Nursing Informatics
The scenario described herein is in grounded in geriatric medicine, and utilizes the NANDA, NIC, and NOC elements to link the various components in standardized language to the data, information, knowledge, and wisdom associated with this exercise. The key parts of the paper are as follows: 1) Introduction; 2) nursing diagnosis (NANDA), including actual diagnosis, risk diagnosis, and wellness diagnosis; 3) nursing outcomes classification (NOC); 4) nursing interventions classification (NIC); 5) conclusions.
Case Presentation
The patient is an elderly woman with early stage dementia, who reports her age as 87 years. The patient's family brought her to the clinic because she has been complaining of malaise and refuses to receive help with dressing, both of which are unusual for the patient. Vitals were taken and all are within normal range, except that the patient had a temperature just above 37.9C. Examination revealed that the patient was experiencing suprapubic pain and costovertebral…...
mlaReferences 4
Beveridge, L.A., Davey, P.G., Philliops, G. & McMurdo, M.E.T. (2011, June). Optimal management of urinary tract infections in older people. Clinical Interventions of Aging, 6, 173 -- 180. . doi: 10.2147/CIA.S13423. PMCID: PMC3131987
Mellen, C.K., Ford, M., & Rindone, J.P. (2010, July). Effect of high-dose cranberry juice on the pharmacodynamics of warfarin in patients. British Journal of Clinical Pharmacology, 70(1), 139-142. doi: 10.1111/j.1365-2125.2010.03674.x.
Nicolle, L.E. (2000). Asymptomatic bacteriuria in institutionalized elderly people: evidence and practice. Canadian Medical Association Journal (CMAJ),163(3), 285 -- 286.
Client Evaluation
The client is a 78-year-old female. She has been divorced for 30 years. She is retired. Her social class is upper middle class. Her medical history is free from significant trauma. She had six hospitalizations, all for childbirth, and one surgery; a cesarean section combined with a tubal ligation. She has two chronic health conditions: high blood pressure and chronic obstructive pulmonary disease (COPD). She is a former smoker. She lives with an adult son and her other children live nearby. She was a domestic violence victim for the 20 years of her marriage and has some lingering physical problems (an improperly healed broken rib) and emotional problems from that period of abuse. Her parents, a younger brother, and two of her children predeceased her.
Medical Issues
The patient is not currently suffering from any acute medical issues. She does have two significant chronic medical issues: high blood pressure and COPD.…...
mlaReferences
Friedman, G.D., Asgari, M.M., Warton, E.M., Chan, J., & Habel, L.A. (2012).
Antihypertensive drugs and lip cancer in non-Hispanic whites. Arch Intern Med, 172(16): 1246-51. doi:10.1001/archinternmed.2012.2754.
Goren, A., Annunziata, K., Schnoll, R.A., & Suaya, J.A. (2014). Smoking cessation and attempted cessation among adults in the United States. PlosOne, 9(3): e93014. doi: 10.371/journal.pone.0093014
Hoonhorts, S.J., Ten Hacken, N.H., Lo Tam Loi, A.T., Koenderman, L., Lammers, J.W.,
Geriatric Population
hat is the best way to assure that older people are well cared for in an acute healthcare setting? hat are the roles that nurses should play when it comes to providing the best possible care to older, frail people? These questions will be addressed in this paper using scholarly research from the available literature.
Advanced nursing skills for frail older people
Sarah Goldberg is a senior clinical academic nurse at the University of Nottingham's University Hospitals, and she writes in the journal Nursing Older People that an "innovative solution" in terms of providing the necessary skilled care to older people is to train experienced nurses to become "advanced nurse practitioners (ANPs) (Goldberg, 2014). An advanced nurse practitioner will be able to conduct comprehensive geriatric assessments, which will be important given that many very old and frail patients have "cognitive impairment, depression and anxiety," which can lead to a sense…...
mlaWorks Cited
Goldman, S. (2014). Developing Advanced Nursing Skills for Frail Older People. Nursing Older People, 26(4). 20-24.
Krail, E., Close, J., Parker, J., Sudak, M., Lampart, S., and Colonnelli, K. (2012). Innovation
Pilot Study: Acute Care for Elderly (ACE) Unit -- Promoting Patient-Centric Care. Herd Journal, 5(3), 90-98.
Geriatric Patient Assessment
Temperature
Pulse
espiration
Blood Pressure: 110/70
Pulse Oximetry: 97% on room air
General Appearance: Fairly good, decently nourished. Non-toxic, Ambulatory female
Mental Status: Patient is alert and fully oriented times 3 . . . .Glasgow coma scale is
Abdomen: Benign
Heart: Mild tachycardia
Lungs: Clear, no noticed issues
Extremities: Pulses are symmetric and seem to be intact
Known Issues/Comorbidities: Type II (Adult Onset) Diabetes, family history of heart disease and arthritis
2A) MMSE will be attached
Pulled from: http://www.dementiatoday.com/wp-content/uploads/2012/06/MiniMentalStateExamination.pdf
2B) KATZ Index will be attached
Pulled from http://micmrc.org/system/files/11.2-ADL.pdf
Vitals fairly in line what is expected a normal for patient of this age, family/patient history of type II diabetes but fairly well controlled, mild arthritis but decently controlled, no sign of heart disease despite family history
4) Patient is putting on a little weight, lives a mostly sedentary lifestyle (but not abnormally so for age bracket), diet a bit substandard based on what is self-reported
5) See goals below where abnormal challenges are listed
6) Four interventions would…...
mlaReferences
Mayo. (2017). Low blood pressure (hypotension) Treatments and drugs - Mayo Clinic. Mayo Clinic. Retrieved 4 April 2017, from http://www.mayoclinic.org/diseases-conditions/low-blood-pressure/basics/treatment/con-20032298
NDEI. (2017). Diabetes Management Guidelines for Elderly ADA/AGS | NDEI. ndei.org. Retrieved 4 April 2017, from http://www.ndei.org/ADA-AGS-diabetes-older-adults-2012.aspx.html
Reese, H. (2017). Nutrition for the Elderly - Diet & Exercise | HealthCentral. Healthcentral.com. Retrieved 4 April 2017, from https://www.healthcentral.com/article/nutrition-for-the-elderly
WebMD. (2017). Arthritis Treatment Options. WebMD. Retrieved 4 April 2017, from http://www.webmd.com/osteoarthritis/guide/options-basics#1
ICU and Delirium
Evidence-Based Project Proposal
Patients that are sixty-five years or older account for an average of more than fifty percent of the visitors to the Intensive Care Unit (ICU) and there are a host of known risk factors that are associated with individuals who are among this demographic and many elderly patients are discharged directly to long-term living facilities due to the fact that they are unable to continue to function independently and maintain daily activities (Tang, Tang, Hu, & Chen, 2016). It is further estimated that approximately one quarter of all of the elderly patients that are admitted to the emergency department display some form of metal impairment related to delirium, dementia, or both, and many hospital departments have made mental assessments for these demographics part of their routine operations (Soryal & al., 2014). Therefore, not only does the prevalence of mental impairments serve as a serious concern for…...
mlaWorks Cited
Barr, J., & al., e. (2013). Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Critical Care Medicine, 263-306.
Malone, M., & al., e. (2014). Acute Care for Elders: A Model for Interdisciplinary Care. Aging Medicine, 233-244.
Soryal, S., & al., e. (2014). Best Practice Models of Emergency Department. Aging Medicine, 220-231.
Tang, H., Tang, H., Hu, F., & Chen, C. (2016). Changes of geriatric syndromes in older adults survived from Intensive Care Units. Geriatric Nursing, 1-6.
Monitoring Home Medication AdministrationIntroductionMonitoring home medication administration for the elderly is essential because this population is at higher risk for medication-related problems due to several factors, including age-related changes in pharmacokinetics and pharmacodynamics, the presence of multiple chronic conditions, and the use of multiple medications. In addition, elderly patients may have cognitive impairments, functional limitations, and social isolation, which can further increase their vulnerability to medication errors and adverse drug events. Monitoring home medication administration for the elderly is essential because this population is at higher risk for medication-related problems due to several factors, including age-related changes in pharmacokinetics and pharmacodynamics, the presence of multiple chronic conditions, and the use of multiple medications. In addition, elderly patients may have cognitive impairments, functional limitations, and social isolation, which can further increase their vulnerability to medication errors and adverse drug events.The MCIOne tool that is used for monitoring home medication administration for…...
mlaReferencesHirsch, J. D., Metz, K. R., Hosokawa, P. W., & Libby, A. M. (2014). Validation of a patient?level medication regimen complexity index as a possible tool to identify patients for medication therapy management intervention. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 34(8), 826-835.Onder, G., Lattanzio, F., Battaglia, M., Cerullo, F., Sportiello, R., Bernabei, R., & Landi, F. (2011). The risk of adverse drug reactions in older patients: beyond drug metabolism. Current Drug Metabolism, 12(7), 647-651.Wimmer, B. C., Bell, J. S., Fastbom, J., Wiese, M. D., & Johnell, K. (2016). Medication regimen complexity and polypharmacy as factors associated with all-cause mortality in older people: a population-based cohort study. Annals of pharmacotherapy, 50(2), 89-95.
The Argument -- She Could be Given a Transplant
I could not find a prohibition against liver transplants for those 70 or over, but there is a good deal of information in the literature supporting transplants for older people. In the PubMed section of the National Institutes of Health a study of 1,446 "consecutive liver transplant recipients was conducted" and 241 elderly patients (over 60) in that group were compared with younger counterparts. The conclusion: "Low-risk elderly patients fare as well as younger patients after liver transplantation" (Levy, et. al, 2001).
Meanwhile, Dr. Gerald S. Lipshutz, assistant professor of surgery at the David Geffen School of Medicine at the University of California reports the results of the findings at the orld Transplant Congress in 2006. In a study of 62 patients (Group I) between the ages of 70-79 that had received liver transplants -- compared with a group of 864 patients getting…...
mlaWorks Cited
Flaman, Paul. "Organ and Tissue Transplants: Some Ethical Issues." St. Joseph's College, the University of Alberta. Retrieved June 23, 2011, from (2001): 1-14.http://www.ualberta.ca/-pflaman/organtr.htm .
Kahn, Katherine. "Age Alone Does Not Affect Outcome of Liver Transplant in Elderly."
Medscape Medical News. Retrieved June 24, 2011, from (2006): 1-2.http://www.medscape.com .
Levy, Marlon, Somasunder, Ponnandai S., Jennings, Linda W., Jung, Ghap J., Molmenti,
hospitals profits come from the cardiology department. One key strategy the hospital should adopt is specializing for growth. Not only has the rise in specialty hospitals increased in the last few years, but it has also enabled hospitals facing stiff competition to maintain or gain new patients. A specialized care strategy must be adopted for proper implementation of strategy. Hospital administrators in this role have to take the time to examine potential or existing specialty healthcare providers within the community. By identifying an area of opportunity, it becomes much easier put into effect a strategic plan that will gain the hospital national and even worldwide recognition.
Specialty hospitals satisfy the needs of a specific population. In the case of the hospital, those are elderly patients with cardiac problems. By examining if the local demographics match this population group, hospital administrators can then focus their attention on recruitment of specialized personnel…...
mlaReferences
Freeze, R., Vinze, A., Santanam, R., & Furukawa, M. (2012). IT Adoption: Healthcare Metrics Tracking. 2012 45th Hawaii International Conference On System Sciences. http://dx.doi.org/10.1109/hicss.2012.392
Girotra, S., Lu, X., Vaughan-Sarrazin, M., Popescu, J., Horwitz, P., & Cram, P. (2011). Abstract P314: The Impact of Hospital Cardiac Specialization on Outcomes After Coronary Artery Bypass Graft Surgery: Analysis of Medicare Claims Data. Circulation: Cardiovascular Quality And Outcomes,4(Suppl 1), AP314-AP314. Retrieved from http://circoutcomes.ahajournals.org/content/4/Suppl_1/AP314.abstract
Elderly Falls
With the help of a thorough clinical evaluation, the risk factors, risks associated with falling and working out adequate intervention methods to curb the rate of elderly falls can be achieved. As per the 2011 AGS / BGS guidelines, (Panel on Fall, 2011) certain particulars need to be incorporated in a particular clinical evaluation: 1: Patient history, physical examination, mental and physical functionality; 2: Number of falls occurring, number of medications taken; issues regarding mobility, balance and gait; blurred eyesight; various mental disabilities; weak muscular strength; uneven heartbeat and rhythm; postural hypotension; problems in feet and risks related to environment (Shubert, 2014).
Strategies to Prevent Elderly Falls and Health elated Consequences
Assistive Devices and Other Protective Equipment: Appropriate footwear is required for particular conditions, for instance, wintery weather necessitates anti-slip shoes whilst warmer weather requires cleated footwear, facilitating decreased falls (Panel on Fall, 2011).
Clinical Disease Management (Acute and Chronic Illness): Using…...
mlaReferences
Clemson, L., Mackenzie, L., Ballinger, C. & Close, J.C.T. (2008). Cumming RG. Environmental interventions to prevent falls in community-dwelling older people: A meta-analysis of randomized trials. J Aging Health. 20(8):954-971.
Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Lamb, S.E., Gates, S., and Cumming, R.G. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. (2), Art.No.: CD007146
Panel on Fall prevention in Older Persons, American Geriatrics Society and British Geriatrics Society, (2011). Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. J Am Geriatr Soc.;59(1):148-157.
Scott V, Gallagher E, Higginson A, Metcalfe S, & Rajabali F. (2011). Evaluation of an evidence-based education program for health professionals: The Canadian Falls Prevention Curriculum (CFPC). Journal of Safety Research. 42(6):501-507.
Patient Access to Experimental Drugs
Experimental drugs are being used in treating cancer and other life-threatening diseases in the hopes that effective cures and treatments can be identified. There are however, ethical questions relating to the use of experimental drugs and this work seeks to answer the question that asks whether patients should have access to experimental drugs and to answer why or why they should not have this access.
Experimental Drugs
Experimental drugs have carved inroads to treating cancer patients and most recently; this has been reported in the form of a drug that serves to "neutralize two mechanisms cancers need to survive." (Coghlan, 2012) The new drug is Cabozantinib. This drug is reported by one individual interviewed in this study to have been used by a family member who died while taking the drug for non-small cell carcinoma in the form of lung cancer. When asked the question of how this…...
mlaBibliography
Beauchamp, TL and Childress, JF (2001) Principles of Biomedical Ethics. Oxford University Press. 15 Feb 2001. Retrieved from: http://books.google.com/books?id=_14H7MOw1o4C&source=gbs_navlinks_s
Coghlan, A.K (2012) New Cancer Drug Sabotages Tumor's Escape Route. 24 Feb 2012. New Scientist. Retrieved from: http://www.newscientist.com/article/dn21516-new-cancer-drug-sabotages-tumours-escape-route.html
Beauchamp, TL and Childress, JF (2001) Principles of Biomedical Ethics. Oxford University Press. 15 Feb 2001. Retrieved from:
Patient Assessment
DIAGNOSIS AND TREATMENT PLAN
Diagnosis and Disease Processes
Using an appropriate patient assessment form (Sample Forms, 2013), D.M. has been found to have uncontrolled Type 2 diabetes, hypercholesterolemia, uncontrolled hypertension, chronic anemia, and probable hypothyroidism (Sample Forms).
Diabetes Type 2
is most probably on a poorly controlled diet of high cholesterol and high simple sugars. Diabetes mellitus type 2 is a metabolic disease wherein the body is not able to properly use ingested food because of insulin resistance. If more simple or refined sugars are consumed, the less the body is able to process them as nutrients. These tend to stay and float in the blood stream, un-used, and in this condition, they cause trouble in the different parts of the body. These include the end organs, such as the brain, the eyes, the kidneys, the heart, and even the feet. A poorly controlled diet and the lack of physical activities in many…...
mlaBIBLIOGRAPHY
Glasgow, R.E., et al. (2005). Development and validation of the patient assessment of chronic illness care. Vol. 43 # 5, Medical Care: PuMed. Retrieved on October 15,
2014 from http://www.ncbi.nlm.nih.gov/pubmed/15838407
Sample Forms (2013). Patient assessment form. Sample Forms.org. Retrieved on October 15, 2014 from http://www.sampleforms.org/patient-assessmentform.html
The results of this analysis highlight the need for hospitals to fine-tune their discharge process to reduce readmissions, and support the expenditure of additional resources for this purpose as a cost-effective intervention; as an example, author cites a hospital in Iowa that implemented a rigorous post-discharge planning process for patients with heart failure and 30-day readmission rates were reduced by 3-9% during the 3-month period following implementation.
Conclusion
The research showed that many elderly patients who suffer from congestive heart failure also suffer from a wide range of comorbid conditions, including diabetes and hypertension. These patients can be reasonably expected to require periodic or even frequent treatment in emergency departments and/or hospitalizations for these conditions, making the need for effective and seamless post-discharge planning especially important. In this regard, the research also showed that there are some valuable evidence-based practice guidelines available, though, that can help clinicians better coordinate post-discharge care,…...
Difficult Patients
Mitigating isks from Dementia
Providing adequate care for an individual suffering from dementia presents many difficulties for nurses. Patients with dementia often have debilitating conditions such as Alzheimer's or similar neurologic diseases which are progressive, thereby making it challenging for them to remember, think lucidly, communicate effectively or complete activities of daily living. Furthermore, dementia can cause rapid variations in mood or even modify personality and behavior. With the tremendous number of elderly in society more and more nurses are required to care for patients with progressive dementias. It is imperative that a diagnosis be reached early in the course of the cognitive impairment and that the patient is closely monitored for coexisting morbidities. Nurses have a central role in assessment and management of individuals with progressive dementia. This essay provides some evidence-based practical strategies for managing the behavioral problems and communication difficulties often encountered in this population.
I currently…...
mlaReference List
Aud, M.A., Oliver, D., Bostick, J. And Schwarz, B. 2011. Effectiveness of Social Model Care Units for Dementia. International Nursing Research Congress 2005.
Care, N.D. 2010. Teaching and Learning. Pulse. Winter Edition.
Fletcher, S. And Zimmerman, S. 2010. Trainee and trainer reactions to a scripted dementia care training program in residential care/assisted living settings and nursing homes. Alzheimer's Care. 11(1): 61-70.
Goodman, C. 2011. The organizational culture of nursing staff providing long-term dementia care is related to quality of care. Evidence-Based Nursing. 47:1274-1282.
Nurse-Patient Relations
The main focus of this essay is going to concern the nurse-patient relationship idea, and why it is important. This was chosen because the researcher desired to achieve a better accepting of how a helpful nurse-patient relationship can be advanced and even from different theorists who have discovered this idea. In this essay, the researcher sets out to demonstrate what they have learnt regarding the nurse-patient relation concept and how this connection can utilized in the clinical practice setting. T The nurse patient connection, according to a study done by Press Gamey Associates Inc., creates the quality of the care experience and generates an influential influence on patient gratification. Nurses will a lot of their time with patients. Patients see nurses' relations with people among the care team and make their own conclusions about the hospital founded on what they are observing. Furthermore, nurses' approaches toward their vocation, those…...
mlaWorks Cited
Berdes, C. & . (2001). Race relations and caregiving relationships: A qualitative examination of perspectives from residents and nurses aides in three nursing homes. Research on Aging, 23(1), 109-126.
Biering, P. (2002). Caring for the involuntarily hospitalized adolescent: The issue of power in the nurse-patient relationship. Journal of Child and Adolescent Psychiatric Nursing, 16(2), 65-74.
Heijkenskjold, K.B. (2010). The patients dignity from the nurses perspective. Nursing Ethics, 6(3), 313-24.
LaSala, C.A.-B. (2007). The role of the clinical nurse specialist in promoting evidence-based practice and effecting positive patient outcomes. The Journal of Continuing Education in Nursing, 38(6), 262-70.
Treatment to Patients
The main objective of providing treatment to patients is to relieve symptoms along with decreasing the progression of the disease as well as the mortality or morbidity. However, in some cases, this objective is not fully achieved, especially in the case of the patients who are admitted to the ICU with some serious and almost always a terminal stage of the disease. For example, when old patients are admitted in the ICU, their immunity is extremely low and this is the perfect time for the opportunistic infections to make matters worse for these patients. There are many infections that are specifically associated with patients admitted in the hospitals. Pseudomonas Aurigeonosa is a micro-organism that is well documented to cause bacterial pneumonia and bacteremia in the patients who are terminally ill and are receiving treatment in the hospital setting. Since most of the patients in the ICU are…...
mlaBibliography:
Beekmann, SE;Diekema, DJ; Chapin, KC;Doern, GV (2003) Effects of rapid detection of bloodstream infections on length of hospitalization and hospital charges.J ClinMicrobiol, 41:3119-3125.
Boussekey, N, Leroy, O, Georges, H, Devos, P, d'Escrivan, T, Guery, B (2005).Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit.Infection, 33:257-263.
Charles, PE, Dalle, F, Aho, S, Quenot, JP, Doise, JM, Aube, H, Olsson, NO, Blettery, B: Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients. Intensive Care Med, 32:1577-1583.
Digiovine, B; Chenoweth, C; Watts, C; Higgins, M (1999)The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J. RespirCrit Care Med, 160:976-981.
1. The impact of technology on the nursing profession
2. The role of emotional intelligence in nursing practice
3. The importance of evidence-based practice in nursing
4. The ethical dilemmas faced by nurses in healthcare settings
5. The challenges of caring for elderly patients in nursing homes
6. The role of cultural competency in providing nursing care
7. The impact of nursing shortages on patient care
8. The importance of effective communication in nursing practice
9. The role of nursing leadership in improving patient outcomes
10. The benefits of interdisciplinary collaboration in healthcare settings.
11. The role of nursing education in shaping the future of....
Key Factors Contributing to Surgical Site Infections in Obstetrics and Gynecology Patients
Surgical site infections (SSIs) are a significant complication in obstetric and gynecological (OB/GYN) surgery, leading to increased morbidity, prolonged hospital stays, and healthcare costs. Understanding the key factors contributing to SSIs is crucial for implementing effective prevention strategies.
1. Preoperative Factors:
Diabetes and obesity: Impaired wound healing and immune function increase the risk of infection.
Smoking: Nicotine constricts blood vessels, reducing oxygen and nutrient delivery to the wound.
Malnutrition: Inadequate nutrition compromises immune function and wound healing.
Vaginal infections: Preoperative colonization of the vagina with pathogens can increase the risk....
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