ahmadian, L. (2020). Nurses’ experiences and viewpoints about the benefits of adopting information technology in health care: a qualitative study in Iran. BMC Medical Informatics and Decision Making, 20(1), 240–240. https://doi.org/10.1186/s12911-020-01260-5

Role, Chao, H., Rosario, C., Ho, P., &Hodgkins, M. (2021). Inpatient Staffing Dashboard: A nursing–information technology collaborative project. Computers, Informatics, Nursing, 39(11), 772–779. https://doi.org/10.1097/CIN.0000000000000778

 

History Of Reimbursement Issues

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History Of Reimbursement Issues

History of Reimbursement Issues

Purpose

The purpose of this discussion is to explore the DNP-prepared nurse’s role, as a member of the interprofessional team, to design systems that optimize reimbursement with a goal to improve the quality of patient care. We will examine the influence of healthcare reimbursement on nursing practice, clinical outcomes, and cost issues. History Of Reimbursement Issues

Instructions

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Reflect upon your readings and professional experience regarding reimbursement issues and address the following.

  1. Analyze how healthcare reimbursement influences your nursing practice.
  2. Examine how the value-based insurance design (VBID) influences clinical outcomes and cost issues.

FROM WEEKEND LECTURE:  With the Affordable Care Act, the reimbursement model is shifting to provide incentives for innovating value-based programs, such as the Medicare Value-Based Insurance Design (V-BID) and Bundled Payment programs. The Value-Based Insurance Design is an approach that drives patients and providers to high value services while discouraging low-value services when the benefits do not justify the cost. The goal of V-BID is to decrease the cost of healthcare while increasing the effectiveness of health services. The V-BID approach structures health insurance in a way that incentivizes and drives patients and providers toward the most valuable services—those most beneficial relative to costs. V-BID has the potential to improve service utilization, quality, and outcomes.  History Of Reimbursement Issues

*Know that All responses will be Turnitin checked.

Instructions:

Use an APA 7 style and a minimum of 350 words. Provide support from a minimum of at least (3) scholarly sources. The scholarly source needs to be: 1) evidence-based, 2) scholarly in nature, 3) Sources should be no more than five years old (published within the last 5 years), and 4) an in-text citation. citations and references are included when information is summarized/synthesized and/or direct quotes are used, in which APA style standards apply. Include the Doi or URL link.

• Textbooks are not considered scholarly sources. 

• Wikipedia, Wikis, .com website or blogs should not be use

Nursing homework help

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Nursing homework help

Patient falls are a significant problem prevalent in healthcare organizations that negatively impacts patient’s quality of care. Studies show that almost a million ailing individuals fall while receiving medical care in healthcare facilities. The issue is worth investigating because it may precipitate negative outcomes such as internal bleeding and fractures that may increase the duration of patients’ stay in hospitals and inflate the cost of treatment (LeLaurin et al., 2018). Therefore, it is necessary to find evidence-based interventions that will enhance the safety of patients by preventing falls. The PICOT question that will aid in finding an effective intervention is: In geriatric Hispanic patients, how effective is screening patients for risk of falls compared to not screening them in reducing incidences of falls in a period of six months? Evidently, the PICOT question is a significant model that will help determine an evidence-based nursing intervention that will improve patient care and positively portray a healthcare agency and the nursing practice. Nursing homework help

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P: Hispanic population based on this organization’s demographic

I: Fall risk assessment using right tools and educate patients regarding fall risks

C: What is other organization’s policy regarding prevention of fall

O: Fall incidents less than 3

T: 6 months

Evidence-Based Solution

Members of the Hispanic population are vulnerable to chronic conditions such as high blood pressure and diabetes which may lead them highly likely to be hospitalized due to the conditions. Therefore, they are the population that is disproportionately impacted by falls in the healthcare setting and specifically to this organization. Studies show that screening patients for falls are an effective procedure that reduces falls in hospitalized patients (Guirguis-Blake et al., 2019). It helps identify the ailing individuals at a high risk of falling, such as those who has history of frequent falls, syncopal episodes, those with a poor posture, and those with a poor gait secondary to comorbidities. Adequate measures are then put in place to ensure that these vulnerable individuals do not fall, such as activate bed alarms, educate patients to use call lights, educate regarding fall risk and possible prolonged hospitalization secondary to fall.  Nursing homework help

Nursing Intervention

Nursing interventions such as screening patients for falls are effective models for preventing patient falls in the clinical setting. This is because nurses are the primary caregivers of patients; hence their role in ensuring their safety is fundamental (Guirguis-Blake et al., 2018). Therefore, instilling a measure that will place nurses at the forefront of preventing patient falls is guaranteed to elicit positive outcomes in the treatment process. It is important that a nurse utilizes the tool to assess patient’s mobility before ambulating a patient. A nurse can use a tool such as BMAT (Bedside Mobility Assessment Tool) to determine the appropriate patient handling and mobility equipment or device to safely move or mobilize the patient (Perez, n.d). It is also imperative to educate patients regarding fall risks to prevent further damage to patient and follow up with evaluation of education by instructing them to verbalize and demonstrate the teaching. Patients will also benefit from prevention of fall if a nurse orient a patient to the room when they first get admitted. A nurse can activate bed alarm, utilize care view monitor, instruct them on how to use a call light when need help, stay with a patient until their business is done, and be quick to answer call lights to further prevent falls.

Health Care Agency

Healthcare agencies are tasked with the critical role of caring for ailing individuals. They are required to ensure that patients elicit positive outcomes during treatment processes. However, aspects such as patient falls reduce the effectiveness of services provided by healthcare agencies. Therefore, it is necessary to use evidence-based protocols such as preventing patients’ falls through interventions such as screening them for susceptibility to falls to prevent the negative occurrences and increasing the quality of care they receive (LeLaurin et al., 2019). The PICOT question will help unveil the evidence that can be applied in the clinical setting.

Nursing Practice

Identifying a problem and implementing interventions to advocate for patients is one of the most important tasks in nursing practice. Using the PICOT question to obtain evidence that will be applied in preventing falls in the clinical setting is a significant aspect that will ensure that the nursing practice is identified as a dependable profession that ensures that ailing individuals are cared for well. It will show that the nurses are at the forefront of ensuring that the nation’s health goals are met by using effective nursing interventions to ensure that patients receive quality care that aligns with their dynamic needs (Guirguis-Blake et al., 2018).

 

 

References

Guirguis-Blake, J. M., Michael, Y. L., Perdue, L. A., Coppola, E. L., & Beil, T. L. (2018). Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. Jama, 319(16), 1705-1716.

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in geriatric medicine, 35(2), 273-283.

Perez, A. (n.d.). BMAT- bedside mobility assessment tool – UCLA health. Retrieved March 13, 2022, from https://www.uclahealth.org/nursing/workfiles/ContinuingEducation2015/TeachBack/UmoveBMAT-TrainingPresentation.pdf

 

 

 

Nursing homework help

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Nursing homework help

DQ#1 Tatiana:Yoga is an ancient practice that has been passed down over many generations for over five centuries ago. The term yoga encompasses aspects such as ‘yuj,’ which means unite, to symbolize the union of a person’s soul with the universal soul, leading to a state of consciousness (Fontaine, 2019). Yoga is related to health and illness. For instance, the World Health Organization defines health as a state of complete, mental, physical, and social well-being and not merely the absence of disease or infirmity; hence, it is evident that health is a multidimensional state (Yoga, 2021). Hence, it can be achieved by using a holistic approach to meet the needs of each of the dimensions. Nursing homework help

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Yoga is an appropriate intervention that guarantees positive outcomes in each dimension. Besides, yoga is a union of yama, asana, niyama, pratyahara, pranayama, dharana, Samadhi and dhyana (Yoga, 2021). Intense practice of such dimensions leads to self-realization. In this manner, yoga is a holistic way of life that leads to a state of complete social, physical, spiritual, and mental wellbeing. Yoga is used as a therapeutic intervention for modern diseases such as obesity, stress, hypertension, diabetes, chronic obstructive pulmonary disease, and coronary heart disease; besides, Studies show the significant role of yoga as a non-pharmaceutical intervention is essential in the treatment of such conditions (Kumar Taneja, 2014). To alleviate sickness or symptoms, yoga helps decrease stress, anxiety and lower the levels of salivary cortisol, including rennin levels. It also keeps epinephrine and norepinephrine levels in balance. Hence, effectively managing sicknesses such as coronary heart diseases, hypertension, and diabetes. Nursing homework help

 

DQ#2: Christian:Several activities and actions are used as complementary medications and they have abilities to yield the best possible results. One of them is meditation, and it is defined as the process of taking the mind away from the stressful points of life to focus only on that, which is helpful. In the former years, meditation was used as a spiritual activity to help the mind understand the mysteries of spiritual and religious aspects. Today, meditation is one of the major recommendations given by healthcare providers as the primary process for relieving the body of stress and bringing mental and physical healing to the whole body.

Meditation can take place in different forms including guided meditation, yoga, prayers, mantra meditation, Qi gong, mindfulness meditation, and Tai Chi among others. All these forms of meditation must have specific elements that include focused breathing, relaxed breathing, a quiet setting, a comfortable position, and an open attitude. The meditations can also be done in different formats including breathing deeply, scanning the body, repeating a mantra, walking and meditating, reading and reflecting, and placing focus on love and gratitude (Farias et al., 2020). Practicing any of these elements for a continuous period helps the body to remain healthy and scholars have argued that it can bring healing to people suffering from conditions such as anxiety, cancer, asthma, depression, chronic pain, high blood pressure, heart disease, tension headaches, and sleep problems (Kreplin et a., 2018).

Meditation mainly works by improving the ability of the body to fight infections and diseases. A clouded mind cannot fight infections as it leads to a weaker immune system. However, a peaceful and calm mind leads to a strengthened body that can fight any condition developing from other parts of the body.

 

DQ#3: Lisdiana:  In this scenario, when there is widespread worry about who may have sprayed graffiti outside the school compound, I would first examine material from various groups that appear to have an understanding of what is going on (Braga & Weisburd, 2006). I’ll choose a few people, primarily student leaders, and ask them if they’ve detected any questionable behaviour from any individual or organization. Because the graffiti appears to be familiar to me, I would examine it and compare it to what I observed at the recent drive-in meeting. I’ll also quiz the librarian to learn more about the physical copy she chose.

The cases have now made their way to Hometown High School (Braga, 2006). After scanning the numerous pieces of information, I gathered and analyzed the data in an attempt to determine what may be the root cause of this graffiti appearing on various structures. I’ll look at the parallels between the physical copy labels and the material they appear to represent. The contents will take me to the computer screen’s owner.

The third stage is to decide how to respond to the information acquired. As my first suspect, I’ll send the student with the computer screen name to interview him. Then I’ll summon the new student who appears suspicious based on his attire. I’ll ask the two to tell me where they were at the time of the crime. I’ll question about their associates, and if any of them does not have an alibi, they’ll be among my suspects, who will be brought before the disciplinary committee and punished ( Braga, 2006).

When attempting to analyze the issue, consider if the reaction was successful in resolving the problem. Assume there is a need to implement more safeguards to prevent similar crimes from occurring in the future (Santos, 2014). I will advise the school to install new security lights in strategic locations across the school grounds. Installing surveillance cameras and increasing school security will also aid in the prevention of such crimes.

 

DQ#4: Yirlem:  The five stages of the Kübler-Ross model denote the gradual acceptance of the loss, and the transition between the featured patterns is necessary to cope with the emotional distress. The text states: “a series of five stages—denial, anger, bargaining, depression, and acceptance—that people go through as they come to grips with their own imminent death” (James & Gilliland, 2017, p.380). The first stage is denial, and the individual strives to reject his condition or fact of the loss with logical arguments. The second stage is anger, and the person starts blaming his life or specific circumstances (Kübler-Ross, (2015). The third stage involves the individual’s willingness to delay or postpone the situation. The fourth and final stages denote the depression that ends with the acceptance of reality, and it can be acceptance of the loss or inevitable fact, like a terminal stage of a disease that has no cure.

There are different types of loss, and they depend on the specific situation and people, and the death of family members is not the only cause of these affections. The reading argues: “People commonly associate certain losses with strong feelings of grief” (Crowell, 2022). In turn, it can be a loss of a friend, child, parents, partner and the death of friends or family members. It is necessary to admit that the loss of a job, position, things, home and abilities is also a common type of grief. People share unique experiences and relationships, and their ends can be the cause of these negative emotions. For instance, the death of a favorite pet is also a type of loss, though it does not share the standard concept of friendship or kinship.

 

 

 

 

DNP-810A EMERGING AREAS OF HUMAN HEALTH

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Case Study: Part 3

You will be creating a case study in stages over four course topics. This assignment will add to your previous work in Topic 3. Use an example from your own personal practice, experience, or own personal/family (however, simulated cases are not acceptable for practice hours and therefore not acceptable for this assignment). Examples might include a patient with Duchesne’s muscular dystrophy, Huntington’s disease, Down’s syndrome, sickle-cell anemia, BRCA 1 or BRCA 2 mutations, or another genetic disorder that you or the organization you practice in may specialize in treating. DNP-810A EMERGING AREAS OF HUMAN HEALTH

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General Requirements:

Use the following information to ensure successful completion of the assignment:

  • Doctoral learners are required to use APA style for their writing assignments.
  • This assignment requires that at least two additional scholarly research sources related to this topic and at least one in-text citation for each source be included.
  • You are required to submit this assignment to LopesWrite for similarity score check.

Directions:

For this assignment (Part 3 of the Case Study), write in about (1,000-1,250 words) incorporating genetics information learned from assigned readings in Topics 1-5. Include the following: DNP-810A EMERGING AREAS OF HUMAN HEALTH

  1. Examine how genetics can influence policy issues.
  2. Discuss any nutritional influences for the cause of this disease.
  3. Discuss the process of nutritional assessment and counseling as it relates to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment      effectiveness.
  4. Discuss the prevalence rates, testing, treatment, and prognosis as they relate to human nutrition.

RESOURCES

Kiechl, S., Pechlaner, R., Willeit, P., Notdurfter, M., Paulweber, B., Willeit, K., Werner, P., Ruckenstuhl, C., Iglseder, B., Weger, S., Mairhofer, B., Gartner, M., Kedenko, L., Chmelikova, M., Stekovic, S., Stuppner, H., Oberhollenzer, F., Kroemer, G., Mayr, M., … Willeit, J. (2018). Higher spermidine intake is linked to lower mortality: A prospective population-based study. American Journal of Clinical Nutrition, 108(2), 371-380.

Brown, H. M., Rollo, M. E., De Vlieger, N. M., Collins, C. E., & Bucher, T. (2018). Influence of the nutrition and health information presented on food labels on portion size consumed: A systematic review. Nutrition Reviews, 76(9), 655-677.

Study findings on diet and nutrition are outlined in reports from Kennedy Krieger Institute (Environmental influences on health and development: nutrition, substance exposure, and adverse childhood experiences). (2019, February 8). Health and Medicine Week, 447.

DNP-810A EMERGING AREAS OF HUMAN HEALTH

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DNP-810A EMERGING AREAS OF HUMAN HEALTH

Genetic Counseling

With the increase in knowledge around genetic issues, it is important that all health care providers are prepared to have thorough genetic-based discussions now with their patients. In this assignment, you will synthesize your knowledge into a client case with a real or potential genetic health-related illness. DNP-810A EMERGING AREAS OF HUMAN HEALTH

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General Guidelines:

Use the following information to ensure successful completion of the assignment:

  • Doctoral learners are required to use APA style for their writing assignments.
  • This assignment requires that at least three additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
  • You are required to submit this assignment to LopesWrite for similarity score & plagiarism check.

Directions:

Write about (1,000-1,250 words) addressing a client case that might benefit from the process of genetic counseling. Describe the reason for the genetic counseling based on the findings from your completion of the family health portrait. Discuss the possible reactions the patient may have to your counseling and how to avoid negative reactions. Imagine this assignment as if you are giving this counseling to a patient and be sure to discuss the following:

  1. Health
  2. Prevention
  3. Screening
  4. Diagnostics
  5. Prognostics
  6. Selection of treatment
  7. Monitoring of treatment effectiveness

RESOURCES

Centers for Disease Control and Prevention. (2020). My family health portrait: A tool from the Surgeon General. http://kahuna.clayton.edu/jqu/FHH/html/index.html

Docherty, A. R., Moscati, A., Dick, D., Savage, J. E., Salvatore, J. E., Cooke, M., Aliev, F., Moore, A. A., Riley, B. P., Admins, D. E., Peterson, R., Webb, B. T., Bacanu, S. A., & Kendler, K. S. (2018). Polygenic prediction of the phenome, across ancestry, in emerging adulthood. Psychological Medicine, 48(11), 1814-1823. https://doi.org/10.1017/S0033291717003312

Berberich, A. J., & Hegele, R. A. (2019). The complex molecular genetics of familial hypercholesterolaemia. Nature Reviews. Cardiology, 16(1), 9-20. https://doi.org/10.1038/s41569-018-0052-6

Salloum, R. G., George, T. J., Silver, N., Markham, M-J., Hall, J. M., Guo, Y., Bian, J., & Shenkman, E. A. (2018). Rural-urban and racial-ethnic differences in awareness of direct-to-consumer genetic testing. BMC Public Health, 18(1), 1-6. https://doi.org/10.1186/s12889-018-5190-6