1-Mr. C has a variety of health issues related to his obesity. He has an elevated fasting blood glucose which indicate that he could be diabetic, an A1C level should be drawn to follow up with that. He also has elevated triglycerides, normal levels for a male should be between 40-170, his is 312. His total cholesterol are elevated as well, which normal levels should be less than 200, and his is 250 (Comprehensive Guide to Normal Lab Values, 2019).  Keeping that in mind, he probably has high cholesterol diagnosis as well. His blood pressure is also elevated, which means that he needs more than just sodium restriction in his diet to control. Without him being on any medication, he is asking for a stroke in my opinion. Further education needs to be provided for him especially in needing to change his diet. Not only does he need to control his sodium intake, he also needs to monitor, carbs and sweets. 

Personally, I would not recommend bariatric surgery until I am convinced that he is ready for the change. I would recommend that he loses some weight first since it would be risky with him being obese, to even undergo anesthesia. 

1. Health      perception- Mr. C has a poor general health as evidenced by his lab levels      and vitals. It seems that with his sedentary lifestyle, he is lacking      exercise which would be very beneficial for him at this point. He is      realizing that he needs help with his obesity and is considering bariatric      surgery, so that is a positive. 

Nutritional-Metobolic Pattern- It seems that with his high BMI, high HDL and cholesterol levels, he has a poor eating habits. He did mention that he attempts to control his blood pressure with sodium restriction. 

Elimination- This category was not discussed. 

Activity-Exercise Pattern- He works at a catalog telephone center, which means that he probably does not get much exercise with this job. He lives a sedentary lifestyle. 

Sleep-Rest Pattern- He mentioned that he has sleep apnea. 

Cognitive-Perceptual Pattern- He did not mention any cognitive deficits or hearing difficulties. He works at a telephone center so he must have good communication skills. 

Self perception- He did not mention much of his life outside of his job, so he may have low self-esteem associated with the obesity. 

Sexuality reproductive pattern- This was not discussed. 

Coping stress tolerance pattern- This was not discussed but he is seeking help with his obesity. 

Values Beliefs pattern- This was not discussed. 

1. 5      problems- His sedentary lifestyle is a problem that needs to be addressed.      Mentioning that including even walking on his lunch break could make a      huge difference in losing weight. Him not being able to control his blood      pressure with just restricting sodium from his diet alone. With this high      of blood pressure and high cholesterol he is a major risk for a stroke, as      I mentioned above. Getting him started on medication would be crucial for      him. I would also address that sleep apnea a little further as well.      Asking if he is using a CPAP machine at home and how deligiant he is at      using it. Another problem, is his diet. I would have him be referred to a      nutritionist or further educate him on learning to maintain his diet. I      would recommend weight watchers, they have a great program that is easy to      manage with just an app. They even have support groups as well so he can      meet people through it. If he does not control his diet and continue      gaining weight, he would be at risk for many other diseases that cause a      shorter life and could be life threatening. 

Reference 

Comprehensive Guide to Normal Lab Values. (2019). Meditec. Retrieved from https://www.meditec.com/resourcestools/medical-reference-links/normal-lab-values/

2-I agree that these days people look for a quick pill to take care of their problems. There are so many fad diets and they are just not realistic in helping people to maintain a healthy lifestyle. A family friend once did an all shake diet and of course lost several pounds because of the lack of caloric intake. He maintained the weight loss for less than a year before quickly regaining it plus some. Changing lifestyle behaviors and educating yourself on the importance of a well-balanced diet is extremely important for making positive and long-term changes for yourself. I think the same would go for Mr. C. He needs to know how to continue to strive for a healthy lifestyle after the surgery in order to maintain his weight after.

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3-it can be tough to face things like obesity and hypertension, especially at such a young age. It is good that she has you and your family for support. It is also good that she is identifying that she has issues that need to be addressed and taking the steps to make better choices. Weight watchers can help to teach individuals about healthy nutrition and portion control. Walking her dog everyday is also a good step towards getting more steps in and living a healthier lifestyle. It can be hard I’m sure to sit behind a desk all day and then come home and find the energy to exercise. Keep on encouraging her!

4-Yes the follow through of diet is so important. When my sister had the surgery several years ago she had to lose about 50# prior to the actual surgery. Part of that process was to shrink the stomach and get used to smaller meals. One of the complications after the surgery can be”dumping syndrome”. This is when a rapid emptying of the stomach occurs and moves into the small intestine. Many people experience this and can have symptoms of bloat, diarrhea, dizziness, nausea and sweating (Rovito, 2019). Ways to prevent this is to have no refined sugar or unnecessary fat, eat 5-6 smaller meals and no liquids between meals (Rovito, 2019). I read that doctors actually don’t mind when thsi occurs in patients because it helps them to try and to eat better. I know for my sister she had to really learn how to eat..she intiially lost an incredible amount of weight and looked quite unhealthy but then it stabilized. She started to gain her weight back but the physician put her on some medication to reduce her appetite and that helped and she lost more weight. She goes to a physician every 6 months and this has helped to keep her on track. She eats very little because she gets so full but she doesn’t mind..her brain has learned to be okay with smaller amounts.

Reference

Rovito, P. (2019, February 4). Complications of gastric bypass surgery 22 potential problems. Retrieved from https://www.bariatricsurgerysource.com

   5- Weight loss has to do with burning more calories than you take in.  You could theoretically eat junk food that totals 1200 calories a day and loose weight.  The problem comes in when you are hungry shortly after eating that junk food.  The trick is to eat foods that help you feel full for a longer amount of time and use portion control.  I would rather eat foods that keep me from feeling hungry.  With bariatric surgery, your stomach is shrunk down so you should only ingest teaspoons of broth at a time.  If you have psychological need to eat foods, you will stretch your stomach out again and regain all the weight you lost.  Eating for most people in this country is not a survival thing….it is an emotional thing.  You tie your emotions to food.  People in Africa or India do not have the luxury of eating due to stress.  Until you recognize food as fuel, you will not likely keep off the weight you lost.  

    I think it is important to teach our children a different way of looking at food.  It should be gas for your body and we should be putting in unleaded.  We should teach them to not overfill the tank; stop associating food with love or other emotions.

   6- I would say most of the people in this class already understand the difference between type 1 and type 2 diabetes.  Type 1 being an autoimmune disease that attacks individuals who are genetic carriers of HLA type genes.  Type 2 has a genetic component however, it is an acquired disorder that becomes active due to obesity and lack of exercise causing insulin resistance.

    There is a very long and detailed explanation regarding your question about obesity and type 1 diabetes.  In the past, type 1 diabetes was only diagnosed in childhood and these children were diagnosed after a significant weight loss.  Children in general were already thin, active and healthy eaters because this was the lifestyle.  In recent times, the increase in technology and junk food has caused a rise in obesity in all populations but especially children.  Type 1 diabetics do not escape this trend.  One article even says that there is a higher incidence of obesity in type 1 diabetics than any other people group (Mottalib et al., 2017).  This article goes further into detail about insulin and the growth hormone along with how they affect the basal metabolic rate.  You can read the details for yourself, but to sum it up, type 1 diabetes does not make your body immune to fat accumulation anymore than anyone else.  If you left type 1 diabetes untreated with insulin for a long period of time, you would have weight loss from cell starvation.  Of course, you would go into significant keto acidosis and could die.

    Treating the type 1 diabetes with insulin reverses the effects of weight loss.  In fact, hyperinsulinemia causes obesity and increases the growth hormone.  This is seen particularly in mothers with gestational diabetes.  The mother has increased glucose levels that increases her need for insulin.  Her body cannot meet the demand, but the fetus has no problem with insulin production.  Glucose crosses the placenta, but insulin does not.  The baby produces the correct amounts of insulin to cover the increased glucose that crossed the placenta.  This hyperinsulinemia causes the baby to grow to an alarming size.  This causes macrosomia.; a baby that is too large for the gestational age.  As a side note, this increases the baby’s risk of developing type 2 diabetes later in life.

    A trend that has been seen in recent years is to have double diabetes.  Now that we are able to do extensive diagnostic testing, we can see that a patient could have the antibodies present with type 1 diabetes and the insulin resistance seen with type 2 diabetes.  Incidentally, obesity in a person with the antibodies that are seen with the type 1 diabetes causes that person to become an actual diabetic sooner.  I would think in layman’s terms it is from placing undue stress on the pancreas to produce higher levels of insulin and the islet cells run out of juice.

    I could go on, but I am guessing this answers your question. 

References

Mottalib, A., Kasetty, M., Mar, J. Y., Elseaidy, T., Ashrafadeh, S., & Hamdy, O. (2017, August 23). Weight management in patients with type 1 diabetes and obesity. Current Diabetes Reports, 17(10). https://doi.org/10.1007/s11892-017-0918-8

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1-The Patient protection and Affordable Care Act has many benefits for nurses and the nursing profession. There are two in particular that really stood out for me personally:

Section 5309 Nurse education, practice, and retention grants. —This section discusses 2 new grants that will be primarily focused on nurse retention rates. One will award grants to accredited nursing schools or health facilities to promote career advancement among nurses. The other will give awards to nursing schools or health facilities that can demonstrate enhanced collaboration and communication among nurses and other health care professionals. Priority directed towards applicants that have not previously received an award.

Section 5509 Graduate nurse education demonstration. Appropriates $50 million per year to establish a graduate nurse education demonstration program in Medicare. Hospitals selected will be reimbursed for educational and clinical instruction costs attributed to training advanced practice nurses to provide primary/preventive care, translational care, chronic care management, as well as any other nursing services appropriate for the Medicare eligible population. Those hospitals selected will partner with community based care settings and accredited nursing schools to undertake the demonstration program and will reimburse partners for their share of costs. 

I chose these two provisions because I feel as if they are important to the future of nursing. Nursing education plays a pivotal role in health care reform as we learned last week. The higher education nurses have, the more competent they are at their jobs and the more they are able to effectively care for patients. Having programs that help fund education can greatly impact the number of nurses that are willing to go back to school. Sometimes cost is the issue and nurses simply may not be able to afford the high cost of a higher educations. These two provisions and many more have realized the importance of nursing education and are investing in it.

2-Patient Protection and Affordable Care Act (PPACA) is the health reform legislation that was established by the 111th Congress. PPACA, also known as the Affordable Care Act (ACA) or Obamacare, was signed into law by President Obama March of 2010. This new legislation provides health insurance for so many individuals who didn’t have health insurance. With the many unique individuals gaining health insurance, the demand for nursing care has also increased. The PPACA has many health-care-related provisions that have been put into action and changed the nursing field. Two key nursing provisions that have impacted nursing practice are the health care workforce loan repayment program and the graduate nurse education demonstration (“Health Care Reform: Key Provisions Related to Nursing,” 2010). The health care workforce loan repayment program gives loan repayment options for psychiatric nurses, social workers, and professional or school counselors who serve in underserved areas. To be eligible, they must work in those areas for at least two years. This will encourage prospective students to choose those fields of practice to qualify for loan forgiveness programs. The second nursing provision is a graduate nurse education demonstration. This program provides grants and loans to nurses who are pursuing advanced nursing practitioners. Advance practice nurses needs are in primary care, translational care, and chronic care management. This program will encourage nurses to pursue an advanced degree and further their education.
References:
Health Care Reform: Key Provisions Related to Nursing. (2010). Retrieved from https://c.ymcdn.com/sites/www.wocn.org/resource/resmgr/AdvocacyPolicy/PPACA_and_Nursing_-_Nursing_.pdf

3-The PPACA has many health-care related provisions that has been put into action and changed the nursing field. The health care workforce loan repayment program offers loan reimbursement options for psychiatric nurses, social workers, and professional or school counselors who work in underserved areas. In order to be qualified, they must work in those areas for at least two years. This will inspire prospective students to pick those fields of practice in order to qualify for the load forgiveness programs. The second key nursing provision is the graduate nurse education demonstration. This program provides grants and loans to nurses who are pursuing advance nursing practitioners. Advance practice nurses are needed in primary care, chronic care management. This program will encourage nurses to pursue an advance degree and further their education.

Alba

Reference

           Health Care Reform:  Key Provisions Related to Nursing. (2010). Retrieved from https://c.ymcdn.com/sites/www.wocn.org/resource/resmgr/AdvocacyPolicy/PPACA_and_Nursing_-_Nursing_.pdf 

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1-As a nurse , Erin Murphey is a great legislator becuase she can advocate for health care system reform bills and help to make a change at the corporate level. Murphey is a registrered nurse with 20 years of experience in the acute care settingAs governor, Murphy said she would sign a bill to legalize recreational marijuana, but she comes at the issue from a criminal justice perspective. She would want any proposal that legalizes recreational marijuana to also include a way to expunge low-level cannabis possession crimes from people’s records.”There is a disproportionate number of people of color, specifically men of color, who are incarcerated for this crime,” she said.She said she also believes it will be easier to keep marijuana out of the hands of young people if it were “regulated and legal.””Minnesotans are ahead of policymakers on this question,” she said. “They are ready to make this move and if the Legislature puts it on my desk, I will sign it into law.” This can be also seen from a healthcare perspective because many pharmaceautical companies are using marijuana in for many different conditions in patients. It is exciting to have a nurse in politics. This is someone just like us who is able to make an impact from the source. Hopefully she does well in implementing her promises.

Miller, K. (2018). DFL governor candidate Erin Murphy shares her views. Retrieved from https://www.mprnews.org/story/2018/07/24/dfl-candidate-erin-murphy-shares-views

2-Lauren Underwood is the newest elected, and youngest registered nurse serving in the U.S. House of Representatives since January 3, 2019. She is representing Illinois 14thcongressional district. In her short time serving, she has been loud and clear about her support regarding affordable health care to all Americans. Just last week she introduced legislation that would improve affordability by reducing premium costs for consumers who purchase plans through the Health Insurance Marketplace and in February, she introduced legislation that would help protect Americans with pre-existing conditions by overturning an Administration rule that expands limited duration insurance, commonly known as “junk plans.” She also supports the prevention of gun violence by serving as a member of the Congressional Gun Violence Prevention Taskforce. Prior to her election into congress she was working to improve healthcare by serving as a Senior Advisor at the U.S. Department of Health and Human Services (HHS) where she helped communities prepare for and respond to disasters and emergencies.

Reference:

Representative Lauren Underwood. (n.d.). Retrieved from https://underwood.house.gov/

3-The congresswomen, Eddie Bernice Johnson, was a Chief Psychiatric Nurse in a hospital (VA Hospital) in Dallas before she became congresswomen (C-Span, 2019). She has recently introduced the National Nurse Act of 2019 in Congress. Eddie Bernice Johnson is the first registered nurse elected to Congress and can be counted between the most well-known nurses in history because of her outstanding accomplishments in that capacity. As an African-American woman, she has encountered many obstacles in both her nursing and political careers. Ms. Johnson is an excellent example of the value of education.

Reference

C-Span. (2019, January 9). Congresswoman Eddie Bernice Johnson Urges House to Support the Allred Health Care Resolution. Retrieved from C-Span: https://www.c-span.org/video/?c4771977/congresswoman-eddie-bernice-johnson-urges-house-support-allred-health-care-resolution

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1-One of the issues that is facing the small community hospital where I live is nursing shortage. Around the world, it seems that larger hospitals are more immune to this problem versus small community hospitals (Cha B. & Choi J., 2015). One way that this affects nurses is in the ED setting. The ED was just added onto to make 23 beds. This is up from 8 beds. Travellers were used for a short time but staff was told that this was not sustainable and the decision was made to only use the correct amount of beds for the amount of nurses that were on shift. The MD’s and other providers insist on filling every room. Two implications for nurses are safety and staff retainability. It is hard for the nurses to feel safe when patient ratios are far above recommended national guidelines. This in turn puts patient’s wellbeing at risk. Secondly, the hospital is having a hard time hiring new staff and retaining current staff. Staff satisfaction has dramatically declined and the word is travelling through the nursing community that it is not a good place to work. 

References

Cha B. & Choi J. (2015).  A Comparative Study on Perception of Patient Safety Culture and Safety Care Activities: Comparing University Hospital Nurses and Small Hospital Nurses. Journal of Korean Academy of Nursing Administration21(4), 405-416. https://doi.org/10.11111/jkana.2015.21.4.405

2-Developing Pediatric Transfer Guidelines based on our available resources and Evidence based practice.

“Additionally, inappropriate transfers to trauma centers may be impacting this finding as well. In a study of patients with orthopedic injuries transferred to Level I trauma centers, Thakur, et al. reported that 52% were inappropriate transfers, and that the majority of inappropriate transfers were uninsured. This transfer effect was not found in Level III or IV trauma centers. Hospitals receiving a larger percentage of transferred patients also have higher proportions of patients requiring critical trauma resources. This is not surprising, as severely injured patients are typically transferred to higher levels of care for specialty expertise and for the management of complex injuries” (Faul, 2015). Nursing staff should be able to ensure the accepting facility has the right resources for the patient.

Developing a Simple SBAR type tool with Standards of Practice for use in outlying facilities and our ED during Transfer Calls. The concept is to improve communication and continuation of care for transferring patients. (ie: if they have give 3 units of RBC, we need to start with plasma.)

“The Joint Commission (2008) has identified effective communication as one of its National Patient Safety Goals. Communication tools like SBAR (Situation, Background, Assessment and Recommendation) can help nurses focus communication to improve the effectiveness of information transfer. SBAR is especially important in urgent or high-acuity situations where clear and effective interpersonal communication is critical to patient outcome” In high acuity, fast paced scenarios a lot of information can be lost or forgotten leading to patient harm (Dunsford, 2009).

Implementing PECARN Imaging guidelines for trauma in the ED & inpatient settings. Leadership from Radiology has asked to be a part of this project.

These are the 3 clinical problems our organization would like us to research and gain positive outcomes from. Clear communication plays a big part in all of these.

Dunsford, J. ( 2015). PubMed. Structured communication: improving patient safety with SBAR. retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/19821914

Faul, Mark (2015). PMS. Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need. retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307735/#b34-wjem-16-98

3-During this practicum, the clinical problem identified within the organization is a lack of musical intervention to reduce agitation, anxiety, and aggression associated with dementia. The first nursing implication for this topic is non-pharmacological musical intervention to reduce behaviors in dementia patients to improve their quality of life (Millan-Calenti, Lorenzo-Lopez, Alonso-Búa, de Labra, González-Abraldes, & Maseda., 2016) The second nursing implication is a reduction of negative side effects associated with the use of pharmacological interventions to treat agitation, anxiety, and aggression in dementia patients (Ridder, Stige, Gunnhild, & Gold, 2013). Current research supports positive outcomes when musical intervention is utilized as a non-pharmacological intervention in the reduction of negative behaviors seen in dementia patients and this organization and its residents could benefit from the implementation of this evidence-based practice.

References

Millán-Calenti, J. C., Lorenzo-López, L., Alonso-Búa, B., de Labra, C., González-Abraldes, I., & Maseda, A. (2016). Optimal nonpharmacological management of agitation in Alzheimer’s disease: challenges and solutions. Clinical interventions in aging, 11, 175–184. doi:10.2147/CIA.S69484

Ridder, H. O., Stige, B., Gunnhild, L., & Gold, C. (2013). Individual music therapy for agitation in dementia: an exploratory randomized controlled trial. Aging & Mental Health, 17(6), 667–678. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685573/

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1-A stakeholder is an individual, group, or organization who may affect, be affected by, or perceive itself to be affected by a decision, activity, or outcome of a project. Stakeholders are either directly involved in the project or have interests that may be affected by the project’s outcome. Internal stakeholders, such as the administration within the hospital, are essential to the success of any project. External stakeholders, such as suppliers and the community may depend on the success of the project and be affected by the outcome of the project (Harrison, Freeman, & Abreu, (2015).

For the success of my Capstone, internal stake holders need to be informed on the impacts that childhood obesity has and will continue to have on the healthcare system. By managing to decline childhood obesity, the end result will be a reduction in healthcare costs. The external stakeholders in this situation are the people in the community. By developing healthier habits, they can have a healthier population that has less strain on the local healthcare system which will free up more resources for the local facility.

In order to secure the support of internal and external stakeholders, the message will be the same. Educating the population through public health clinics, child care facilities, schools, and churches can have an enormous impact financially and on the lives of the children that are in the community.

References

Harrison, J. S., Freeman, R. E., & Abreu, Mônica C, S. (2015). Stakeholder Theory As an Ethical Approach to Effective Management: applying the theory to multiple contexts. Revista Brasileira de Gestão de Negócios, 17(55), 858-869. https://dx.doi.org/10.7819/rbgn.v17i55.2647

2-Stakeholders are some of the most important parts of any organization, they can either be internal or external stakeholders but the facility cannot exist or even work without them. This also means that it is very important to involve them in the process of any project being implement in the facility. They are very core at making decisions on what is allowed in the facility and what is not. This is because they have to determine whether that is the right use of their resources, whether it is the right direction for their facility to take (Harrison, 2016). Therefore, they have a very strong position in the facility. For this reason, one needs to gain their support in any project. Without their support, it is very likely that the project will fail. For example, without support of internal stakeholders, implementation will almost be impossible. External stakeholders will also not allow their resources to be used in the project. For this reasons it is important that one gets the stakeholders to support them.

The best way to secure their support is through first looking for evidence to support the project. The stakeholders can be easily being convinced using evidence that supports the project. For the external stakeholders, it is important that one is able to show them how they will benefit from the project. The external stakeholders will do anything that benefits them. Therefore, having evidence that they can benefit from the project is key to gaining support from them. The internal stakeholders can be convinced through showing them that the project is a part of the facility being able to achieve its mission and vision (Blackburn, Blackburn, & Williamson, 2017). The internal stakeholders work to be able to achieve the vision and mission. Therefore, being able to relate the project to the facility’s vision and mission is enough to ensure that the internal stakeholders support the project.

References

Blackburn, R., Blackburn, B. R., & Williamson, R. (2017). Internal and External Stakeholders. Advocacy from A to Z, 47-50. doi:10.4324/9781315647470-9

Harrison, J. S. (2016). Stakeholders. Management. doi:10.1093/obo/9780199846740-0096

3-Great post. Internal and external stakeholders are equally important for different reasons. The internal stakeholders are your cohorts that can assist you in facilitating the implementation of your evidence-based proposal. The support of your coworkers and their adoption of your initiative is what will help ensure that it remains in place long after the implementation process. External stakeholders include interested parties that benefit from the success of your project. You stated that your project reduces the incidence of maternal death. Insurance companies benefit from projects that aim at preventative measures versus tertiary as they are cost effective. A health insurance company would be interested in the success of your proposal because healthier patients equal less expenditure on their part. Either way as you pointed out communication and support are both necessary to be successful. Thank you for your post!

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