Nursing

Manny Castillo and his partner, Andy White, have just moved to Kinzig from the bustling city of Chicago.  They were hoping to move out of the busy city to reduce Manny’s stress level because it has taken a toll on his health.  Due to uncontrolled hypertension Manny has been diagnosed with renal insufficiency.  Manny is being followed by Dr. Martin, a nephrologist in Kinzig who was recommended by his nephrologist in Chicago. His records were sent to Dr. Martin’s office and Manny has set up his first appointment with Dr. Martin.              Manny went to Dr. Martin’s office and had blood work drawn.  Dr. Martin conducted a comprehensive exam and reviewed his health history, medications and developed a plan of care for Manny.  Manny left the office with a new medication regime to treat his renal insufficiency.  The medications he will take are:  20mg furosemide once a day, 10mg enalapril once a day, and 1 Nephplex vitamin capsule once a day. ·      What are the indications for the furosemide, enalapril, & Nephplex vitamin? ·      What non-pharmacological treatments could help Manny? A few days later Manny received the test results and was educated that he needed to be sure to follow his medication regime and watch his diet.  A couple weeks after the visit with Dr. Martin, Manny and Andy received a phone call from the adoption agency notifying them of a possible little girl who they could adopt.  This was great news for Manny and Andy because they have been waiting for this phone call for years!  They want nothing more than to be parents and now it could be possible.  Even though this was going to add stress to Manny’s life, they decide to go through with the paperwork as this was their ultimate dream.  ·      What could the added stress do to Manny’s health? ·      How can Manny decrease his stress level during this intense time? A few months later Manny started feeling bad and went back to the nephrologist.  Dr. Martin ordered more lab tests and a urinalysis.  Two days later Manny received a phone call from Dr. Martin’s office regarding his blood work and lab tests and was asked to immediately come to see Dr. Martin.  In fear of bad news, Manny called Andy and he met Manny at the Dr.’s office to provide support.  Once they arrived to the office, Dr. Martin reviewed the blood work with Manny and Andy. Manny’s BUN is 50mg/dL, creatinine is 5.6mg/dL, GFR is 14mL/min, K is 6.2 mEq/L, Phosphorus is 5.4mEq/L, Hemoglobin is 8.2mg/dL, Hematocrit is 27.3. His UA revealed protein and glucose in his urine. ·      What do you think is happening here? ·      What are normal BUN & Creatinine, GFR, K, Mg, Phosphorus, Hemoglobin and Hematocrit levels? ·      Why did he have protein and glucose in his urine? Dr. Martin instructs Andy to immediately take Manny to the hospital because he will need to be admitted for emergency dialysis.  This news worried Manny and Andy’s ability to adopt their little girl.  They worried they would not be approved due to Manny’s declining health. An interesting point about the little girl they could possibly adopt is that she too has renal issues and requires special medical care. Manny was admitted to the hospital and a hemodialysis catheter was placed and dialysis was done.  His lab values trended back to normal and he was able to go home but on a dialysis schedule of Monday, Wednesday & Friday.  During his hospital stay he had an AV fistula created in his left lower arm by a very skilled vascular surgeon, Dr. Evans.  Manny understand that he still needs to continue having his dialysis using his hemodialysis catheter until his AV fistula matures. He was also sent home with a different medication regime.  His new regime is: 10mg enalapril PO BID 800mg Renvela PO TID with meals 50units/kg Epogen IV 3 times a week (during dialysis) 100mg Iron sucrose IV 3 times a week (during dialysis) 1 Nephplex vitamin PO BID   ·      What are the therapeutic indications of each of these drugs? ·      What are the adverse reactions/side effects of each of these drugs that you would need to teach Manny? ·      What dietary restrictions are you going to educate Manny about? ·      What will you educate Manny about regarding his new AV fistula? Manny goes home and reports Monday to an outpatient dialysis clinic for his dialysis session.  After 30 minutes on the dialysis machine, Manny complains of severe cramping and pain. ·      What can the nurse do for him to alleviate the cramping and pain? Good news, the adoption was approved and Manny and Andy have their little girl!

identifies a Minimum of Six SMART goals associated with being a leader of the change project outlined in part I Formats SMART goals appropriately and includes all required elements of a SMART goal APA style 7edition to Include a Reference Page .

Work on a paper providing anticipatory guidance education for the parent(s) of a toddler or preschooler. The work must be done in APA style .200-300 words .References should be within last 5 years.

I am currently using shadow Health to complete my clinical rotations. Given that information please answer the following questions below   Provide the following information (if more than one list them each separately): Name of site  – Shadow Health Are there any age restrictions for patients at this office? (i.e., this office does not see children under the age of 12, etc.)  –  No age Restriction What is your tentative clinical schedule at the practicum?  One virtual client per week Discuss your feelings about starting your first practicum rotation (good or bad) and identify at least 3 possible factors which might be barriers to your success in the completion of the clinical requirements.   600 words APA Format

Respond to two posts. First post Quantitative research originates from the positivist paradigm (Keele, 2012). Some main tenets of the positivist worldview are that a single reality exists and can be measured, cause and effect relationships can be tested, and research can be conducted objectively (Keele, 2012). According to Polit and Beck (2016), positivism was the paradigm that dominated nursing research for decades. Quantitative research is a “formal, objective, deductive approach to problem solving” (Keele, 2012, p. 35). Other characteristics of quantitative research include numbers and statistical analyses, theory testing, and a concise and narrow focus (Keele, 2012). The four quantitative designs are descriptive, correlational, quasi-experimental, and experimental (Keele, 2012). According to Keele (2012), “descriptive studies are designed to gain more information about characteristics of a topic of interest” and “is most appropriate when very little research is available on the topic” (p. 38). Correlational designs are used to study relationships between variables (Keele, 2012). Quasi-experimental designs are used to examine causality, but lack randomization of the sample (Keele, 2012). Experimental designs, also known as randomized control trials (RCTs), are the “gold standard for research and evidence-based nursing practice” (Keele, 2012, p. 41). Experimental designs must include randomization of samples, control of treatment/intervention, and treatment and control groups (Keele, 2012). Quantitative research is considered a hard science (Keele, 2012).  Qualitative research originates from the naturalist paradigm (Keele, 2012). A main tenet of the naturalist worldview is that “there are multiple realities that are continually changing, which make it very difficult to measure” (Keele, 2012, p. 35). Other assumptions of the naturalist worldview are that research is subjective, findings cannot be generalized beyond the study sample, and cause and effect relationships can not be tested (Keele, 2012). Qualitative research is an “informal, subjective, inductive approach to problem solving” (Keele, 2012, p. 35). Other characteristics of qualitative research include a complex and broad focus, theory development, words and narrative as the basis of analysis, and meaning and discovery as the basis of knowing (Keele, 2012). The most common qualitative designs are phenomenology, grounded theory, and ethnography. Phenomenology is used to explore everyday life experiences (Keele, 2012). Grounded theory is utilized to develop theory (Keele, 2012). Ethnography focuses on the culture of a group of people (Keele, 2012). Qualitative research is considered a soft science (Keele, 2012)   second post Quantitative research developed from the positivism nursing paradigm (Polit & Beck, 2016, p. 9). “Adherents of positivism assume that nature is basically ordered and regular and that reality exists independent of human observation” (Polit & Beck, 2016, p. 9). Furthermore, “the positivists’ scientific approach involves using orderly, disciplined procedures with tight controls of the research situation to test hunches about the phenomena being studied” (Polit & Beck, 2016, p. 9). Quantitative researchers use a systematic approach, implementing control strategies in order to gather empirical evidence, or objective data obtained via the senses (Polit & Beck, 2016, p. 11). Keele (2012) further defines quantitative research as an objective process utilizing deductive reasoning and statistical analysis to test theories concerning observed cause and effect relationships in a single reality (p. 36). There are four types of quantitative research design, descriptive, correlational, quasi-experimental, and experimental (Keele, 2012, p. 38). Each are preceded by a level of research questions (Dickoff & James, 1968, as cited in Keele, 2012, p. 38). Level one questions consist of factor-isolating questions, which are best answered using descriptive studies (Keele, 2012, p. 38). “Descriptive studies are designed to gain more information about characteristics of a topic of interest” (Keele, 2012, p. 38). Level two, or factor-relating questions, use correlational study designs to answer questions about relationships between factors (Keele, 2012, p. 39). Furthermore, situation-relating questions are categorized into level three (Keele, 2012, p. 40). “These types of questions are best answered through quasi-experimental designs where the researcher is evaluating some intervention” (Keele, 2012, p. 40). Lastly, “situation-producing researchable questions are the highest level of inquiry, requiring the most control by the researcher” (Keele, 2012, p. 41). Therefore, a more structured and regulated research design is needed. “Often called a randomized control trial (RCT), and experimental research design is the “gold standard” for research and evidence-based nursing practice” (Keele, 2012, p. 41). No matter what quantitative research design is used, both external and internal validity are needed to measure the success of a study (Keele, 2012, p. 42). “Internal validity refers to whether or not the manipulation of the independent variable really makes a significant difference on the dependent variable” (Keele, 2012, p. 42). Whereas, external validity refers to how well the study’s findings can be generalized and applied to a larger population (Keele, 2012, p. 42).            Qualitative research was birthed out of the constructivist paradigm (Polit & Beck, 2016, p. 12). “Researchers in constructivist traditions emphasize the inherent complexity of humans, their ability to shape and create their own experiences, and the idea that truth is a composite of realities” (Polit & Beck, 2016, p. 12). As a result, qualitative research entails the gathering of narratives and subjective data in order to understand the human experience (Polit & Beck, 2016, p. 12). This method of research is contrasting to that of quantitative research, which utilizes statistical analysis an objective data (Keele, 2012, p. 36). Keele (2012) discusses three of the most widely used qualitative designs, ethnography, phenomenology, and grounded theory (p. 44). “Ethnographies focus on studying the culture of a group of people” (Keele, 2012, p. 47). “They involve the description and interpretation of that culture’s behavior” (Keele, 2012, p. 47). Additionally, “phenomenology is an approach to exploring people’s everyday life experiences” (Keele, 2012, p. 46). Finally, grounded theory uncovers patterns that facilitate further date collection and apply meaning to a study’s outcomes (Keele, 2012, p. 47). Furthermore, like internal and external validity in quantitative research, the success of a qualitative study is measured by truth-value and applicability. “To achieve truth-value, a qualitative study must present a faithful description or interpretation of the human experience so that people having that experience can identify with it” (Keele, 2012, p. 49). A qualitative study’s applicability refers to its generalizability and how well it can be applied to a larger sample size, similar to external validity (Keele, 2012, p. 49).

Assignment: This week’s assignment is a PowerPoint presentation.  Be sure anytime you complete a PPT there is a title slide, objective slide, the content slides, and reference slide. BE SURE TO CITE ALL SOURCES USED IN AN APA FORMATTED TEXTBOX. PUT ALL YOUR FINDINGS INTO ONE POWERPOINT PRESENTATION. Requirements for PPTs are found at this recorded Webinar PPT presentation, including Speaker Notes and citing – https://screencast-o-matic.com/watch/cqhZqgT2Fu The PPT should be 15-27 slides as noted below and use at least 3 sources throughout. Follow best practices for PowerPoint presentations related to text size, color, images, effects, wordiness, and multimedia enhancements. Be sure to use a design, slide notes, slide transitions, and pictures/smart art as this is worth 50%. The Rubric is for PPT – found in the Assignment Upload link in the lower right corner– please review. Pick a cultural group (different from yours) that you commonly care for at work. Research the answers to the following and explain in the PPT what you find… Title Slide (1 slide) Objective Slide (1 slide) Health Beliefs and Practices (1-2 slide) Family Patterns (1-2 slide) Communication Style (1-2 slide) Space Orientation and Time Orientation (1-2 slide) Nutritional Patterns (1-2 slide) Pain Responses (1-2 slide) Childbirth and Perinatal Care (1-2 slide) Death and Dying (1-2 slide) Spirituality, Religion, and Faith (include holy days) (1-2 slide) Prayer and Meditation (1-2 slide) Knowledge Gained (What knowledge did you gain about this group that you were not aware of? (1-2 slide) Personal Impact on Care (How will this knowledge change the way you care for this cultural group? (1-2 slide) References (1 slide)

TASK Clinical Practice Guidelines   Post your initial response to the topic below Clinical practice guidelines use available evidence to develop recommendations that guide practice to improve patient care.  Select a clinical practice guideline, based on your area of interest, from one of the web sites below or another site. Describe the following information from the guideline you selected.  Identify the name of the clinical guideline and date developed. Identify the population. Identify 3 recommendations found in the guideline. Identify the grade or level of recommendation for the three recomendations identified and describe what the assigned grade or level means. How can you use the information from the guideline in your practice? Suggested Clinical Practice Guideline sites: https://www.guidelinecentral.com/summaries/specialties/nursing/ https://www.ena.org/practice-resources/resource-library/clinical-practice-guidelines https://www.uspreventiveservicestaskforce.org/BrowseRec/Index https://guidelines.ecri.org/

This week there will be 3 Case Studies. Pick 1 and then SBAR the patient.  SBAR is situation, background, assessment, and recommendation. I do not expect you to know what exactly to recommend, but if there is an oxygen issue you might want to recommend an ABG and/or oxygen. It does not have to be the exact modality.  Or if there is an issue with the heart an ECG might be needed.  Review the Case Studies at the end of Chapter 21 for guidence. You do not need to replay to your classmates posts.  You will have to post your answer before seeing your classmates answers. Do Not Edit without notifing me first. Case Study 1 You work at a medium size community hospital and are called to the emergency department to see a patient who is complaining of SOB. An order has been written for bronchodilator treatment. On arrival, you find a 68-year-old moderately obese man sitting upright on the examination table in the examination room. You observe that his respiratory rate is about 22 breaths/minute, with pursed-lip breathing and slight cyanosis around the lips, and he is unable to say more than a few words per breath. He is complaining of left elbow pain. His heart rate is 129 beat/minute and irregular. On auscultation, you hear fine crackles in both lung bases. He reports a nonproductive cough for the last 3 days, with increasing SOB, an inability to lie flat, and increasing leg pain. You notice that he is unable to tie his shoes because his feet are swollen and that his legs are very red, shiny, and painful to the touch. His current PEF is 45% of predicted. A room air ABG was done before your arrival: pH, 7.47; PaCO2, 32 mm Hg; PaO2, 53 mm Hg; HCO3?, 23 mEq; BE, 0; SaO2, 89%. No chest radiograph has been ordered yet. You give the ordered bronchodilator treatment with O2, but the patient reports no subjective relief. No changes in vital signs are noted. His color does improve a little during the treatment (O2 at 6 L/minute via small-volume nebulizer), and his breath sounds are unchanged. His cough is nonproductive, and there is no measurable change in the peak flow after treatment. SBAR this patient. Case Study 2 You are the night shift respiratory therapis at a local hospital. The charge nurse calls you to the medical floor on the night shift because a patient has awakened with SOB. You find a 63-year-old man sitting upright in his bed, leaning forward on the nightstand. He is pursed-lipped and using accessory muscles to breathe, with a prolonged expiratory phase, at a rate of 18 to 20 breaths/minute. In the dim light of his private room, it is hard to see his color, but his skin is warm and moist over his upper torso, and his chest has an increased anteroposterior diameter. His SpO2 is 85% on room air. On auscultation, you hear fine crackles in the right base and expiratory low-pitched wheezing in the upper lung fields bilaterally. Breath sounds in the left lung base are diminished. He has expectorated at least 8 mL of thick greenish-yellow sputum; no blood is seen. By palpation, his pulse is rapid and occasionally irregular. He was admitted 8 hours earlier for a knee fracture incurred during a fall that afternoon. When interviewed, he relates that he has COPD but has not been receiving any treatment for it for the last 8 months. When he was taking medication, it was only one MDI, 2 puffs in the early morning and afternoon, but he does not remember the name of the medication. The physician has been called, and you are awaiting a return phone call. You and the nurse agree to do the following: 1. Start O2 therapy at 2 L/min via nasal cannula 2. Repeat SpO2 after O2 therapy 3. Get an ECG stat 4. Call the physician again and call the nursing and respiratory supervisors Immediately after completing these interventions and telling your supervisor what you have done, you sit down to chart your assessment and what has transpired. SBAR this patient. Case Study 3 You work at a large city hospital and you are just starting your morning shift in the adult ICU, and you have been assigned a 20-year-old woman with a history of acute asthma. The shift report to you is that she has been on q1h bronchodilator therapy with 2.5 mg albuterol in 3 mL normal saline for 16 hours; concurrently she has been receiving 50% via air-entrainment mask, with a “PRN ABG for SOB” order and with a continuous pulse oximeter and ECG. She has been alert and cooperative, and her SOB had diminished through the night shift. Her admission ABG levels on 50% FIO2 were pH, 7.46; PaCO2, 30; PaO2, 70; HCO3?, 22; BE, 1; SaO2, 94%; Hb, 12.0; COHb, 0.7%. When you arrive in the ICU, you note a slightly sleepy but easily aroused cooperative young adult. Her SpO2 is reading 92% on 50% O2, heart rate is 128 beats/minute, and respiratory rate is 18 breaths/minute without accessory muscle use. Auscultation reveals that she has bilateral inspiratory and expiratory wheezing. Her chest radiograph report states that there is hyperinflation noted bilaterally, with patchy infiltrates and atelectasis in the right lung base. Her radial pulses are strong and unaffected by her respiratory pattern. Her stat morning electrolyte levels are all within normal limits; her CBC shows eosinophilia but otherwise is within normal limits. You start her treatment at 0730 and finish at 0745; vital signs and breath sounds are unchanged throughout the treatment. You finish your charting and go to your next patient. At 0800, the nurse calls you and asks you to come see the same asthmatic patient. You immediately recognize that her ECG rate and respiratory rate have increased in the last 30 minutes, and her accessory muscle use has increased. She is becoming restless, pulling her air-entrainment mask off and complaining of increasing SOB. You cannot hear any breath sounds over her right lower lobe. With the nurse helping hold the patient’s arm steady, you draw an arterial sample. Her SpO2 is now 88% on the air-entrainment mask when she keeps it on. Before you go to analyze the ABG levels, you put her on a non-rebreather mask per physician orders. Her ABG levels are pH, 7.26, PaCO2, 52 mm Hg; PaO2, 50 mm Hg; HCO3?, 22; BE, 5; SaO2, 86%; Hb, 12.0. On your return, the patient’s physician is at the bedside, and she tells you the patient is going to be intubated and placed on a ventilator. The anesthesiologist is called to intubate as you leave to get the ventilator. The patient is successfully intubated and placed on the ventilator per physician initial orders. Before you start an in-line bronchodilator treatment, you note and report that her auto-PEEP is 10 cm H2O at a respiratory rate of 16 breaths/minute with an I/E ratio of 1:2.5. After the in-line treatment, the breath sounds, peak pressures, and auto-PEEP are all unchanged, but the SpO2 has improved to 96%. According to hospital policy, you now have to write an assessment in the medical record. SBAR this patient I only need about 300 words,

In a 3-page paper, written in APA format using proper spelling/grammar, research the topic of menopause and address the following: Explain perimenopause, surgical menopause, stress menopause, and postmenopause. Describe the signs of menopause. Which other life changes (e.g., physical, psychosocial, and cognitive) may influence a women’s experience during menopause? Which women are at the highest risk for osteoporosis? Describe the traditional and alternative therapies for the conditions associated with menopause. Suggest appropriate health, nutrition, and exercise guidelines for middle-aged and older adults. Be sure to include APA citations for any resources you used as references.

Discuss the human body and how the body parts work. Focus on the male reproductive system.