150 words no reference-NURSING RESPONSE POST

 

The ASAs campaign has been completely devoid of evidence, but they have gotten away with it because they have utilized the media to their advantage, as with this Facebook example.  These days people spend a lot of time on social media and tend to obtain a lot of their information that way, many getting duped by total nonsense.  Unfortunately very few people actually take the time to find real information from legitimate sources. Through out our last discussion, we saw that there is in fact sufficient evidence to prove that CRNAs are as safe as anesthesiologists, but there continues to be a disconnect between this information and the public. And so, I completely agree with that colleague’s statement; “I believe the CRNA associations need to start writing and circulating the research articles to prove otherwise.”  While it is important to continue new research endeavors to build more evidence to fight the VAs ruling and other decisions like it, I believe at this time it is imperative to focus on effectively disseminating the information already available in ways which will easily reach the lay public.  Perhaps utilizing things like videos posted on platforms such as Facebook, and YouTube, which people commonly use to look for information.  These videos could explain what CRNAs do, their safety, cost-effectiveness, while making emphasis on the training necessary to become a CRNA and the difference to a staff RN, as well as the fact that CRNAs are equivalent to anesthesiologists.  It can also make mention of the research already done to support these claims and post links to the articles for further reading.  There could also be videos of interviews done with patients that have been treated by CRNAs and what their experiences were.  

 

There is a lot of work left to be done and we as SRNAs can join the AANA in its mission “to advance the science of anesthesia through education and research” in many ways. The AANA supports and sometimes funds research conducted by SRNAs.  This research can be presented through the “State of Science” Oral or General Poster Presentations for which they could be $1000 award.  The research can also be presented through the AANA NewsBulletin in a designated section to research called Discoveries of Distinction.

 

Other ways that SRNAs can participate within the AANA can be through the Student Advocate program which was established in 2015.  The goal of the program is to have a student acting as a liaison between the AANA and the nurse anesthesia programs. The program is currently attempting to have one student advocate per state, but its ultimate goal is to have one student per anesthesia program. Aside from the Student Advocate position, the AANA also has a position for a student on the board of trustees.  This student keeps the flow of information open between the foundation’s board of trustees and SRNAs. Students can also showcase their non-anesthesia related talents like singing or playing a musical instrument, at fundraising events like that of 2014 “The Stars Come out Again”.  There are also multiple meetings and workshops through out the country SRNAs can be part of like the Nurse Anesthesia Annual Congress taking place in September or The Mid-Year Assembly which will take place in Washington D.C. in April 2018, where nurses go to “learn about the healthcare policies impacting nurse anesthesia, and develop the skills needed to effectively advocate for your profession during meetings with your federal legislators.” This will be a good time to learn how we can be most helpful in affecting change as with the current VA debate.

 

 I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 120-150 WORDS

 

What nursing interventions are appropriate for Mrs. J. at the time of her admission?

Mrs.  J. is being admitted to the ICU due to acute decompensated heart failure. The subjective and objective data obtained is the following: Mrs. J is overweight based on her height and weight (5 feet 9 inches and weighs 210.5 pounds). For three days she has been experiencing a low grade fever (99.68), pharyngitis, and malaise. She denies pain but feels that she cannot breathe due to dyspnea. She claims that her heart is running away which indicates tachycardia (HR 118 and irregular). Her heart rate is working harder to compensate for the low blood pressure of 90/58. Her peripheral pulses are +1, demonstrating jugular distention, and ventricular rate of 132 with atrial fibrillation. She has crackles at auscultation, decreased breath sounds on right lower lobe, coughing frothy blood-tinged sputum, with and a very low oxygen saturation level of 82%. This patient is having left sided heart failure based on the subjective and objective data obtained.

Intervention: Place patient on continuous oxygen 2-4 LPM via n/c.

Rationale: To alleviate dyspnea symptoms and allow patient not to work as hard breathing

Intervention: Establish guidelines and goals of daily activity.

Rationale: Patient will most likely be more willing to cooperate if she is included in the goals being set.

Intervention:  Assess patient’s mentation regularly.

Rationale: This is to determine if the patient is becoming more severe. Anxiety and confusion are late signs when a patient is having decreased cardiac output.

Intervention: Keep patient semi to high-fowlers position.

Rationale: This will help alleviate some of the shortness of breath.

Intervention: Asses heart rate and blood pressure frequently.

Rationale: Sinus tachycardia and increased arterial blood pressure are in the early stages and the blood pressure decreases as the condition worsens.

Intervention: Assess peripheral pulses frequently.

Rationale: weak pulses are indicators of low cardiac output.

Intervention: Assess skin color and temperature.

Rationale: Cold and clammy skin is an indicator of low cardiac output and desaturation.

Intervention: Assess fluid balance and weight gain.

Rationale: A compromised regulatory system can result in sodium and fluid retention.

Intervention: Continuous assessment of lung sounds.

Rationale:  Crackles are indicative of fluid accumulation and secondary to left ventricular failure.

Intervention: Asses urine input and output.

Rationale: Decreased urine output is an indicator of lack of renal perfusion.

Intervention: Assess for chest pain.

Rationale: Indicates lack of oxygen supply. (Ackley & Ladwig, 2011).

 

What is the rationale for the administration of each of the following medications?

1. IV furosemide (Lasix) – Furosemide is a loop diuretic and used to decrease fluid volume (pre-load). Patient is demonstrating. It is also used as an adjunct therapy. Mrs. J has crackles and coughing frothy blood-tinged sputum that is indicative of pulmonary edema. Nurse must check patient’s urine input and output and electrolytes due to possible dehydration, depletion of potassium, and metabolic alkalosis.
2. Enalapril (Vasotec) – is an angiotensin-converting enzyme (ACE) inhibitor. Enalapril is used for congestive heart failure which is a weakness of the heart that leads to buildup of fluid in the lungs and the surrounding tissues. Patient has crackles, and she is coughing frothy blood-tinged sputum (McKenry, 2006).
3. Metoprolol (Lopressor) – Lopressor is a beta blocker and the standard use for heart failure. Beta blockers are used in patients with heart failure because it helps improve the hearts ability to relax, decrease the production of harmful substances produced by the body in response to heart failure, and slows down the heart rate. Mrs. J has a ventricular rate of 132 and atrial fibrillation (WebMD, 2015).
4. IV morphine sulphate (Morphine)- Morphine is an opioid and it is used to alleviate Mrs. J’s dyspnea. Morphine lowers the breathing rate in the brains respiratory center. This will help Mrs. J’s heart not work so hard. Morphine does this by widening the blood vessels in the extremities which will allow the heart not to work hard and use less oxygen. It is also great use for anxiety. Mrs. J is experiencing anxiety due to dyspnea and fear of complications (McKenry, 2006).

Describe four cardiovascular conditions that may lead to heart failure

Obesity – Mrs. J is overweight (210.5 lb). Obesity can cause congestive heart failure. Left Ventricular hypertrophy is very common in patients with obesity.

High Blood Pressure – Mrs. J has a history of high blood pressure. The history of years of high blood pressure probably caused damage to the artery walls. The constant pushing on the walls of the arteries probably weakened her heart.

Atrial Fibrillation – Mrs. J is currently having atrial fibrillation. This means that the heart is not pumping enough blood to meet the needs of the body. This can lead to heart failure because the heart is beating so fast and working so hard that the heart doesn’t fill-up properly to pump blood to the body. The blood then can back up in the pulmonary veins which cause fluid buildup which Mrs. J is currently experiencing. Mrs. J is also has fatigue and dyspnea due to lack of rich oxygenated blood that is not being delivered to her body and brain (American Heart Association, 2015).

Coronary Artery Disease – Coronary artery disease is the most common form of heart disease and heart failure. It is the accumulation of fatty deposits buildup that causes reduction in blood flow, weakening the heart, and causing permanent damage to the heart. 

And what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

Obesity Intervention – Establish short and long term goals, encourage calorie intake appropriate for body type and lifestyle, encourage Mrs. J to keep a daily log of food and liquid consumption. Encourage Mrs. J to be more aware of nutritional habits that may contribute to weight gain. Encourage Mrs. J to exercise and encourage consultation of a dietician for further assessment and recommendations regarding a weight loss program. Educate Mrs. J of the importance of routine follow-up MD visits.

High Blood Pressure – Mrs. J has been smoking two packs of cigarettes daily for the last forty years. Smoking cause’s blood pressure to rise but the chemicals in the tobacco causes damage to the lining of the artery walls causing arteries to narrow, increasing the blood pressure. Educating the patient with the outcome of smoking is beneficial. Mrs. J needs to be educated on the importance of taking her blood pressure on daily and keeping a log of the blood pressure reading. Mrs. J should be placed on a low sodium cardiac diet. Educating Mrs. J on the importance of taking her medication on a daily basis as prescribed to prevent organ damage. Informing Mrs. J that lifestyle adjustment must be made to reduce the risk of cardiovascular morbidity. This is not a short term goal and it will take time for patients to get use to the lifestyle change and nursing follow is important for the patient to feel supported and follow the program.

Atrial Fibrillation – Atrial fibrillation is the loss of synchrony between the atria and ventricles. The goal is to maintain adequate cardiac output and tissue perfusion to make sure Mrs. J does not develop a thromboembolism. Monitoring the heart rate is very important and making sure that the systolic rate does not go below 90mmHg. Mrs. J should be educated on reporting any chest discomfort in which oxygen therapy would be beneficial. Continuous cardiac monitoring is imperative. Also making sure Mrs. J receives education on medications such as Amiodarone or Digoxin to control the atrial fibrillation. Educate Mrs. J how to obtain her own pulse and recognize symptoms of toxicity.

Coronary Artery Disease – is the accumulation of plaque buildup on the coronary arteries which leads to blockage. The heart is deprived of oxygen due to the blockage and is unable to pump efficiently. Very important to access patient level of consciousness, evaluate for chest pain, assess heart rate, blood pressure, peripheral pulses, and evaluate skin color and temperature. Provide oxygen in conjunction with medication therapy. Monitor fluid volume to prevent overloading the heart and lungs Reduce anxiety by providing Mrs. J to share her fears or concerns. Provide a quiet environment and uninterrupted sleep.

Discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients.

Intervention: Interview Mrs. J to obtain a complete drug history that includes prescribed, OTC, home remedies, herbals, vitamins, and any drug allergies (Ackley & Ladwig, 2011).

Rationale: This will help the healthcare provider identify any potential side effects that might occur with the medications, OTC, home remedies, herbals, vitamins, or drug allergies (Ackley & Ladwig, 2011).

Intervention: Teach Mrs. J how to make a list of each medication, including the name, strength, appearance, purpose, and effects (Ackley & Ladwig, 2011).

Rationale: Educates the patient on the reason for taking the medication and what to look for(Ackley & Ladwig, 2011).

Intervention: Question Mrs. J on her self-medication practices. How does Mrs. J remember to take her medication? Does she forget to take her medication and what does she do when she remembers (Ackley & Ladwig, 2011).

Rationale: This allows the healthcare provider know if Mrs. J is over or under medicating herself (Ackley & Ladwig, 2011).

Intervention: Determine if Mrs. J is capable of administering medications (Ackley & Ladwig, 2011).

Rationale: There might be a physical impairment, memory loss, health, cultural beliefs, financial constraints, or social support lacking (Ackley & Ladwig, 2011).

.

References

 

Ackley, B., & Ladwig, G. (2011). Nursing diagnosis handbook: An evidence-based guide to planning care (9^th ed.). St. Louis: Mosby, Elsevier.

 

American Heart Associatio. (2015). Why atrial fibrillation (af or afib) matters. Retrieved fromhttp://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/Why-Atrial-Fibrillation-AF-or-AFib-Matters_UCM_423776_Article.jsp#.Vp151vkrLIU

 

Kozier, B. (2012). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice(9^th ed.).

  Boston: Pearson.

 

McKenry, L., & Tessier, E. (2006). Mosby’s pharmacology in nursing (22nd ed.). St. Louis, Mo.: Elsevier

  Mosby.

 

WedMD. (2015). Heart failure health center. Retrieved fromhttp://www.webmd.com/heart-disease/heart-failure/heart-failure-beta-blocker

The IOM report Writing Assignment

Due Date 9/5/2017

 

            Download a copy of the IOM Report future of nursing document; Read part 1 pages 21-46 the document and then construct a one page paper discussing:

1.     Provide brief description of the IOM report

2.     Reflect on the purpose of the IOM report and what it means for nursing

3.     Discuss the pro and cons (if any) of the IOM’s plans for nursing

 

Writing Assignment Guidelines: Assignment must be typed with appropriate punctuation, spelling, sentence structure and APA format for citing of reference and reference page.

Incorrect placement of commas, incorrect capitalization, spaces where none are allowed are examples of APA errors and points will be deducted. Papers are to be submitted hard copy, must be stapled, and NOT be enclosed in folders. Written work should be submitted with a cover page according to APA cover page guidelines. If writing requirements are not followed precisely, your grade on written materials may begin with a grade of 91.

 

Specific Writing Requirements:   Rewrites are NOT allowed. 

 

A.    Use precise APA format that includes correct punctuation, spelling, sentence structure and references. The “easy” on-line APA software has errors and should not be used.

B.    Type must be Times Roman, 12-point font, and double spaced

C.     Use the spell check function on your computer (will help with #1)

D.    Use a COVER page following APA guidelines

E.     DO NOT use a folder. Staple all assignments. Assignments are to be hard copy-not via email. Save your work as you may be asked to submit a back-up email as needed.

F.     Papers turned in past the due date will receive an automatic deduction of 10 points with the grade starting at 89 (B) unless prior arrangements have been made with the professor

If the page numbers are limited, pages that exceed the limit will not be read and further points may be removed if critical content was included on the excess pages

  

 

 

 

 

 

 I NEED A POSITIVE COMMENT BASED IN THIS DISCUSSION QUESTION..BETWEEN 120-150 WORDS

 

What clinical manifestations are present in Ms. G?

Ms. G presents Pain, heaviness, chilling, unable to bear weight on her left leg, round, yellow-red wound with yellow drainage, elevated white count, neutrophils, bands, wound culture with Staphylococcus aureus.

Ms. G is a young female (23y/o) with diabetes that weighs 184.3 pounds and measures 5 feet 2 inches tall. Based on Ms. G’s weight and height she is obese. She has been home applying heat to her leg for the past 48 hours. The heating pad could have caused damage to the tissue possibly already infected causing further damage. Obesity has also been identified as being one of the risk factors in the development of lower extremity cellulitis (Antimicrobe, 2014).

The pain, heaviness, and chilling are all indicators that her body might be fighting infection. The open wound observed with erythema, swelling, and thick yellow exudate is also indicative of infection. According to Antimicrobe cellulitis is an acute infection of the skin that involves the subcutaneous tissues. It is manifested by: swelling, erythema, tenderness, warmth, and fever (Antimicrobe, 2014).

Ms. G has a low grade fever of 102.2. According To Your Health website a patient with a fever between 100 degrees Fahrenheit and 102.2 degrees Fahrenheit is beneficial by assisting the body in repelling the microbes or invader from the body (To Your Health, 2012).

White blood cells help fight infection (leukocytes). Elevated WBC is due to infections that are mostly related to bacteria. Neutrophils are the first cells to respond and arrive at the site where inflammation occurs. Neutrophils conventional units are between 45%-73%. Neutrophils increase with an acute infections, trauma, surgery, and leukemia to name a few (Brunner, 2008). Ms. G’s, neutrophils are just slightly elevated at 80%.

The body’s immune system responds by the inflammatory response which is started by the response of tissue injury or invading organisms.

Normal band count is between 2-6%. Bands are immature white blood cells. When the body is under significant attack by bacteria or virus and immature cells might be released early into the circulation to fight infection. Ms. G has 12% band count which is also indicative of infection.

What recommendations would you make for continued treatment?

Cooling measures plus Tylenol should be started to reduce fever and pain. Provide wound care on a daily basis and practicing proper skin hygiene. Making sure that patient has their lower extremity elevated to reduce edema. Advise to pump her feet on a regular basis to promote circulation.  Provide patient with a diabetic diet while in the hospital. An antibiotic treatment will need to be started. Accu checks with a sliding scale should be implemented. Provide diabetic education before the patient is discharged.

Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”

The ARC: Anatomy Resource Center (n.d.), identifies that the muscle groups affected would be the soleus, tibialis, anterior extensor, digitorum longus, and the gastrocnemius.

What is the significance of subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care?

Objective date is collected by physical examination, including observation, palpation, percussion, and auscultation, and by laboratory analysis and other studies to eliminate possible diagnosis pertaining to the patient’s signs and symptoms.

Subjective data is a collection of data that has been provided by the patient or family. The subjective data is retrieved from the description of an event rather than from a physical assessment.

What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delay wound healing?

A diabetic patient takes longer for their wound to heal but the wound can rapidly get worse, so it requires close monitoring. If the patient has an elevated blood sugar it will cause the arteries to stiffen and cause narrowing of the blood vessels. Narrowed blood vessels than lead to decreased blood flow and oxygen to the wound. The patient having an elevated blood sugar also decreases the function of red blood cells that are able to fight infection. Ms. G lives alone has not been able to walk for three days and has not had proper nutrition based on her current weight and current situation making the wound to get worse. Without the proper and sufficient nutrition and oxygen the wound will heal very slowly.

References

Antimicrobe. (2014). Cellulitis. Retrieved from http://www.antimicrobe.org/e1.asp#t1

ARC: Anatomy Resource Center. (n.d.). Explore the human body. Retrieved from http://conhs.gcumedia.com/bio155/anatomy/arcBio155v2.swf

Brunner, L. (2008). Brunner & Suddarth’s textbook of medical-surgical nursing (11th ed.).Philadelphia: Lippincott Williams & Wilkins.

To Your Health. (2012). The facts about fevers. Retrieved from http://www.toyourhealth.com/mpacms/tyh/article.php?id=1521

 

 I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 150-200 WORDS

 

Numerous theories have been developed regarding what motivates people in various environments. In reality, internal and external factors lead to motivation. Personality and self-concept play a significant role in determining whether an individual will be intrinsically or extrinsically motivated (Schunk, 2012). If one gets to understand the differences between intrinsic and extrinsic motivational factors, they tend to have a greater probability to motivate themselves and others.
 
Every behavior has a cause, and there is a need to understand the cause of the behavior. Motivating factors are the key to changing and improving outcomes in individual lives. Intrinsic motivation means internal.  An individual who is intrinsically motivated enjoys an activity, skill development or any course, for the sake of sole satisfaction. This person learns with fun and has an inward drive to remain competent. There is no source of internal inducement especially when intrinsic motivation is the cause of any behavior.

In the case of extrinsic motivation, this is external. Such a kind of motivation is everywhere and is used within the society. When an individual has to be motivated to behave or do something, this is regarded as extrinsic motivation. Examples of extrinsic motivation include medals, trophies, and discounts for the purpose of increasing morale. A person who is intrinsically motivated tends to do almost everything by himself, without being coerced. On the other hand, an extrinsically motivated person has less morale, unless aspects such as rewards are incorporated.

Extrinsically motivated individuals seek to be rewarded especially when they do what is expected of them. If an organization chooses not to reward this type of personnel, they tend to be less motivated and less inspired to produce more productive results. Extrinsically motivated individuals can be motivated by pay, promotions and job security. These external factors play a significant role and enable workers to perform their best.

Intrinsically motivated workers, on the other hand, find pleasure from completing their tasks. These individuals can, therefore, be motivated through recognition and praise from their management. This, however, does not make them feel more or less satisfied with their job. Intrinsically motivated individuals believe an individual needs to have a genuine fascination for a particular aspect or task to achieve.

Most members in high performing teams are always optimistic that it is fun to work on collaborative teams. This is because they are asked to contribute their best. Characteristics of performance driven teams include;
a) Every individual is working toward the same goals and objectives.
b) Every member is clear on how to work with each other (Stipek, 2013).
c) Team members are ready to diffuse tension among themselves actively.
d) Team members make a decision when there is an agreement, where criticism is highly constructive.
e) Every member respects the team process and other members.

References

Schunk, D. H., Meece, J. R., & Pintrich, P. R. (2012). Motivation in education: Theory, research, and applications. Pearson Higher Ed.

Stipek, D. J. (2013). Motivation to learn: From theory to practice. New York: Cambridge