Nursing

Discuss: Intraoperative Nursing Management
Discuss: Intraoperative Nursing Management
Pearl Richards, 69 years of age, is a female patient who is in the operating room for a repair of an abdominal aortic aneurysm. The patient has a history of hypertension controlled with medications, osteoporosis, chronic obstructive pulmonary disease, and has smoked two packs of cigarettes per day for 40 years. (Learning Objectives 2, 6, and 9)
a. What nursing interventions are instituted to reduce the surgical risk factors related to the patient’s age?
b. Explain the role of the nurse in providing patient safety measures during the intraoperative period.
Permalink:
QUESTION 19: Chapter 19, Postoperative Nursing Management
1. Rita Schmidt, 74 years of age, is a female patient who was admitted to the surgical unit after undergoing removal of a section of the colon for colorectal cancer. The patient does not have a colostomy. The patient has several small abdominal incisions and a clear dressing over each site. The incisions are well approximated and the staples are dry and intact. There is a Jackson-Pratt drain intact with minimal serous sanguineous drainage present. The patient has a Salem sump tube connected to low continuous wall suction that is draining a small amount of brown liquid. The patient has no bowel sounds. The Foley catheter has a small amount of dark amber-colored urine without sediments. The patient has sequential compression device (SCD) in place. The nurse performs an assessment and notes that the patient’s breath sounds are decreased bilaterally in the bases and the patient has inspiratory crackles. The patient’s cardiac assessment is within normal limits. The patient is receiving O2 at 2 L per nasal cannula with a pulse oximetry reading of 95%. The vital signs include: blood pressure, 100/50 mm Hg; heart rate 110 bpm; respiratory rate 16 breaths/min; and the patient is afebrile. The patient is confused as to place and time. (Learning Objectives 4 and 7)
a. Explain the assessment parameters used to provide clues to detect postoperative problems early and the interventions needed.
b. What gerontological postoperative considerations should the nurse make?
2. Mr. John Smith is admitted to the hospital for surgical incision and drainage (I&D) of an abscess on his right calf, which resulted from a farm machinery accident. The right calf has an area 3 cm × 2.5 cm, which is red, warm and hard to touch, and edematous. (Learning Objective 5)
a. Explain the wound healing process according to the phase of Mr. Smith’s wound?
b. The surgeon orders for wet-to-dry sterile saline dressing twice a day with iodoform gauze to the wound, covered with the wet-to-dry dressing. Explain how to perform this dressing change
REFERENCE TEXTBOOK:
Fundamentals of Nursing Second Edition Theory, Concepts and Applications by Judith M. Wilkinson, Leslie S Treas .

Assignment: Noise Reduction Project
Assignment: Noise Reduction Project
Permalink:
The author of this paper wants to present the proposal of a Night Time Noise Reduction Project
in the hospital for the funding to the board. Sleep is the essential part of human life and it is related to the normal functioning of the body. According to Ulrich and Joseph, “Hospitals are extremely noisy, and noise levels in most hospitals far exceed recommended guidelines” (Joseph and Ulrich, 2007). The noise of the hospitals includes the noise from machine and equipments, staffs conversation, roommates, alarms, intercoms and pagers. This author is a registered nurse who wants to propose the night time noise reduction project for the improvement of the quality and patient outcome. She is well aware of the various issues worsened by the noise-induced stress affecting not only the patients but also the family members. Therefore, I hope this kind of project will help to reduce noise during night time promoting the quality care to patients and great hospital environment.
Purpose
There is plenty of evidence that sleep is a biological necessity, and disturbed sleep is associated with a number of health problems. Noise heightens the anxiety and stress and lead to physiological responses such as facial grimacing, muscular flexion, increased blood pressure, increased heart rate and vasoconstriction; also slows the healing process. Moreover, nurses’ performance is highly affected by the hospital environment; nurse working in noisy environment complaints of exhaustion, burnout, irritability and depression (Mazer S.E., 2012). Night noise has various effects such as increase in heart rate, arousals, increase in medicine use and insomnia (WHO, 2009). The main purpose of this project is to access the noise level of the hospital units and contribute to the maintenance of sound environment using Yacker Tracker device. This project also aims to generate awareness about the consequences of noise in the health of patients and staffs.
Target Population
A large number of groups are at risk due to hospital noise especially at night. Elderly people and pregnant women at higher risk, besides them children and patients with ill health are also considered as risk groups. To add up, registered nurses and shift workers are also at risk as their sleep structure is under stress (WHO, 2009).
Benefits
A number of aspects of health and quality of life are associated with the sleep and these aspects are impaired with disturbance in sleep. Therefore, sound sleep is essential for the patients and various measures should be applied to maintain the peaceful and quiet environment in the hospital especially at night time as a component of patient care. Many studies has shown that various pilot projects were initiated for the reduction of noise in the hospital and they all have positive outcome leading to the sound hospital environment and sound sleep of patients at night. This project aims to promote the patients health and create great environment for the workers by reducing the noise at night. Sleep deprivation results in unsatisfied patients and that ultimately causes the declination of the overall rating of hospitals. This may also affect the hospital revenue in the long term. Therefore, the Night Time Noise Reduction project helps to cope with such consequences in the long run.

Discussion: Developing Practice Project
Discussion: Developing Practice Project
Permalink:
I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS
After discussion with your mentor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account in developing the evidence-based practice project. Explain how your proposal will, directly and indirectly, impact each of the aspects.
Speaking with the mentor, the financial aspect of the project would be hours spent trying to get nurses educated on the proposed guidelines for late preterm infants. Hours will be needed as well to get the basic checklist implemented into the computer in this particular area, which requires going to different committees and getting approvals needed. This takes more than one nurse or person to get this done. This requires more hours of pay, and that would be the financial aspect of the proposed project.
Now, the clinical aspect that has to be taken into account with developing the project would be how the nurses will accept the project. As lifelong learners, staff nurses continually encounter new knowledge of relevance to their patients. The conscientious nurse remains alert to clinical problems and encourages investigation into ways to improve patient outcomes(Di Lenoardi, 2014). The nurses need to be given research and data that proves this could help readmission of late preterm infants. If given this data, they would be involved in the process of implementing as well,
In 2001, the Institute of Medicine (IOM) recommended evidenced based practice to improve healthcare outcomes(Stephens, 2013). This project is to improve the quality outcome of late preterm infants and prevent their readmission to hospital.
All the aspects brought together will make a good impact on the project the author believes with the research and data given to the nurses, implementation and then follow up of results will show this is a great solution to help alleviate many readmissions nationwide as well. If this hospital shows that the guidelines are helping there, then they can show other colleagues in the nation that this helps and also will cut costs by preventing readmissions.
References
Di Lenoardi, B. C. (2014). Bringing evidence-based practice to life. Retrieved from https://lms.rn.com/getpdf.php/2145.pdf
Stephens, K. R. (2013, May 13). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing., 18. https://doi.org/10.3912/OJIN.Vol18No02Man04

Discussion: Leadership Strategies
Discussion: Leadership Strategies
Permalink:
As faculty members, you have been asked to design a 4-hour Leadership Strategies course that would accommodate the learning styles for a selected 10 students. The students have all completed a learning style inventory in which three of the students are determined visual learners, four are kinesthetic learners, and the rest are auditory learners. Note: The intended audience for the course can be either newly graduated nurses or experienced staff nurses as you choose. Compose a 1,000-1,250-word paper which describes your plan to accommodate the learning styles of each student. This plan starts with defining course objectives; use the “A-B-C-D Method of Writing Objectives” resource as a guide. The objectives should incorporate Bloom’s taxonomy, be written at the appropriate level for the audience, and include at least two learning domains (cognitive, psychomotor, and affective). Make sure to include the following: 1. An outline of the course content and agenda that will be covered. 2. Descriptions of the learning activities and the rationale for the learning activities selected 3. Strategies to assess learning, based on the learner objectives 4. Use at least three scholarly, peer-reviewed sources less than 5 years old in addition to the course materials. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required. Refer to “Learning Styles Rubric,” prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center. Please use the -A-B-C-D Approach to Objective provided. SEE A-B-C-D APPROACH BELOW.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required. Refer to “Learning Styles Rubric,” prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center. Please use the -A-B-C-D Approach to Objective provided. SEE A-B-C-D APPROACH BELOW.

Assignment: Wahhabism for terrorism
Assignment: Wahhabism for terrorism
Read the following article:
Summarize the author’s major claims in the article. Do you agree or disagree with the claims put forth in this article? Defend your position.
Permalink:
Make sure to cite academic sources in your discussion. Use the FIU Library’s online databases for academic research (). Try the for a more specific starting point.
Final Research Paper
[WLO: 3] [CLOs: 1, 3, 4, 5]
Prior to beginning work on this assignment, please review your feedback from the Week 3 Assignment: Summarize Your Sources for the Final Research Paper. Make sure that your instructor approved of the sources you chose for the final paper and your working thesis statement. Make any changes that your instructor requested prior to beginning work on the final paper.
For help in completing this assignment, see the which will walk you through how to successfully complete the Final Research Paper.
See this for an overview of what should be covered in each part of the paper.
See the for a list of requirements for each part of the paper.
If you’d like to see a bigger version of this tutorial, please .
In the Final Research Paper, you will
Describe an aspect of your own culture from an etic (outsider’s) perspective in Part I of the paper.
Describe an aspect of another culture from an emic (insider’s) perspective in Part II of the paper.
Apply cultural relativism in order to examine misconceptions about culture that may occur due to ethnocentrism.
Keep the distinction between cultural relativism and moral relativism in mind as you write your final paper.
Even if you do not personally agree with a cultural practice, explain how the practice makes sense in its cultural context.
Avoid opinionated or judgmental language in your paper.
Analyze your chosen aspect in terms of how it developed as part of a social system within both your culture and another culture.
Analyze your chosen aspect in terms of its purpose as part of a social system both within your own culture and another culture.
The Final Research Paper
Must be five to six double-spaced pages in length (excluding title page and references page, meaning it will be seven to eight pages total), and formatted according to APA style as outlined in the Ashford Writing Center’s .
Must include a separate title page with the following:
Title of paper
Student’s name
Course name and number
Instructor’s name
Date submitted
For further assistance with the formatting and the title page, refer to .
Must utilize academic voice. See the resource for additional guidance.
Must include an introduction and conclusion paragraph. Your introduction paragraph needs to end with a clear thesis statement that indicates the purpose of your paper.
For assistance on writing as well as , refer to the Ashford Writing Center resources.
Must include at least one full-text scholarly resource ideally from the Ashford University Library in addition to the textbook, the Miner article, and the article chosen from the in Part II of the Week 3 assignment.
The table offers additional guidance on appropriate source types. If you have questions about whether a specific source is appropriate for this assignment, please contact your instructor. Your instructor has the final say about the appropriateness of a specific source for a particular assignment.
Must document any information used from sources in APA style as outlined in the Ashford Writing Center’s
Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center. See the resource in the Ashford Writing Center for specifications.
Helpful Tips:
Submit your paper to to check for spelling and grammatical errors.
To avoid potential errors in acknowledging your sources, run your paper through Turnitin (review ) to check for any problems.
Review how to interpret a Turnitin report starting on page nine of
To correct any mistakes, review the Ashford Writing Center’s guide to .
In this class, you have three tutoring services available: Paper Review, Live Chat, and Tutor E-mail. Click on the Ashford Writing Center (AWC) tab in the left-navigation menu to learn more about these tutoring options and how to get help with your writing.

Assignment: Mental Health Theories
Assignment: Mental Health Theories
Permalink:
Submit a paper which compares and contrasts two mental health theories:
You may choose your theories from the textbook or from other sources.
Describe each theory, including some history about the person who developed the theory and the major ideas and applications of the theory.
Describe the ways in which the two theories are similar, and how they differ.
Include a statement of how each theory could be used in your nursing practice. Include specific patient examples if you have them. You may also critique the theory: Is there anything with which you disagree or are there any problems you can identify?
It is expected that this essay will be 2-3 pages in length (not including the title page), double-spaced. Your paper should include an introduction and conclusion and proper APA citations from any source material you use, including your text.Submit a paper which compares and contrasts two mental health theories:
You may choose your theories from the textbook or from other sources.
Describe each theory, including some history about the person who developed the theory and the major ideas and applications of the theory.
Describe the ways in which the two theories are similar, and how they differ.
Include a statement of how each theory could be used in your nursing practice. Include specific patient examples if you have them. You may also critique the theory: Is there anything with which you disagree or are there any problems you can identify?
It is expected that this essay will be 2-3 pages in length (not including the title page), double-spaced. Your paper should include an introduction and conclusion and proper APA citations from any source material you use, including your text.

Ethical Decision Making Discussion
Ethical Decision Making Discussion
Permalink:
QUESTION 3: Case Study, Chapter 3, Critical Thinking, Ethical Decision Making, and the Nursing Process
1. Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of the small intestine. She is currently receiving comfort measures only in hospice. She has gangrene of her right foot and has a history of diabetes controlled with oral agents. She is confused and the physician has determined that she is unable to make her own informed decisions. The hospice nurse, not realizing that the weekly order for CBC and renal profile had been discontinued, obtained the labs and sent them to the nearby laboratory for processing. The abnormal lab results obtained later that day revealed that the patient needed a blood transfusion. The hospice nurse updated the patient’s medical power of attorney who was distressed at the report. The patient’s wishes were to die peacefully and to not have to undergo an amputation of her right foot. But if the patient receives the blood transfusion, she may live long enough to need the amputation. The patient’s physician had previously informed the medical power of attorney that the patient would most likely not be able to survive the amputation. The patient’s medical power of attorney had made the request to cease all labs so that the patient would receive comfort measures until she died. The patient has no complaint of shortness of breath or discomfort. (Learning Objective 4)
What ethical dilemma exists?
Who are the stakeholders and what gains or losses do each have?
What strategies should the hospice nurse take to resolve the ethical dilemma?

Assignment: pharmacokinetic and pharmacodynamic processes
Assignment: pharmacokinetic and pharmacodynamic processes
Permalink:
To prepare:
•Review this week’s media presentation with Dr. Terry Buttaro, as well as Chapter 2 of the Arcangelo and Peterson text, and the Scott article in the Learning Resources. Consider the principles of pharmacokinetics and pharmacodynamics.
•Reflect on your experiences, observations, and/or clinical practices from the last five years. Select a case from the last five years that involves a patient whose individual differences in pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug. When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.
•Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
•Think about a personalized plan of care based on these influencing factors and patient history in your case study.
Post 1 page discussion paper on a description of the case you selected. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient from the case you selected. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case.
REFERENCES
•Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
?Chapter 2, “Pharmacokinetic Basis of Therapeutics and Pharmacodynamic Principles” (pp. 15–29)
•Scott, S. A. (2011). Personalizing medicine with clinical pharmacogenetics. Genetics in Medicine, 13(12), 987–995. Retrieved from
Media
•Laureate Education, Inc. (Executive Producer). (2012). Introduction to advanced pharmacology. Baltimore, MD: Author.

Assignment: Using Query Design
Assignment: Using Query Design
Permalink:
1
Start Access. Open the downloaded Access file named exploring_a03_Grader_a1.
2
Create a query using Query Design. From the Clients table, display the client’s first and last name. From the Accounts table, select the savings balance and account open date. Sort the query by savings balance in descending order.
3
Add a calculated field named AccountTime that calculates the number of days each client’s accounts have been open. Assume today’s date is 12/31/2017. Recall dates must be enclosed in # to denote to Access it is a date. Format the results in General Number format. Save the query as Account Longevity, and close the query.
4
Create a query using Query Design. From the Clients table, display the client first name and last name. From the Accounts table, select the savings balance.
5
Add appropriate grouping so the client’s total retirement account savings balances are displayed. Add a sort so the highest total savings balances are displayed first.
6
Switch to Datasheet view. Add a totals row displaying the count of the clients and the average of total savings balances. Save the query as Total Balances By Client, and close the query.
7
Create a copy of the Total Balances By Client query. Name the query Total Balances By State. Open the query in Design view and remove the client name from the query. Add grouping by the client’s state.
8
Sort by the client’s state in Ascending order. Add criteria so clients with retirement account savings balances of $10,000 or more are factored in to the query. Save and close the query.
9
Create a new query using Query Design. From the Clients table, select the client first name, last name, and state. From the Accounts table, select the Savings Balance. Add criteria so only customers with balances under $15,000 are displayed.
10
Add a new field named LoanPaymentusing the Expression Builder. Insert the PMT function to determine the monthly payment for a 2-year loan, paid monthly, with a 5% yearly interest rate. The present value is 25000 minus the savings balance. For example, if the purchase price were 25000, with 5000 in savings to put toward the purchase, your present value would be 20000. Ensure the number displays as a positive number.
11
Change the format of the LoanPayment field to Currency. Change the caption to Loan Payment. Save the query as Monthly Loan Payments and close the query.
12
Close all database objects. Close the database and then exit Access. Submit the database as directed.

Discussion: Clinical Pathways
Discussion: Clinical Pathways
Permalink:
Complete each case study utilizing collegiate formatting (MLA or APA); typed in Cambria or New Times Roman 12 point font in ONE document. Citations required.
Case studies are case specific. Your answers should reflect the assessment and your analysis of the information in the case study… no generalized answers of all matter regarding the content.
QUESTION 1: Healthcare Delivery and Evidenced –Based Nursing Practice
The registered nurse working in the cardiac care clinic is tasked with implementing quality improvement measures. To educate the clinic staff, the nurse plans an in-service program to introduce concepts of quality improvement and evidence-based practice. Additionally, the role of the case manager will be included in the presentation. The nurse plans on using care of the patient with Congestive Heart Failure as a template, and prepares sample clinical pathways, care maps, and multidisciplinary action plans. (Learning Objective 3)
a. Describe how clinical pathways are used to coordinate care of caseloads of patients.
b. What is the role of the case manager in evaluating a patient’s progress?
c. What are examples of evidence-based practice tools used for planning patient care?
QUESTION 2: Community-Based Nursing Practice
Mrs. Johnson, a 67-year-old female patient, has recently been discharged from the hospital following an admission for COPD. She has a past medical history of a colon resection related to acute diverticulitis. She developed a surgical wound infection that requires daily wet to dry wound packing and IV Zosyn. Mrs. Johnson was discharged with home oxygen. To manage her care at home, home care visits were ordered. (Learning Objective 5). Mrs. Johnson, a 67-year-old female patient, has recently been discharged from the hospital following an admission for COPD. She has a past medical history of a colon resection related to acute diverticulitis. She developed a surgical wound infection that requires daily wet to dry wound packing and IV Zosyn. Mrs. Johnson was discharged with home oxygen. To manage her care at home, home care visits were ordered. (Learning Objective 5).
a. What would be involved in setting up the first home care visit?
b. Describe the nursing assessments and management that would occur during the visit.