Follow Instructions 18960151

Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions.

Case Scenario

Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.

Subjective Data

  1. Is very anxious and asks whether she is going to die.
  2. Denies pain but says she feels like she cannot get enough air.
  3. Says her heart feels like it is “running away.”
  4. Reports that she is so exhausted she cannot eat or drink by herself.

Objective Data

  1. Height 175 cm; Weight 95.5 kg
  2. Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58
  3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint; all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation
  4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%
  5. Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin

Critical Thinking Questions

What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?

  1. IV furosemide (Lasix)
  2. Enalapril (Vasotec)
  3. Metoprolol (Lopressor)
  4. IV morphine sulphate (Morphine)

Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.

 
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Focused

  

1. Focused Reflection (30 points)   

Objective: To reflect on the interprofessional roles (MD, SW, OT, PT, RT, RD, PharmD) you saw on the unit and describe communication between them and the nurse. 

· List all of the different providers that were involved in your patient’s care. What was the focus of each of these providers in the patient’s care? What was your nursing focus in the patient’s care? Be specific and give examples. 

· How did you or the nurse communicate with each different provider? How did each provider communicate with the nurse? Be specific and give examples. 

· What did you see done well and what would you improve? What would you specifically do to improve it?

The reflection should be 2-3 pages, but not longer than 3 pages. Use Times New Roman 12 point font, 1 inch margins, and double spacing to format your paper. The reflection does not need a title page or references. See syllabus for late assignment point deductions.

Focused Reflection rubric

  

0

3

 

Length and Mechanics

Does not meet page   requirement.

One formatting   error. Multiple spelling/grammar   errors. Point is not   understandable.  

3 pages typed.

Double spaced.

TNR 12 pt font.

1 inch margins.

Minor spelling/ grammar   errors, but point is understandable

 

0

3

5

7

9

 

Listed providers and   their focus vs. nursing focus. Was   specific and gave examples.

Does not address.

Needs improvement.

Mostly complete.

Above   average.

Completely   addresses.

 

0

3

5

7

9

 

Described nurse to   provider and provider to nurse communication. Was specific and gave examples. 

Does not address.

Needs improvement.

Mostly complete.

Above   average.

Completely   addresses.

 

Described what was done   well and what to improve. Gave   specific suggestions on their improvements.

Does not address.

Needs improvement.

Mostly complete.

Above average.

Completely addresses.

Clinical Check-Offs 

1. Medication Administration Check-off

STUDENTS CAN ONLY ADMINISTER MEDICATIONS WITH THE CLINICAL INSTRUCTOR. This includes the administration of any kind of medication by any route. Medications cannot be administered with a staff nurse. Failure to follow this rule will result in failure of the check-off, immediate dismissal from the clinical site and inability to pass NM 322. 

The clinical instructor will give medications with two students per day. Students must pass the medication check-off by the end of the semester.

2. Clinical Performance Evaluation

The Clinical Performance Evaluation will be reviewed with the student as needed, at mid-semester and at the end of the semester.  Failure to satisfactorily meet core competencies on the Clinical Performance Evaluation can result in being sent home from the clinical site, an academic alert, a corrective action plan and/or dismissal from the nursing program.

Please review the Student Laboratory and Clinical Handbook, especially the sections entitled “Standards for Student Behavior in the Laboratory and Clinical Setting” and “Clinical Attendance Policy.” 

Other Clinical Expectations

1. Timeliness

Students are expected to be in the assigned room ready to go for pre-clinical at 2:00 pm. Time will be determined via the instructor’s cell phone. 

Students arriving after 2:00 pm will be given the opportunity to prepare for patient care. Failure to complete the Pre-Clinical Patient Care Form completely by the end of pre-clinical will result in the student being sent home from the clinical shift and losing all points associated with the clinical day. 

Students who are able to complete the Pre-Clinical Patient Care Form will be allowed to stay for clinical, but will lose all points associated with the clinical day. All assignments must still be completed for the clinical day. 

Failure to arrive on time will be reflected on your Clinical Performance Evaluation. Failure to meet core competencies on the Clinical Performance Evaluation can result in being sent home from the clinical site, an academic alert, a corrective action plan and/or dismissal from the nursing program.

Any student who is not at pre-clinical at 2:00 pm needs to have notified their clinical instructor. See the first page for how to notify instructor.

2. What You Can Do as a Student Nurse

Provide the best possible care for your patient that day. This includes assessing the patient, documenting your assessment and providing personal cares. Learn as much as you possibly can from this experience. Attend therapy or tests/procedures with your patient. Please notify the patient’s nurse, so they know where you and the patient are at all times. 

Students should answer call lights when they are not providing care for their patient. The student should then check with the patient’s nurse regarding the patient’s request before carrying it out. For example, a patient may ask for water and be NPO. The student would not know this without checking with the nurse. A patient may say they can walk to the bathroom, but really need assistance with transferring. 

3.  What You Can’t Do as a Student Nurse (Per BSN Clinical Instructor handbook)

1. Administer Blood

2. Program a PCA pump

3. Manage Epidural Infusion, Tubing or Pump Settings

4. Do EKG or Fetal Monitoring Interpretation (it is crucial that students not document in a fashion that would suggest they have done any monitoring interpretation)

5. Take Verbal or Telephone Orders

6. Verify Informed Consent

7. Advance the plan of care (must be licensed professional)

8. Blood Glucose Monitoring 

9. Blood draws from any line

10. Discontinue a central line

11. Administer IV push medications, including IV flushes

12. Start IVs

13. Administer chemotherapy

14. Insert a urinary catheter (Regions new policy)

4. What You Can Do as a Student Nurse, But Only with the Instructor Present

a. Administer medications by any route

b. Anything IV or tube feeding related (hanging a new bag, programming the pump, etc.)

c. For anything other than a patient assessment or personal cares, the student must connect with the clinical instructor. The clinical instructor will then determine if the student can perform the skill with the patient’s nurse or the instructor. Students can always observe a nurse doing anything for a patient, if it is okay with the patient.

Failure to follow the rules regarding what a student can/can’t do will be reflected on your Clinical Performance Evaluation. Failure to meet core competencies on the Clinical Performance Evaluation can result in being sent home from the clinical site, an academic alert, a corrective action plan and/or dismissal from the nursing program.

Last Day of Clinical

We will show our appreciation for all of the unit staff for their help on every clinical day. All interactions with staff should be respectful and include a thank you for their help. In addition to our daily thanks, we will sign a card and bring treats for the staff on our last  v vvvvvv

 
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Focused Assessment Skin

 Select a system and conduct a focused assessment for Skin hives caused by strawberries allergy. By using an attached file below. One reference from peer-reviewed Nursing journal is required, as well as APA format. This document can be copied, the only thing that needs to be fixed is chief complaint (skin hives, rash, itching, swelling….) and focused assessment of integumentary system in the table, also Nursing diagnoses needs to be related to the problem. Please message me if you have any questions. 

 
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Focused 19449371

  

1. Focused Reflection (30 points)   

Objective: To reflect on the interprofessional roles (MD, SW, OT, PT, RT, RD, PharmD) you saw on the unit and describe communication between them and the nurse. 

· List all of the different providers that were involved in your patient’s care. What was the focus of each of these providers in the patient’s care? What was your nursing focus in the patient’s care? Be specific and give examples. 

· How did you or the nurse communicate with each different provider? How did each provider communicate with the nurse? Be specific and give examples. 

· What did you see done well and what would you improve? What would you specifically do to improve it?

The reflection should be 2-3 pages, but not longer than 3 pages. Use Times New Roman 12 point font, 1 inch margins, and double spacing to format your paper. The reflection does not need a title page or references. See syllabus for late assignment point deductions.

Focused Reflection rubric

  

0

3

 

Length and Mechanics

Does not meet page   requirement.

One formatting   error. Multiple spelling/grammar   errors. Point is not   understandable.  

3 pages typed.

Double spaced.

TNR 12 pt font.

1 inch margins.

Minor spelling/ grammar   errors, but point is understandable

 

0

3

5

7

9

 

Listed providers and   their focus vs. nursing focus. Was   specific and gave examples.

Does not address.

Needs improvement.

Mostly complete.

Above   average.

Completely   addresses.

 

0

3

5

7

9

 

Described nurse to   provider and provider to nurse communication. Was specific and gave examples. 

Does not address.

Needs improvement.

Mostly complete.

Above   average.

Completely   addresses.

 

Described what was done   well and what to improve. Gave   specific suggestions on their improvements.

Does not address.

Needs improvement.

Mostly complete.

Above average.

Completely addresses.

Clinical Check-Offs 

1. Medication Administration Check-off

STUDENTS CAN ONLY ADMINISTER MEDICATIONS WITH THE CLINICAL INSTRUCTOR. This includes the administration of any kind of medication by any route. Medications cannot be administered with a staff nurse. Failure to follow this rule will result in failure of the check-off, immediate dismissal from the clinical site and inability to pass NM 322. 

The clinical instructor will give medications with two students per day. Students must pass the medication check-off by the end of the semester.

2. Clinical Performance Evaluation

The Clinical Performance Evaluation will be reviewed with the student as needed, at mid-semester and at the end of the semester.  Failure to satisfactorily meet core competencies on the Clinical Performance Evaluation can result in being sent home from the clinical site, an academic alert, a corrective action plan and/or dismissal from the nursing program.

Please review the Student Laboratory and Clinical Handbook, especially the sections entitled “Standards for Student Behavior in the Laboratory and Clinical Setting” and “Clinical Attendance Policy.” 

Other Clinical Expectations

1. Timeliness

Students are expected to be in the assigned room ready to go for pre-clinical at 2:00 pm. Time will be determined via the instructor’s cell phone. 

Students arriving after 2:00 pm will be given the opportunity to prepare for patient care. Failure to complete the Pre-Clinical Patient Care Form completely by the end of pre-clinical will result in the student being sent home from the clinical shift and losing all points associated with the clinical day. 

Students who are able to complete the Pre-Clinical Patient Care Form will be allowed to stay for clinical, but will lose all points associated with the clinical day. All assignments must still be completed for the clinical day. 

Failure to arrive on time will be reflected on your Clinical Performance Evaluation. Failure to meet core competencies on the Clinical Performance Evaluation can result in being sent home from the clinical site, an academic alert, a corrective action plan and/or dismissal from the nursing program.

Any student who is not at pre-clinical at 2:00 pm needs to have notified their clinical instructor. See the first page for how to notify instructor.

2. What You Can Do as a Student Nurse

Provide the best possible care for your patient that day. This includes assessing the patient, documenting your assessment and providing personal cares. Learn as much as you possibly can from this experience. Attend therapy or tests/procedures with your patient. Please notify the patient’s nurse, so they know where you and the patient are at all times. 

Students should answer call lights when they are not providing care for their patient. The student should then check with the patient’s nurse regarding the patient’s request before carrying it out. For example, a patient may ask for water and be NPO. The student would not know this without checking with the nurse. A patient may say they can walk to the bathroom, but really need assistance with transferring. 

3.  What You Can’t Do as a Student Nurse (Per BSN Clinical Instructor handbook)

1. Administer Blood

2. Program a PCA pump

3. Manage Epidural Infusion, Tubing or Pump Settings

4. Do EKG or Fetal Monitoring Interpretation (it is crucial that students not document in a fashion that would suggest they have done any monitoring interpretation)

5. Take Verbal or Telephone Orders

6. Verify Informed Consent

7. Advance the plan of care (must be licensed professional)

8. Blood Glucose Monitoring 

9. Blood draws from any line

10. Discontinue a central line

11. Administer IV push medications, including IV flushes

12. Start IVs

13. Administer chemotherapy

14. Insert a urinary catheter (Regions new policy)

4. What You Can Do as a Student Nurse, But Only with the Instructor Present

a. Administer medications by any route

b. Anything IV or tube feeding related (hanging a new bag, programming the pump, etc.)

c. For anything other than a patient assessment or personal cares, the student must connect with the clinical instructor. The clinical instructor will then determine if the student can perform the skill with the patient’s nurse or the instructor. Students can always observe a nurse doing anything for a patient, if it is okay with the patient.

Failure to follow the rules regarding what a student can/can’t do will be reflected on your Clinical Performance Evaluation. Failure to meet core competencies on the Clinical Performance Evaluation can result in being sent home from the clinical site, an academic alert, a corrective action plan and/or dismissal from the nursing program.

Last Day of Clinical

We will show our appreciation for all of the unit staff for their help on every clinical day. All interactions with staff should be respectful and include a thank you for their help. In addition to our daily thanks, we will sign a card and bring treats for the staff on our last  

 
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Flyer 19035507

 

Assignment Instructions

ASSIGNMENT: Educate Consumers on Patient Portal Usage

CAHIIM Competency: Subdomain III.F. Consumer Informatics. 

  • Educate consumers on patient-centered health information technologies

Instructions: After reading the material for the week, create an educational flyer for patients at a 10-physician outpatient clinic. The information should explain the clinic’s patient portal. Be sure to cover what it is, how to register for it, and the features of the portal. List the benefits of using the portal. The goal is to convince consumers of the value of using the portal and increase usage.

For some research, you might want to search for resources on a real patient portal vendor. If your health service provides this service, you can also use them as a research example to create your flyer.

The flyer can be composed using MS Word or PowerPoint.

Submission

 
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REMEBER I LIVE IN FLORIDA, if you find any from here it is PERFECT

 
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