Paragraph 1 for the week

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Paragraph 1 for the week

Please write a Paragraph answering to this discussion below with your opinion. Please include citations and references in alphabetical order in case of another source.

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Although all age groups are subject to abuse, infant abuse is often the most difficult to identify and report. Abused infants frequently suffer from neglect and from physical trauma. The reason it is so difficult to identify infant abuse is because infants have no way to convey what has happened to them, and the person who perpetrated the abuse is often in contact with medical staff, controlling the story. For this reason, recent research indicates that almost half of abuse cases are missed during medical screening (Guenther, Powers, Srivasta, & Bonkowsky, 2010).

This information begs the question of what can be done to increase awareness of the signs of abuse among medical staff. The most obvious solution to this problem is continued education an ongoing training. Vomiting, irritability, or a call to 911 can be signs of abuse and may be associated with abusive head trauma (Guenther et. al, 2010). Training programs must consider this information so that it becomes common knowledge and nurses are more aware of what to look for during treatment.

While many of the aforementioned signs are objective, interpretation of cultural variations in health practice can be very subjective and can be misidentified as child-abuse. Some cultures practice religious restrictions that severely limit the type of medical care that maybe administered to underage believers. This can result in conflict between the families of patients and attending medical staff. These situations have even resulted in legal proceedings and loss of custody. Another example of cultural variation is the administration of superstitious remedies, such as coining in the Thai culture. This holistic religious practice can leave marks that are similar in appearance to bruises. An awareness of these kinds of practices can prevent the misreporting of abuse and can help establish trust between nurses in patients.

Where I work in the state of California, mandatory reporting is a legally required in cases of suspected or reported child abuse. Hospital policies fall in line with state law and require reporting to local law enforcement and the Department of Children and Family Services within 24 hours. Such a report also initiates the response of Social Services for in-home follow-up. While these laws and policies are critical to protect children, they cannot be carried out without awareness and courage, which begins with the attending nurse.

paragraph 3- question for the wwek

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paragraph 3- question for the wwek

Please write a Paragraph answering to this discussion below with your opinion. Please include citations and references in alphabetical order in case of another source.

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There are many forms of abuse to include physical, emotional, sexual, and neglect. Infants can be subjected to any of these forms of abuse. Neglect, physical, and even sexual abuse are easier to see on an infant. Things to observe for would be malnutrition, dehydration, poor weight gain, and failure to thrive in an infant. Forms of physical abuse would be bruising at different stages, hand print or oval finger marks on the trunk or arms (Stanford Medicine, 2018). Other signs to look for in case of sexual abuse would be bruising to the genitalia or inner upper thighs, even oral injuries, torn or bruised frenulum, damage to oral mucosa, tongue, palate, lips. Sadly, even looking for STDs from forced oral sex. Most commonly would be head trauma, signs of Shaken Baby Syndrome, head injury, or even subdural hematomas. According to Stanford Medicine, bruising is the most common sign of physical abuse in children, up to 52% of child abuse cases.

Cultural variations that can be misconstrued as child abuse can be practices such as coining or caogio, which is dermabrasion therapy (intense rubbing of the skin) practiced by Vietnamese, Cambodians, and Laotians. It is a healing practice used to treat headaches, coughs, fevers, upper respiratory infections, and sore throats. It can be manifested as long streaks of bruising up along the back of the child.

Another practice used in China to rid the body of illness is called spooning or guasha – the spoon is rubbed on the wet skin also leaving bruising.

Cupping is practiced in the Middle East, Asia, Latin America, Eastern Europe, it can be either done as wet or dry cupping. Leaving perfectly round circular bruises and marks on the child’s back.

There is also moxibustion practiced in Asia where they burn rolled pieces of moxa herb over the skin surface, leaving what could be misconstrued as cigarette burns (Killion, 2017). These are a few cultural health practices that may occur and requires nurses to be aware for proper assessment when these are noted on children.

Nurses have a responsibility to report all suspected child abuse cases here in the state of Texas. It is our policy at our hospital to call and report any suspected cases to Child Protective Services. Social services and case management are notified and the process is started at that time. Any suspected sexual abuse case, the police department is notified and an assessment by the SANE (Sexual Abuse Nurse Examiner) nurse is conducted.

Refernces:

Killion, C. M. (2017). Cultural healing practices that mimic child abuse. SciMed Central. Annals of Forensic Research and Analysis 4(2). 1042.

Stanford Medicine (2018). Child abuse. Retrieved June 18, 2018 from http://childabuse.stanford.edu/.

Paragraph 2 – Question for this week

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Paragraph 2 – Question for this week

Please write a Paragraph answering to this discussion below with your opinion. Please include citations and references in alphabetical order in case of another source.

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In 2004, over one thousand school aged children in the United States died as a result of abuse or neglect. School aged children are most likely to encounter violence from caretakers at school, family friends, neighbors, but the highest risk is from their own family members and relatives.. The two most prevalent types of abuse is physical abuse, neglect, and sexual abuse. Physical and emotional abuse are experienced my many school aged children it is part of a nurse’s assessment to look for signs of abuse in these young children. Nurses should be on the look out for many signs that a child will display, most of the time the children will be too scared to report the abuse because of threats that have been made, they don’t want to betray their family members or they don’t understand what is going on is wrong. Physical symptoms to look for in a school aged child is burns, spiral fractures in extremities, x rays that show old healing fractures with no history of treatment, cigarette burns, injuries to face, scars, subdural hematomas. The nurse should always ask for explanations of the injuries to the child and parent separately. Sexual abuse assessments should include looking for signs of repeated UTI, STD’s etc. Assessment of emotional/neglect abuse in school aged children should include looking for signs of vacant affect, the child does not cry even if the situation warrants crying, craving too much physical attention, delated physically, emotionally, cognitively. A nurse should look for signs of poor hygiene in a child, poor school outcomes. ( Maurer and Smith, 2009)

Some cultures have a different way of raising their children, in a strict environment. It is up to the nurse to try and differentiate between normal child activity and abuse. It can be hard to determine the difference but as nurses we must advocate for the children we care for because they may not always know what to do or who to report to.

A nurse’s responsibility to take action against child abuse is to verbally report to child protection agency or local law enforcement agency. In California, reports should be sent to child protection agency within 48 hours of initial complaint and a couple to the state attorney’s office.

Maurer , F. , Smith, C. “ Community/Public Health Nursing Practice” 2009. St Louis, MS.Elsevier.

Tags: nursing please help paragraph with your opinion citations and refrences

Paragraph 4- Question for the week

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Paragraph 4- Question for the week

Please write a Paragraph answering to this discussion below with your opinion. Please include citations and references in alphabetical order in case of another source.

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Children have their own set of health issues that they face. There are environmental factors that affect children’s health that are directly linked to poverty and health disparities. Children raised in communities of poverty are more likely to be exposed to certain hazardous environmental factors such as cigarette smoke, unsafe air quality, high amounts of toxins if living in a highly populated un kept environment. These factors can lead children to have certain health issues later in life such as asthma, allergies, and other respiratory issues. Commonly in communities living in poverty there is less access to education, health care, and social support. This leaves children without guidance and information on healthy lifestyles which can lead to poor choices later in life . “Evidence shows that experiences in early and middle childhood are extremely important for a child’s healthy development and lifelong learning. How a child develops during this time affects future cognitive, social, emotional, language, and physical development, which in turn influences school readiness and later success in life. Research on a number of adult health and medical conditions points to pre-disease pathways that have their beginnings in early and middle childhood” ( Centers for Disease Prevention and Health Promotion, 2018).

Centers for Disease Prevention and Health Promotion. ” Early and Middle Childhood”. 2018. Retrieved from : healthepeople.gov

paragraph 5- question for the week

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paragraph 5- question for the week

Please write a Paragraph answering to this discussion below with your opinion. Please include citations and references in alphabetical order in case of another source.

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Children in poverty have increased risk to infant mortality due to frequent and severe chronic diseases such as asthma (American Academy of Pediatrics, 2018). According to the World Health Organization, lower respiratory infections were among the largest causes of mortality in children. The largest contributors to air pollution being second hand smoke and exposure to cookstoves. Poverty stricken areas have house related exposure to air pollutions such as mold and crowding can lead to pneumonia, upper respiratory infections, and eventually to chronic diseses. Providing clean air for young children, including quitting smoking by the parents, will improve health for the school aged child. According to the American Lung Association, asthma is the most chronic condition among children.

References:

American Academy of Pediatrics. (2018). Poverty threatens health of U.S. children. Retrieved June 18, 2018 from

https://www.aap.org/en-us/about-the-aap/aap-press-…

American Lung Association (2018). Asthma and children fact sheet. Retrieved June 18, 2018 from

http://www.lung.org/lung-health-and-diseases/lung-…

World Health Organization. (2017). Don’t pollute my future! The impact of the environment on children’s health. Retrieved from

http://www.who.int/ceh/publications/don-t-pollute-…

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see document

For this Assignment, you will select one of the following case studies below. Then, using the case information and best evidence, complete the chart below. Make sure to address all columns in the chart.

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Select a case study of interest to you from the listed scenarios below.

Case #1: Jane

Jane is a 42-year-old G4P2103. Jane is divorced and works long, hard hours as a real estate agent. Jane was having irregular and heavy menses for 6 months, and then they abruptly stopped 3 months ago. Jane has been having nausea and vomiting for 6 weeks but attributed it to having the flu recently. She also admits to gaining about 10 pounds in the last few months and experiencing breast tenderness. Jane comes to the clinic today to discuss menopause symptoms and treatment. During the visit, a urine pregnancy test came back positive. During the exam, you palpate a 16-week-size uterus and get fetal heart tones of 165. Jane is in disbelief.

Case #2: Natalie

Natalie is a 27-year-old G4P0120. Natalie is married; she and her husband both work two part-time jobs to cover the bills. Natalie presents to your office at about 20 weeks gestation for her initial OB visit. Natalie states she has not been evaluated prior to today for the pregnancy because of lack of funds and ability to get off of work. Natalie also complains of multiple yeast infections during this pregnancy. During your interview with Natalie, you find she has no known medical diagnoses, she is not taking medications, she is a smoker, and she has a negative surgical history. Natalie’s OB history includes two spontaneous losses at 8 and 12 weeks gestation and a loss of a 32 weeks infant following premature rupture of membranes. The 32 week infant was 7 pounds; lived 24 hours; and experienced hypoglycemia, respiratory distress, and sepsis infections. Natalie tells you she waited to seek prenatal care until this point because she did not have enough money to pay for the visit. She and her husband are still paying off medical expenses from the death of their 32 week infant. She tells you that she probably would have waited longer, but she keeps getting these terrible yeast infections. On exam you note a fundal height of 26 weeks and urine dip reveals 1+ leukocytes, 1+ protein, trace blood and 3+ glucose.

Case #3: Katie

Katie is a 17-year-old G1P0. She presents to your office with four missed periods in a row. Katie is a high school student; she is in the 10th grade. She lives with her mother and four siblings. You ask Katie about the father of the baby and she tells you he states “that baby is not mine.” They are not speaking to each other right now. Katie tells you she has been “vomiting a lot and her stomach hurts when she pees.” A urine pregnancy test comes back positive. Katie is so confused because she has been using douching after intercourse as her method of birth control. You ask Katie about the father of the baby, and she tells you he states “that baby is not mine.” They are not speaking to each other right now.

Katie’s past medical history is positive for chlamydia twice in the last year. She was treated at the Health Department but never went back for a follow up. Katie has had no surgeries and is on no medication. When asked, Katie states her last known weight was about 120. Katie’s V/S are BP 110/70, temp 102.5, weight 107. You note enlarged cervical lymph nodes, FHTs are 160, fundal height is 18. Katie’s urine reveals 2+ ketones, 2+ nitrates, and 3+ leukocytes.

Case #4: Sara

Sara is a 32-year-old G1P1001. She presents to your office for a 6-week postpartum check following a normal vaginal delivery of a healthy baby girl. Sara had an 18-hour labor with Pitocin augmentation and delivered a 7 pound 2 oz. girl with a second degree laceration repaired with sutures. Sara spent 2 days in the hospital and was discharged home with her infant and husband. Over the last few weeks, Sara has called the office multiple times with questions about breastfeeding and her sutures healing. Upon walking into the exam room to see Sara, you see her baby in the stroller crying and Sara sitting on the exam table crying into her hands.

Complete the following chart:

MN577 Unit 9 Pregnancy Case Review Chart

Description of the case chosen:

Subjective data, identify both given and needed data

Objective findings, identify both given and needed data

Diagnostic or laboratory testing needed with rationales

List of three differential diagnoses with rationales

Medications and or treatments needed with rationales

Patient education needed

Referrals for collaborative care needed with rationales

 

 

 

 

Make sure to address all sections. Do not leave any section blank.
Include relevant subjective and physical objective findings.
Identify appropriate diagnostic and laboratory testing needed.
List at least three differential diagnoses with rationales for choosing.
Identify usual medications, treatments, or patient education needed.
Determine referrals for collaborative care.
Summarize the case study and include any further research, diagnostics, procedures, or follow-up needed.
Provide evidence-based references.
please follow the attached copy. just change the words.

Leadership and Management

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Leadership and Management

Instructions:

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Choose the topic below, then post your response for this discussion.
Response should be 250 words or more.
Topic Analyze the leadership style of your current supervisor.
Does the supervisor’s leadership behaviour vary from situation to situation?
Would the supervisor be classified as transformational, transactional, authentic, charismatic, visionary, or other leader? Why?
References not older than 3 years
Tags: nursing foundations of professional nursing

Professional Capstone and Practicum Reflective 10 week Journal

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Professional Capstone and Practicum Reflective 10 week Journal

Students are required to maintain 10 week reflective narratives throughout the course to combine into one course-

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long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.

In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:

New practice approaches
Intraprofessional collaboration
Health care delivery and clinical systems
Ethical considerations in health care
Population health concerns
The role of technology in improving health care outcomes
Health policy
Leadership and economic models
Health disparities
Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.

New practice approaches are present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Intraprofessional collaboration information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Health care delivery and clinical systems information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Ethical considerations in health care information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Population health concerns information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Information on the role of technology in improving health care outcomes is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Health policy information content is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Information on leadership and economic models is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Information on health disparities is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Rapid Assessment of a Client (reply)

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Rapid Assessment of a Client (reply)

When first discovering Mr Johnson, I would yell for help, for someone to activate the emergency response protocol.

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I would quickly wash my hands and put on a pair gloves. While waiting for help to arrive I would assess if Mr Johnson is breathing, if he has a pulse, then complete a full set of vitals. I would talk to Mr Johnson to see if he can be easily woken, perform a chest rub if needed and assess his pupils for reaction to light. Next, I would assess how Mr Johnson is lying. What is his position? Are there any obvious signs of injury from his fall? Is he safe in his current position on the floor until help arrives? I may need to reposition an arm or leg if they ended up in an unnatural position from his fall or move any equipment that may have fallen, making the loud crash that alerted me to his room in the first place. I would probably place a nasal cannula on 2 liters of oxygen as well. If Mr Johnson woke up I would ask him what happened to assess his orientation and cognition. I would assess for pain, dizziness, check for facial symmetry, hand grip strength, clarity of his speech and sensation of all extremities (Jarvis, 2016). If Mr. Johnson does not wake up, once help arrived we would carefully place him back into his bed together, probably using a bed sheet. If Mr. Johnson wakes up and denies dizziness, I would first help him to a sitting position and take another set of vitals. I would assess for pain and dizziness with the position change or a change in vitals. If Mr. Johnson appears stable, with help of another clinician, we could help him into a chair. Once in the chair another set of vitals, assessment of pain or dizziness. Hopefully, in the chair, Mr. Johnson’s current vitals and condition is stable enough that with assistance he can be pivoted back into bed. Once back in bed, with rails up and in the lowest position for safety with call light in reach I could leave him long enough to get his chart and a phone to call the Dr with if I didn’t already have it with me. If possible, I would have a nurse’s aide stay with him while I went to gather any supplies I thought I would need. In this scenario, the classmate I am giving report to could be the Dr.

S-Situation- Mr. Johnson experienced an unwitnessed fall on the way the bathroom with loss of consciousness.

B-Background- Mr. Johnson was admitted yesterday with the diagnosis of cerebral vascular accident. He also has a long standing history of hypertension, hyperlipidemia and unexplained syncopic episodes.

A-Assessment- Mr. Johnson woke with a chest rub and was disoriented as to what happened. Pt complains of pain on the back of his head 6\10, HR 110, BP 85\45, T 97.8, R 20. Pupils PERRLA, equal hand grips, speech clear, hand grips equal, denies numbness or tingling in any extremity, reports dizziness that resolved within 3 minutes. Pt was assisted to sitting position with vitals as follows, pain in head 6\10, HR 100, BP 95\54, T 97.8, R 20, reports dizziness that resolved within 2 minutes. Pt pivoted into bed with hands on assistance. Once in bed pt’s vitals as follows, pain in head 4\10, HR 95, BP 100\55, T 97.8, R 20. Pt assessed Q15 min x 4. Most recent set just prior to this report as follows, pain in head 2\10, HR 82, BP 110\65, T 97.8, R 18. Pt states, “I don’t know what happened. I felt fine then all of a sudden woke up on the floor with all of you standing around me.”

R-Recommendation- I will continue to monitor Mr. Johnson’s vitals and neuro assessment, but would you like him to have an EKG or any lab work to assess his status further? I will notify you of results and any changes in neuro status or vitals. Is there anything else you would like updated on?

SBAR report format referenced from Center for Learning and Innovation, Pro Health Care, RN to Physician SBAR Examples.

Thank you,

Julie O’Connor

References

Jarvis, C. (2016). Physical Examination and Health Assessment (7th ed.). Canada: Elsevier Inc.

Paragraph 6- question for the week

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Paragraph 6- question for the week

Please write a Paragraph answering to this discussion below with your opinion. Please include citations and references in alphabetical order in case of another source.

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According to the World health Organization (WHO), children are constantly growing, breathing more air, consuming more food and drinking more water in proportion to their body mass than adults. Children are at a greater risk due to behaviors such as placing their hands into their mouth after touching unseen toxins such as grass that may have pesticide. Children are still growing as well as major organs and systems developing. During this growing years the risk of toxins in the environment can lead to damages which are often times irreversible. The children have no control over their environment and are unaware of the risks of this exposure which can lead to lifelong health issues.

Urbanization, industrialization and pollution the environmental factors that are present today. Decreased physical activity has been on the rise in both the wealthy and poor countries. Over population often leads to unsanitary living conditions which contribute to respiratory and autoimmune disorders. Decreased physical activity and poor nutrition can lead to undernourishment and obesity. Flooring can also contribute to a toxic indoor environment. Many health issues has been liked to volatile organic compounds (VOC’s) which are chemicals that evaporates into the air and are inhaled by the inhabitants of a home. Children are at increased risk when exposed to these elements due to their growing organs and smaller body mass. When choosing flooring and paint for the home, the use of non VOC’s should be an important factor to consider (Children’s environmental Health Network, n.d.).

References:

Children’s environmental Health Network (n.d.) A healthy environment for all children, Retrieved June 18, 2018 from http://www.cehn.org/our-work/eco-healthy-child-car…

World Health Organization (WHO, n.d.) Retrieved June 18, 2018 from http://www.who