The patient had undergone spinal anesthesia for appendectomy. To prevent spinal headache, the nurse should place the patient in which positions?
This week’s topic is : The case of “I can’t catch my breath”
John, a healthy twenty-eight year old electrical engineer, was driving home from work one evening when he experienced sudden stabbing pain in his right pectoral and right lateral axillary regions. He began to feel out of breath and both his respiratory rate and heart rate increased dramatically. As luck would have it, John passed a hospital each day on his way home and was able to get himself to the hospital’s emergency room. The emergency room physician listened to John’s breathing with a stethoscope and requested blood gas analysis and a chest x-ray. John answered a few of the doctor’s questions. The doctor noted that John had no history of respiratory problems but was a heavy smoker.
After viewing the chest radiograph, the doctor informed John that he had experienced a spontaneous pneumothorax, or what is commonly called a collapsed lung. The doctor explained that a hole had opened in John’s right lung and that this hole had allowed air to leak into the cavity surrounding the lung. Then, as a result of the lung’s own elastic nature, the lung had collapsed. The doctor said he could not be certain of the cause of thepneumothorax, but smoking cigarettes had certainly increased the likelihood of it happening. He told John he was fortunate the pneumothorax was small, which meant that relatively little air had escaped from the lung into the surrounding cavity, and it should heal on its own. He instructed John to quit smoking, avoid high altitudes, flying innon pressurized aircraft, and scuba diving. He also had John make an appointment for a re-check and another chest x-ray.
Case Background
Spontaneous pneumothorax occurs when a blister on the surface of the lung opens, allowing air from the lung to move into the pleural cavity. This occurs because alveolar pressure is normally greater than the pressure in the pleural cavity. As air escapes from the lung, the lung tissues will recoil, and the lung will begin to collapse. The lung will continue to collapse until the difference between the alveolar pressure and pleural pressure disappears or until the collapsing of the lung causes the opening to seal.
The pneumothorax decreases the efficiency of the respiratory system, which in turn results in decreased blood oxygen concentration, increased respiratory rate, and increased heart rate. If the pneumothorax is small, the air that escapes into the pleural cavity can be reabsorbed into the lung once the opening has sealed shut. If thepneumothorax is large, a needle or chest tube may have to be inserted into the pleural cavity to draw the air out and allow for the re expansion of the lung.
Utilizing the med terms you learned this week answer the following questions
Why was John instructed to avoid high altitudes and flying in non pressurized aircrafts?
That is, what are the effects of high altitudes and or decreased air pressures on the respiratory system.
Here are the discussion board requirements.
Complications of asthma can be sudden. Consider the case of Bradley Wilson, a young boy who had several medical conditions. He appeared in good health when he went to school, returned home, and ate dinner. However, when he later went outside to play, he came back inside wheezing. An ambulance took him to the hospital where he was pronounced dead (Briscoe, 2012). In another case, 10-year-old Dynasty Reese, who had mild asthma, woke up in the middle of the night and ran to her grandfather’s bedroom to tell him she couldn’t breathe. By the time paramedics arrived, she had passed out and was pronounced dead at the hospital (Glissman, 2012). These situations continue to outline the importance of recognizing symptoms of asthma and providing immediate treatment, as well as distinguishing minor symptoms from serious, life-threatening symptoms. Since these symptoms and attacks are often induced by a trigger, as an advanced practice nurse, you must be able to help patients identify their triggers and recommend appropriate treatment options. For this reason, you need to understand the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation.
To Prepare
· Review “Asthma” in Chapter 27 of the Huether and McCance text. Identify the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Consider how these disorders are similar and different.
· Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of both disorders. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
· Review the “Mind maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Consider the epidemiology and clinical presentation of both chronic asthma and acute asthma exacerbation.
To Complete
Write a 2- to 3-page paper that addresses the following:
· Describe the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Be sure to explain the changes in the arterial blood gas patterns during an exacerbation.
· Explain how the factor you selected might impact the pathophysiology of both disorders. Describe how you would diagnose and prescribe treatment for a patient based on the factor you selected.
· Construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.
Use below resources for reference
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
This chapter provides information relating to the structure and function of the pulmonary system to illustrate normal pulmonary function. It focuses on gas transport to build the foundation for examining alterations of pulmonary function.
This chapter examines clinical manifestations of pulmonary alterations and disorders of the chest wall and pleura. It covers the pathophysiology, clinical manifestations, evaluation, and treatment of obstructive lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis, and emphysema.
This chapter focuses on alterations of pulmonary function that affect children. These alterations include disorders of the upper and lower airways.
Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.
This chapter begins with an overview of normal structure and function of the lungs to provide a foundation for examining various lung diseases such as asthma and chronic obstructive pulmonary disease (COPD).
Dicusss a disease , condition, or procedure of the respiratory system — 2 page report
Dicusss a disease , condition, or procedure of the respiratory system — 2 page report
1)
The final presentation topic I have chosen explores the integration of health information technology within the nurse-patient relationship and how this relationship improves quality of care at the bedside. My topic also explores how health information technology can be utilized to improve nursing clinical workflow efficiency and quality. Some conclusions I have drawn from the literature research are that utilizing technology at the point of care delivery has made a significant impact on positive patient outcomes. It is important to note that the proper utilization of this technology is paramount in safe patient outcomes and in aiding the bedside clinician to improve workflow efficiency, quality, and patient safety. I believe that this is a very relevant topic, especially as we may have all recently learned that a former nurse at Vanderbilt University Medical Center in Nashville, Tennessee was arrested and charged with reckless homicide for making a medication error that resulted in a patient’s death. A full review of the plight of this nurse, and the judgement made against her is beyond the scope of this post, but its relevance can be related to the information systems and technology at the point of care that were involved in this incident.
According to Darvish, Bahramnezhad, Keyhanian, and Navidhamidi (2014), in an ever-changing advancing healthcare system, technology plays a major role in education and nursing work. Because of the ever-increasing pace that technology develops, the literature notes the need for appropriate education technology programs. Darvish et al. (2014) notes that in order to integrate information technology to effect positive outcomes and improve quality, there needs to be educational arrangements made within an organization to create short term and long-term specialized courses to focus on target groups and their various levels of education. By focusing on these groups and identifying their needs regarding information technology education, the goal is to increase quality of care, safety, and ultimately improve clinical workflow efficiency.
In my current practice a well-designed electronic health record system (EHRS) has been implemented for years. The system we are using currently is EPIC. We currently have excellent workflow efficiency in our extremely busy practice setting. Medication administration safety is enhanced with an integrated scanning system. The only potential issue from my current practice that I can identify as problematic, is that in an extremely rushed preoperative or PACU environment it is very easy to override the scanning tool and administer a medication urgently at the clinician’s discretion. In a PACU during a post-surgical emergency this is essential but when a clinician is just rushed to keep up with the workflow, then this presents a concern.
References
Darvish, A., Barhamnezhad, F., Keyhanian, S., & Navidhamidi, M. (2014, June 24). The role of nursing informatics on promoting quality of healthcare and the need for appropriate education. Global Journal of Health Science, 6(6), 11-18. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825491/
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2)
Working on the final presentation has brought me to a few conclusions. First is that the nurse informaticists plays a key role in linking nursing and technology. This type of nurse takes their clinical knowledge and applies it to technology to improve patient outcomes. The nurse informaticists is crucial in being the change agent when it comes to introducing new technology or changes within technology at the bedside. Second conclusion is that using change theory is important for new technology to be accepted and successfully implemented into practice. The third conclusion is that technology is expanding at a rapid rate, the incorporation of electronic health records has made improvements in patient outcomes. The future of EHR applications have unlimited possibilities, however, ethical considerations need to be addressed. Just because technology can make improvements does not necessarily mean it should. And lastly, nurses at the bedside should be involved in the process of change. They are the stakeholders in change, the ones that experience the positives and negatives of incorporating changes into healthcare.
For the final presentation I am researching the interoperability of the EHR to improve triage accuracy. My focus is using EHR clinical systems such as clinical decision support systems to process data gathered during triage to support accurate triage acuity assignment. (Hebda, Hunter, Czar, 2019) Thus far in researching literature I have concluded that it is not just my experience in witnessing inaccurate triage assignments. Tam, Chung, and Lou (2018) research describes how worldwide there are problems in assigning accurate acuity levels despite the triage algorithm used. Experience and training are key factors in triage accuracy. Applying thinking algorithms could assist the triage nurse in making the important decision of how long a patient may safely wait to be seen in the emergency room. Monga (2017) discusses how incorporating “thinking” algorithms into EHRS can be done to guide practitioners in decision making. The question is should it be done? Ethical dilemmas arise, such as what if the algorithm applies the same biases as the nurse, or use of suggested acuity level is no longer a suggestion because the nurse becomes too dependent on the system. (Char, Shah, & Magnus, 2018) This application to the triage process would not create a change in nursing practice as it should be used as a support process and not a definitive decision process.
References
Char, D. S., Shah, N. H., & Magnus, D. (2018). Implementing machine learning in health care – Addressing ethical challenges. The New England Journal of Medicine, 378(11), 981–983. doi:10.1056/NEJMp1714229
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of Informatics for Nurses and Healthcare Professionals (6th ed.). New York, NY: Pearson.
Monga, K. (2017). Using machine learning to increase agility in HIM. Journal of AHIMA, 88(7), 30-32. Retrieved from https://search.proquest.com/docview/1912093679?accountid=34574
Tam, H. L., Chung, S. F., & Lou, C. K. (2018). A review of triage accuracy and future direction.BMC Emergency Medicine, 18(1), 58. doi:10.1186/s12873-018-0215-0
200 words for each response
Responding to two classmates
1) My signature assignment topic that I have chosen is how computer hackers are able to hack into computers that healthcare professionals use to diagnose and treat patients daily. I am not sure what my title will be yet I am still working on it and thinking about it. I chose this topic because I think this very important and when I first learned about this it was pretty disturbing to me. To think that someone would interfere with possible treatment by manipulating a computer system is somewhat scary to think about. Everyday in healthcare, computers are used to make decisions, store patients personally information, determine results and outcomes and the list is endless. So the use of the computer and computer systems are largely used in health care regardless of what kind of healthcare setting it is. I usually choose google scholar to look up resources. So far I have not had any trouble finding articles that are related to my signature assignment. I will say that a lot of the articles are not related to healthcare. So its just a matter of finding a relevant article that fits my assignment. A article that has enough information for me to use and to quote from. There are many other websites that offer peer reviewed sources. To name a few of them are DOAJ, PubMed, Scienceopen, and Academic search. Every since I started with Aspen University I have used google scholar. One article stated that “beginning in 2016, healthcare organizations in the United States have been targeted for malware attacks, a specific type of cyberattack.” (Branch, Eller, Bias, McCawley, Meyers, 2018). Another article stated that the United States is not prepared to deal with an attack of this kind. I am hoping that the United States and any other country have expanded their technology in finding ways tp combat this problem of computer hackers.
2)
I am having more of a problem narrowing down my choices for sources actually more than anything. My topic is Electronic Health Records (EHRs), which is a very broad topic as EHRs encompasses many fields such as medical charting, medication administration, medical records, imaging test, real time lab test results, and Doctor’s notes. Researching and finding articles that give me the information I am looking for has always been one of my weaker points and is what consumes most of my time when it comes to writing. So far in my research process, the wording in the articles is not so difficult to comprehend compared to the textbook. The textbook for me is hard to understand and comprehend for some reason and requires me to read most sections multiple times before understanding. However, once I comprehend the information in the textbook, I find it very helpful and is usually my main source of information. I have been using the databases provided by Aspen University and Google Scholar.
“Reduce Errors with an EMR: It’s the most efficient way to keep records and improve patient care” is the first peer reviewed journal I have located. This journal advocates for using the EHRs to improve patient care by reducing errors because EHRs allow safeguards to be put into place that prevent errors. For example, medication administration errors. If a medication that the patient is allergic to is scanned before being given, a safeguard notification will pop up warning the nurse about the allergy.
“I.V. integration helps clinicians reduce medication errors” is the second academic journal I found in which EHRs have safeguard for high alert medications that provide safeguards for unfamiliar dosages and weight based dosage for pediatric patients. Basically, this means it stops the nurse from accidentally overdosing if a dose is entered into the computer that seems suspicious.
These are just a few examples of the advantages of EHRs and the technology capabilities that they possess. I am still looking for more resources but so far these have stuck out to me most. Many people do not like how time consuming EHRs and computer charting can be, but if the patient and nurse safety are the goals, then EHRs are far more effective than paper charting. With the right prioritization and time management, there is a way to make time for patient care and computer charting.
References
Hultman, J. (2012). Reduce Errors with an EMR: It’s the most efficient way to keep records and improve patient care. Podiatry Management, 31(3), 67–69. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=108172173&site=ehost-live
Rinda, J. (2012). I.V. integration helps clinicians reduce medication errors. Health Management Technology, 33(10), 12–13. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=104424094&site=ehost-live
Please Respond to two people, Ma and Eve Add 2 APA references. Thanks
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Respond to two colleagues.
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