L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia. L.N. is 5′4″ and has always been on the large side, with her weight fluctuating between 165 and 185 lb.

Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%.

Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. was initially treated with lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP control has fluctuated.

One year ago, microalbuminuria was detected on an annual urine screen, with 1,943 mg/dl of microalbumin identified on a spot urine sample. L.N. comes into the office today for her usual follow-up visit for diabetes. Physical examination reveals an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm.

Questions

1. What are the effects of      controlling BP in people with diabetes?
2. What is the target BP for patients      with diabetes and hypertension?
3. Which antihypertensive agents are      recommended for patients with diabetes?

 

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Clinical Field Experience C: Literacy Activity Implementation

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There is never enough practice for implementing activities. Each time a lesson is taught, a teacher learns something new about effective teaching practices through self-reflection, especially when implementing multiple content areas in one lesson for cross-disciplinary instruction.

Allocate at least 5 hours in the field to support this field experience.

Part 1: Implementation

For this field experience, you will deliver the literacy activity you created in Topic 2, or a lesson of your mentor’s choice, to a small group of students that your mentor teacher has selected. Remember to focus on:

Instructional strategies for literacy development. Differentiation, including accommodations to meet the diverse needs of students. Creating engagement and promoting discussion.

 

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Managing NonProfits

 

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A new healthcare manager put some changes into place that would facilitate staff involvement in decisions related to patient care. One of these changes included transitioning to staff self-scheduling, with a few rules that the staff helped develop. One of the rules included that the more senior staff members would have first choice in their schedule. This new schedule process was well received until the holiday schedule started to be created. Negotiation and the importance of supporting each other to ensure everyone had some time with their family over the holidays was not prioritized, unlike in years past. A staff divide developed between the senior and less senior staff members. Senior members would give the less senior members the silent treatment and became noticeably less available to help the less senior members throughout their shifts. The conflict resulted in one staff member leaving work in tears and several others desiring to change floors or leave the hospital completely.

In your submission, respond to the following: Summarize the key problem outlined in the case study. How would you apply the ten steps to resolving an interest-based conflict (Quantum Leadership, pp. 250-253) to address this problem?

 

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Complete Journaling Activity 7-1 on pg. 222. Answer all 5 questions using the assessment tools found in the chapter and document your findings to be handed in to the instructor at the end of the Community class.

1 In your clinical journal, describe a situation you observed or were told about in which a client or family experienced difficulty because of lack continuity. If you have the opportunity, ask the client or family to identify what they think would have avoided these difficulties. If you were the nurse in charge, what would you have done differently to avoid these problem,

2 In your clinical Journal, relate a situation in which you observed a client who received effective continuity of care discharge planning, what made the care effective?

3 In your clinical Journal, describe a situation you have observed in clinical setting where a client received effective case management. What made the care effective?

4 In your clinical Journal describe a situation where you observed or initiated two of the following intervention strategies. Discuss what happened

A ) health teaching

B) Screening 

C) Counselling 

D) Referral and followup

E) Consultation 

F) Collaboration

G) Advocacy

5 List any barrier you have noticed that have interrupted continuity for client you have cared for in a clinical setting. Discuss what happened and what you would do differently. Identify any system issue that created or did not address the barriers (eg Chart forms such as discharge forms, admission forms unit policies) 

 

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