Nursing

Assignment: Organizational Culture
Assignment: Organizational Culture
Assignment: Organizational Culture
Week 2 discussion Discussion Prompt 1 How is organizational culture and the SIPOC tool utilized in project planning? Describe the importance of understanding the strategic vision and alignment of the organization where the system change occurs and how this affects information technology implementation. Discussion Prompt 2 State two major theories and models underpinning informatics and apply one of the theories to a clinical system problem in a healthcare organization. Justify your choice of this theory to the selected problem.
Ravasi and Schultz (2006) characterise organizational culture as a set of shared assumptions that guide behaviors. It is also the pattern of such collective behaviors and assumptions that are taught to new organizational members as a way of perceiving and, even thinking and feeling. Thus organizational culture affects the way people and groups interact with each other, with clients, and with . In addition, organizational culture may affect how much employees Organizational culture encompasses and behaviors that contribute to the unique social and psychological environment of a business .[] The organizational culture influences the way people interact, the context within which knowledge is created, the resistance they will have towards certain changes, and ultimately the way they share (or the way they do not share) knowledge. Organizational culture represents the collective values, beliefs and principles of organizational members.[] It may also be influenced by factors such as history, type of product, market, technology, strategy, type of employees, , and national culture. Culture includes the organization’s , values, norms, systems, symbols, language, assumptions, environment, location, beliefs and habits.[

Assignment: Interdisciplinary Geriatric Care
Assignment: Interdisciplinary Geriatric Care
Week 3 discussion
With the growing population of frail elders, there is an increase of geriatric patients requiring ongoing care for multiple medical conditions. This creates the need for interdisciplinary geriatric care teams. Often, the dynamics and culture of these teams differ across various sites of care, such as assisted living, home care, hospitals, long-term care, and rehabilitation facilities. As an advanced practice nurse, it is important to understand your role in the care team as well as your potential impact on patient care. In this Discussion, you explore models of interdisciplinary geriatric care teams for different sites of care and the varying roles of the advanced practice nurse.
Consider the following three case studies:
Case Study 1
Mrs. Martinez is an 83-year-old Mexican American widow who lives in her own home and is cared for by her adult daughter. Mrs. Martinez owns the home, and her daughter lives with her and provides the care. Her daughter brought her mother to the clinic today to ask to speak to the social worker. She requests that her mother be placed in a nursing home. The daughter states that her mother has nothing to do during the day. The television is on The Weather Channel most of the day because Mrs. Martinez has limited English capability and is unable to read closed-captioning. Mrs. Martinez also has two sons who do not live in the local area, but they do call regularly and check in with their mother and sister. The two sons are opposed to moving their mother to a nursing home because they had promised her that they would “never put her away.”
Case Study 2
Mr. Williams, a 79-year-old African American widower, resides in a foster care home. He has lived there for 4 years since his wife died. He is a former minister. His medical history includes long-term diabetes, high blood pressure, and benign prostatic hypertrophy. The home care provider has requested a home visit to evaluate Mr. Williams’s ability to remain in the home. The provider states that because Mr. Williams’s vision is seriously compromised (he is nearly blind), and because he has been unable to get to the toilet as quickly as necessary (he is very unsteady on his feet), his care is becoming burdensome. According to the home care provider, for safety reasons, Mr. Williams may not fit the criteria for remaining in the foster care home.
Case Study 3
Mrs. Randall is a 77-year-old female who resides in a long-term care facility. She has a history of frequent falls and is severely cognitively impaired. The nursing staff at the long-term care facility called the nurse practitioner at the medical home office to report the recent development of productive cough and high fever. There have been cases of flu in the facility; however, Mrs. Randall has had a flu shot. The nurse practitioner in the office requests a chest x-ray in the long-term care facility. The nurse on duty in the facility states that there is no portable chest x-ray equipment available. She further requests that Mrs. Randall be transferred to the emergency room of the local hospital. Mrs. Randall’s daughter has durable power of attorney for health care decisions for her mother. The long-term care facility has notified the daughter of the change in her mother’s condition. The daughter says whatever the nursing home wants is fine with her.
To prepare:
Review this week’s media presentation, as well as the American Geriatrics Society and Arbaje et al. articles in the Learning Resources.
Research models of interdisciplinary geriatric care teams that are used at various sites, such as assisted living, home care, hospitals, long-term care, and rehabilitation facilities.
Consider the model used for the interdisciplinary geriatric care teams at your current practicum site. Compare this model to models used at other sites.
Reflect on how the role of the advanced practice nurse differs according to the site of care.
Select one of the three case studies. Consider how care should be facilitated for the patient in the case you selected based on the model used for the interdisciplinary geriatric care teams at your practicum site.

Assignment: Mobile Health Discussion
Assignment: Mobile Health Discussion
Assignment: Mobile Health Discussion
Week 8 Signature Assignment Mobile Health and Social Media Plan As a new NI, you are provided the task of creating a new mHealth and social media plan aimed at providing patient education for your organization. The fictional organization can be any size or location you like, but specific details about its facilities, locations, staff, services, and patient demographics should be included in your assignment submission. Be creative! Think about social media tools such as Facebook, Instagram, Twitter, and Snapchat, and research how you can use these tools to provide patient education and gather statistics for an organization. Create a plan that includes the following: Describe in detail your fictional organization, including the previously listed details and any others you feel are pertinent to the project. Select one of the tools and explain why you think it would be a good choice to provide patient education to the population your organization serves and to gather statistics for the type of fictional organization you have created. Provide a summary of the initial content that you would post, explaining why you chose this particular content. Then, provide a summary of at least four possible follow-up posts with explanations on why they align to the initial post. Include a visual example—a screenshot of an example you have seen that you would like to model or the actual design if you have already built one—that shows how you would design the page/blog/video. (Please note that you are not expected to actually build anything on social media sites for the purpose of this assignment. Create and describe a dissemination plan for both initial and ongoing implementation and how you plan to evaluate the effect/usage of using this tool. Describe what benefits and challenges you foresee in both creating and maintaining this type of social media tool for your organization. Your plan/paper should follow APA format and include at least five scholarly resources. Examples of scholarly sources include professional journal articles and books obtained from library databases, national guidelines, and informatics organizations, published within the last five years.

Assignment: The Scope Statement
Assignment: The Scope Statement
Assignment: The Scope Statement
Week 6 discussion Discussion Prompt 1 Compare and contrast the scope statement and the statement of work. Discussion Prompt 2 In regards to your chosen HIT project, what barriers do you anticipate the project manager will face trying to meet the requirements for the meaningful use stage? Bullet your responses and prioritize them in order of importance, explaining your rationale.
A project scope, or project scope statement, is a tool used to describe the major deliverables of a project including the key milestones, high level requirements, assumptions, and constraints. The project scope statement is a useful tool for future decision making when new change requests are considered to modify the project scope.
It also defines the boundaries of a given project and clarifies what deliverables are in and out of scope. The following sections describe a project scope statement and show you how to use MindView to create a project scope statement.
An effective project scope includes the following items:
The key project objectives
Key deliverables
Key milestones
High level requirements
Assumptions and Exclusions
Any known issues or risk
Stakeholder review and approval
Key Elements
Project scope objectives are the overall objectives that will meet your customers’ needs for the given product, service, or result. Project teams need to understand the project objectives as it provides a rationale for future decision making and enables teams to compare the current status to the original objectives within the project.
In the project scope mind map in Figure 2, the website redesign project had three key objectives including redesigning the current site for better search engine performance, improve product sales and help establish market leadership using a blog platform. Effective project objectives also indicate when the results are to be delivered and with cost estimates.
Project scope deliverables are the expected outputs of the project. Projects are executed to meet certain objectives and the deliverables from the project should support the objectives. It is helpful to conduct a brainstorming session to determine the specific deliverables that will result from the project.
Project scope milestones are zero-duration events that mark progress across the project timeline. In a web site design project, finalizing requirements, procuring web hosting, and finalizing the “look and feel” and launching the site make up the key milestones to measure progress. By identifying milestones, financial costs and project schedules can be better managed.

Assignment: Servant Leaders
Assignment: Servant Leaders
Assignment: Servant Leaders
Week 16 discussion Looking back on your time with your mentor, would you consider him or her a servant leader as described by in the textbook? Explain your answer. Elaborate on what characteristics your mentor displayed most consistently. Share examples from your experience to support your response.Servant leadership is a philosophy in which the main goal of the leader is to serve. This is different from traditional leadership where the leader’s main focus is the thriving of their company or organizations. A Servant Leader shares power, puts the needs of the employees first and helps people develop and perform as highly as possible.Servant leadership inverts the norm, which puts the customer service associates as a main priority. Instead of the people working to serve the leader, the leader exists to serve the people. As stated by its founder, , a Servant Leader should be focused on, “Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants?” When leaders shift their mindset and serve first, they benefit as well as their employees in that their employees acquire personal growth, while the organization grows as well due to the employees growing commitment and engagement. Since this leadership style came about, a number of different organizations have adopted this style as their way of leadership. According to a study done by Sen Sendjaya and James C Sarros, Servant Leadership is being practiced in some of the top-ranking companies today, and these companies are highly ranked because of their leadership style and following.

Assignment: Patient Care Technologies
Assignment: Patient Care Technologies
Purpose
The purpose of this assignment is explore the assigned topic related to information systems in healthcare, research and analyze the topic, and describe how you will apply your new found knowledge to your nursing practice.
Course Outcomes
This assignment enables the student to meet one or more of the following Course Outcomes depending on the topic selected.
CO 1: Describe patient-care technologies as appropriate to address the needs of a diverse patient population. (PO 1)
CO 2: Analyze data from all relevant sources, including technology, to inform the delivery of care. (PO 2)
CO 3: Define standardized terminology that reflects nursing’s unique contribution to patient outcomes. (PO 3)
CO 4: Investigate safeguards and decision-making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers. (PO 4)
CO 5: Identify patient care technologies, information systems, and communication devices that support safe nursing practice. (PO 5)
CO 6: Discuss the principles of data integrity, professional ethics, and legal requirements related to data security, regulatory requirements, confidentiality, and client’s right to privacy. (PO 6)
CO 7: Examine the use of information systems to document interventions related to achieving nurse sensitive outcomes. (PO 7)
CO 8: Discuss the value of best evidence as a driving force to institute change in delivery of nursing care. (PO 8)
Points
This assignment is worth a total of 200 points.
Due Date
Your completed paper is due by 11:59 p.m. MT Sunday by the end of Week 4
Be sure to submit your assignment. Post your questions to the Q & A Forum. Contact your instructor if you need additional assistance. See the Course Policies regarding late assignments and academic integrity. Failure to submit your paper on time will result in a deduction of points.
Topics
Topic for the focus of your paper.
Bar code medication administration (CO 5, CO 8)
Directions
You are required to complete the form using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the “.docx” format. Do NOT save as Word Pad. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREE by downloading from the student portal at http://my.chamberlain.edu (Links to an external site.)Links to an external site.. Click on the envelope at the top of the page.
You are to research, analyze, and write an APA-formatted scholarly paper on bar code medication administration.
Click on the APA template (Links to an external site.)Links to an external site. to complete this assignment.
(Links to an external site.)Links to an external site.Write an introduction that defines and describes the topic. Address what purpose the topic serves and how it impacts the delivery of healthcare in general and nursing care in particular.
Search for scholarly sources and relevant websites. Include a minimum of two scholarly sources. The course textbook does not qualify as a scholarly source. Cite all sources in the body of the paper and include them in the References list following proper APA formatting.
Provide one example of this topic. Describe the main features or aspects of the example with support from your sources.
Describe an experience where the topic impacted you personally, either when you were receiving healthcare or when you were providing nursing care. Relate one positive aspect or one negative aspect of this experience and how it could have been improved.
Write a conclusion that summarizes the topic, the purpose, and how your newfound insight will influence your nursing care.
Use the APA template above to develop your paper. Use APA formatting. Refer to the Publication manual of the APA, sixth edition. Review the various APA documents included in this course and the SSPRNBSN Student Success course that can help you with your writing. Take advantage of the tutoring services that are available to Chamberlain students for free.
The length of the paper should be a maximum of 4-5 pages, excluding the title page and the reference page. There should only be one small quote maximum in the paper. Citations should primarily include summary and restatement.

Discussion: Cancer Treatment Center
Discussion: Cancer Treatment Center
Week 1 Achieving Interoperability in Times of Change Paper
A hospital system has acquired a cancer treatment center that does not currently have an electronic health record system.
Complete the two-system merger interactive scenario to get started.
Then briefly research the functions, significance, and factors that affect implementation of EHR technology discussed in the textbook.
Compose your paper discussing each listed component in APA format, citing a minimum of two scholarly resources in addition to the assigned reading. Examples of scholarly sources include professional journal articles and books obtained from library databases, national guidelines, and informatics organizations, published within the last five years. A title page is not necessary, but you do need to include a reference page.
Your paper should be 2 to 3 pages in length.
Week 2 HL7 Messaging Structure Paper
Discuss in a one-page paper what HL7 messaging structure is and why it is used. Provide an example of a real-world event that you have had occur and how that would translate into an HL7 message.
Utilize the assigned reading and a minimum of one outside scholarly resource.
Examples of scholarly sources include professional journal articles and books obtained from library databases, national guidelines, and informatics organizations, published within the last five years. Compose your paper in APA format. A title page is not necessary, but you do need to include a reference page.
Week 3 HL7, Interoperability, and Transitions of Care Paper
Write a two- to three-page paper discussing how the Health Level Seven (HL7) Clinical Document Architecture (CDA) and Continuity of Care Document (CCD) promote interoperability and transitions of care. In your paper, discuss the ways this affects technical, semantic, and process interoperability using examples from your own practice.
Utilize your course readings and a minimum of three outside scholarly resources in your paper.
Examples of scholarly sources include professional journal articles and books obtained from library databases, national guidelines, and informatics organizations, published within the last five years. Compose your paper in APA format. A title page is not necessary, but you do need to include a reference page.
Week 4 The Influence of DICOM Paper
In a two-page paper, describe the implementation, use, and necessity of DICOM in a new organization. Discuss the advantages of having DICOM and its effects on meaningful use and interoperability.
In addition to course resources, use a minimum of two additional scholarly resources.
Examples of scholarly sources include professional journal articles and books obtained from library databases, national guidelines, and informatics organizations, published within the last five years. Compose your paper in APA format. A title page is not necessary, but you do need to include a reference page.
Week 5 LOINC and Interoperability Paper
In a one-page paper, discuss the background, functions, and format of LOINC. Include the fields included in the database, and the ways LOINC affects interoperability.
Include a minimum of two scholarly sources in addition to the course resources.
Examples of scholarly sources include professional journal articles and books obtained from library databases, national guidelines, and informatics organizations, published within the last five years. Compose your paper in APA format. A title page is not necessary, but you do need to include a reference page.
Week 6 Utilizing SNOWMED CT Website Activity and Reflection
Visit the website: http://browser.ihtsdotools.org/ Click for more options
Click on Local Extensions/United States.
In the database browser, search for a disorder, organism, procedure, or substance (e.g., naegleria > (disorder) > infection caused by naegleria).
Discuss the following:
What was your search item? (1–2 sentences)
How many search results did you get?
What is the purpose of SNOMED CT?
Write all the structures of your search item (e.g., “infection caused by naegleria”). It may be easier to use Microsoft Word or PowerPoint to draw this structure.
Compose a one-page paper in APA format, citing a minimum of one scholarly resource.
Examples of scholarly sources include professional journal articles and books obtained from library databases, national guidelines, and informatics organizations, published within the last five years. A title page is not necessary, but you do need to include a reference page.

Assignment: The Spinal Nerve
Assignment: The Spinal Nerve
Assignment: The Spinal Nerve
• Question 1 Which statement is NOT true regarding spinal nerves? Answers: A. The ventral root of the spinal nerve will contain motor fibers (axons) that innervate the skeletal muscles B. Each spinal nerve is associated with a specific dermatome C. All 31 spinal nerves contain thousands of individual nerve fibers (axons) carrying information to and from the spinal cord D. Spinal nerves only innervate the skin, muscles and joints • Question 2 Which of the following choices is NOT an effect of the sympathetic nervous system? Answers: A. Decreased blood flow to the gastrointestinal system while increasing blood flow to the skeletal muscles B. Increased heart rate C. Constriction of the pupils D. Increased blood pressure • Question 3 Which two major nerves are associated or represent sensory (touch) information of the hand? Answers: A. Ulnar and Medial nerves B. Radial and Medial nerves C. Ulnar and Radial nerves D. Axillary and Ulnar nerves • Question 4 Referred pain is when the body perceives somatic pain as visceral pain? Answers: True False • Question 5 Which type of sensory receptor will detect the sensation of pain? Answers: A. Thermoreceptor B. Nociceptor C. Chemoreceptor D. Mechanorececptor • Question 6 What statement is false regarding the sympathetic nervous system? Answers: A. Prepares the body for “fight or flight” activities/responses B. The postganglionic fibers are all very short in length when compared to the postganglionic fibers of the parasympathetic nervous system C. The preganglionic axons originate from the thoracic and lumbar region of the spinal cord D. All of the preganglionic axons pass through the superior cervical ganglion • Question 7 Which of the following choices is NOT true regarding reflexes? Answers: A. Somatic reflexes activate skeletal muscle B. The stretch or tendon reflexes are commonly performed during a physical examination C. Neural integration (processing) of all reflexes occurs in the brain D. The sensory neuron of a reflex arc transmit afferent impulses to the spinal cord • Question 8 Which major nerve is associated or represents the largest and thickest nerve in the body and almost innervates the entire lower limb? Answers: A. Sacral nerve B. Ulnar nerve C. Axillary nerve D. Sciatic nerve • Question 9 Which cranial nerve is associated or represents a majority of its innervation to be parasympathetic in its action and innervates a wide variety of internal organs including the heart, lungs, intestines and liver? Answers: A. CN V: Trigeminal nerve B. CN X: Vagus nerve C. CN IX: Glossopharyngeal nerve D. CN IV: Trochlear nerve • Question 10 The majority of the cranial nerves originate from the brain stem? Answers: True False • Question 11 Which cranial nerve is associated or represents sensory information of most of the face, assists in innervating the muscles of mastication and is divided into three divisions? Answers: A. CN VII: Facial nerve B. CN XI: Accessory nerve C. CN V: Trigeminal nerve D. CN XII: Hypoglossal nerve • Question 12 A ganglia is a collection of nerve cell bodies within the peripheral nervous system? Answers: True False • Question 13 Which statement is NOT true regarding a nerve? Answers: A. A nerve itself is surrounded by an outer protective covering called the epineurium B. Can contain hundreds and thousands of individual fibers (axons) of neurons C. Nerves can always repair themselves no matter the damage or trauma D. Can contain sensory (afferent) and motor (efferent) nerve fibers (axons) • Question 14 Which of the following choices is NOT an effect of the parasympathetic nervous system? Answers: A. Stimulates elimination of wastes such as feces and urine B. Dilation of the bronchi in the lungs to increase airflow C. Gastrointestinal system function is activated and increased to digest food D. Decreased blood pressure • Question 15 A lower motor neuron damage occurs will cause hyporeflexia? Answers: True False

Assignment: Upgrading an EHR
Assignment: Upgrading an EHR
Assignment: Upgrading an EHR
Week 1 discussion Discussion Prompt 1 Review the seven critical success factors for healthcare initiatives. Choose four of the seven and discuss their effects on the success of implementing or upgrading an EHR. What might be potential areas of concern for an EHR that heavily uses third-party services to supply critical clinical functionality, such as decision support or medical reference links? In what circumstances might a clinical infrastructure based on either third-party service providers or mobile applications be desirable? What cautions should we place on these technologies in the same circumstances? Discussion Prompt 2 Describe a workflow issue you have encountered in practice and explain how you could use a gap analysis to plan for change. Week 2 discussion Discussion Prompt 1 What opportunities do you see for CDS to facilitate the work of healthcare professionals? Explain how usability is important when integrating clinical decision support. Discussion Prompt 2 Discuss the importance of the user experience when implementing or changing components of health information technology. Outline a usability test for one module of your current EHR. Include the elements discussed in the chapter in your proposed usability test. Describe why you chose the methods you did. Week 3 discussion Discussion Prompt 1 You are the NI assigned to manage the implementation of an EHR. Discuss the common short- and long-term goals you will include in your plan. What are some of the approaches that can be used to coordinate care during an incremental go-live as patients are transferred from units that have gone live to units still waiting to go live? Discussion Prompt 2 Discuss the reasons why some institutions experience significantly more satisfaction or dissatisfaction during an implementation than do others. Describe why script testing is important to the EHR adoption process. Week 4 discussion Discussion Prompt 1 You have been asked to implement a new blood glucose monitoring software application. Provide a communication plan that includes who, what, when, and how. Discussion Prompt 2 Describe the policies and/or procedures to put into place that will assist in the management of an electronic health record. Identify creative strategies to encourage physicians and other clinicians to participate in the implementation of a new health IT system. Should employees who have repeatedly failed to attend go-live classes be subjected to discipline measures? Week 5 discussion Discussion Prompt 1 Discuss two anticipated risks during optimization and your plans to minimize these risks. Discussion Prompt 2 Use course materials and outside resources to help you discuss a plan to manage EHR downtime in a large hospital system. Compare and contrast the roles of the informatician, the clinician, and IT personnel in system downtime planning. Contrast different communication methods for system downtime events and summarize the pros and cons of each. Week 6 discussion Discussion Prompt 1 The following websites include toolkits for completing a risk assessment: http://www.himss.org/ASP/topics_pstoolkitsDirectory.asp?faid=569&tid=4 https://healthit.ahrq.gov/health-it-tools-and-resources/health-information-security-and-privacy-collaboration-toolkit Review the risk assessment guides available at these sites and then answer the following question: Because HIPAA requires that a covered entity appoint a security officer, what is the role of the health professional or informatics specialist in working with the security officer to complete a risk assessment? In your discussion, consider who has access to the information required to complete the assessment and how the information should be collected. Discussion Prompt 2 List and describe the federal agencies and committees that are responsible for facilitating electronic exchange of health information in the United States. What are the current time periods for the meaningful use program under Medicare and Medicaid, respectively? How do providers avoid payment penalties for failing to satisfy meaningful use requirements? Week 7 discussion Discussion Prompt 1 Discuss the role of informatics in home health care and related community-based systems. What are your experiences with such settings? Do you expect to have more contact with them in the future? Discussion Prompt 2 Monitoring population health status is a central public health activity. A variety of survey systems, such as the CDC’s National Health and Nutrition Examination Survey (NHANES) and National Health Interview Survey (NHIS), as well as state and national reporting systems, such as the Behavioral Risk Factor Surveillance System (BRFSS), Pregnancy Risk Assessment Monitoring System (PRAMS), and National Electronic Disease Surveillance System (NEDSS) provide public health practitioners with the ability to assess health trends, identify and respond to emerging health hazards, and guide development of interventions and policies that address serious health conditions such as obesity, smoking, and diabetes. With the proliferation of EHRs within acute and ambulatory care systems, how much of this survey activity do you think can be folded in under routine data collection and exchange activities? Week 8 discussion Discussion Prompt 1 Do an Internet search for new technologies that focus on patient engagement. Discuss one of your findings. Also describe two strategies a provider can use to engage patients in monitoring their health. In the interest of public health, do you believe all capable patients should be expected to monitor their health using accessible tools? What, if any, are the unintended consequences of that expectation? Discussion Prompt 2 What societal and technological trends do you see that might promote increased adoption and use of personal health records (PHRs)? What specific types of data or functions do you think would draw people who are not current PHR users to adopt and use the PHR? How do you think this might vary by user attributes (e.g., age, disease status, health literacy)?

Patient with Dementia and Depression
Patient with Dementia and Depression
Week 6 discussion
With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as the advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care. Consider the patient presentations in the following case studies. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?
Case Study 1
HPI: Mrs. Mayfield is a 75-year-old woman who is brought to the emergency room by the police at 11 p.m. She was found wandering and confused in a local neighborhood. The police were called when Mrs. Mayfield tried to use her key on a neighbor’s door. When confronted by the police she became abusive, confused, and frightened and looked very pale and agitated. The police could not establish her correct address and they subsequently brought her to the emergency room.
Review of Symptoms (ROS): Unable to obtain at this time.
Objective Data:
PE:
VS: Pulse 96 and regular; B/P 150/90; Axillary temperature 99°F.
General: She appears clean and well nourished, with no signs of injury, trauma, or neglect.
Her physical exam is unremarkable except –
Neuro: No gross focal neurological signs, but she is only intermittently cooperative. Her mental status fluctuates and a full neurological evaluation is not possible at this time.
Psych: A & O x 1 to person only. She has episodes of agitation and alternating withdrawal/somnolence. During the examination, it takes several attempts to gain Mrs. Mayfield’s attention to answer questions, but once focused, she rambles on in a disorganized and incoherent way.
Case Study 2
CC: “irritable and forgetful”
HPI: Mrs. White, a 78-year-old married woman, is brought to the office of her primary care provider by her husband because of increasing forgetfulness and irritability over the past 3 months. Mr. White claims that his wife has had problems for several years now, but has just gotten “worse in her memory” in the past few months. She recently misplaced her purse and accused her son of stealing it.
On three occasions, she left the stove on and boiled a pot dry, nearly causing a fire. She recently put a container of ice cream into the washing machine instead of into the freezer and her husband did not discover it for more than a week. Mrs. White claims her family wants to take her money and leave her with nothing. “No matter what they say, there is nothing wrong with me,” she states.
Past Medical History (PMH) includes: hypothyroidism, treated with Synthroid, and successful treatment of breast cancer approximately 15 years prior. She also takes over-the-counter ibuprofen for chronic lower back pain and occasional Benadryl to help her sleep at night.
Objective data: Her physical examination is within normal limits.
Case Study 3
HPI: Mr. George is a 72-year-old male who has lived alone since his wife died approximately 1 year ago. He has lived in the same house for 45 years. He is brought in by his son who is concerned that his father has lost more than 35 pounds over the past year. Mr. George admits to not eating well because “I don’t know how to cook for myself.”
PMH: He has been in good health with the exception of hypertension, which is well controlled.
Social history: He spends most of his time watching sports on television. He occasionally drinks one or two cans of beer when he is watching TV. He does go to his son’s house to visit with his grandchildren about once a week, and he says he enjoys that. He does not receive any social services, he still drives but only in the daytime, and he does not participate in any other leisure activities.
Objective data: His physical examination is normal. He responds correctly to questions, although he appears to have a flat affect.
To prepare:
Review Chapters 6–8 of the Holroyd-Leduc and Reddy text.
Select one of the three case studies. Reflect on the way the patient presented in the case study you selected, including whether the patient might be presenting with dementia, delirium, or depression.
Think about how you would further evaluate the patient based on medical history, current drug treatments, and the patient’s presentation. Consider whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist.
Week 7 discussion
Discussion: Nutrition and Hydration
Geriatric patients have many nutritional and hydration concerns that impact their health and ability to acquire sufficient nutrients. Advanced practice nurses evaluating these patients must be able to account for all barriers that prevent elders from obtaining adequate nutrition, including medical conditions, transportation, finances, physiologic changes, and functional abilities. When evaluating patients, it is important to consider how they eat, what their diet consists of, and whether they have any special dietary needs that are not being met. Assessment tools, such as the Lawton Instrumental Activities of Daily Living (IADL) Scale, are an integral part of this evaluation process as they help providers identify potential obstacles for patients. In this Discussion, you assess a patient at your current practicum site and consider strategies for improving any nutrition or hydration issues.
To prepare:
Review this week’s media presentation, as well as 29 and 30 of the Resnick text.
Assess a patient using tools for inpatient and long-term patient care, such as the Lawton IADL Scale.
Note: You should coordinate this opportunity with the Preceptor at your practicum site.
Consider whether nutrition and/or hydration might be impacted by the patient’s functional abilities. Reflect on whether the patient is able to go out and get food to eat, cook meals, safely use the stove, etc.
Consider the patient’s diet and whether they have any special dietary needs due to medical conditions, such as congestive heart failure, end-stage kidney disease, diabetes, oral health issues, etc. Reflect on whether or not the patient is attempting to compensate for a medical issue and thus creating a deficiency or excess in his or her diet.
Based on your patient assessment, think about strategies for improving any nutrition issues that might have presented (e.g., nutritional supplements, community resources such as Meals on Wheels, referral to a nutritionist or dietician, etc.).
Week 8 discussion
Discussion: Nursing Homes in Your Community and Neighboring Communities
Nursing homes have become a viable option for geriatric patients who require routine care and need help performing basic activities of daily living, with about 3.3 million patients residing in nursing homes in the United States (Centers for Medicare & Medicaid Services, 2013). While nursing homes provide care and services to patients, problems can arise resulting in reduced quality of care and, in some cases, illness and morbidity. The severe implications of pressure ulcers make them a major concern for elders residing in nursing homes. The Centers for Medicare & Medicaid Services (2013) estimate that 7.5% of nursing home residents have pressure ulcers and about 82,000 patients develop them each year. In your role as the advanced practice nurse, you must understand factors that contribute to the incidence of pressure ulcers in order to improve patient outcomes.
For this Discussion, you examine the prevalence of pressure ulcers in nursing homes and develop strategies for increasing awareness and reducing incidence.
To prepare:
Review Chapter 32 of the Resnick text and Chapter 12 of the Holroyd-Leduc and Reddy text.
Select four nursing homes in your community and/or neighboring communities. Research and locate reports on these nursing homes through organizations such as Centers for Medicare & Medicaid Services.
Compare the four nursing homes you selected based on reported cases of the development of new pressure ulcers.
Think about factors in the nursing home setting that contribute to pressure ulcer issues, such as patient activity, nutrition, or the number of staff available to care for patients.
Research guidelines for the prevention of pressure ulcers. Think about how you might increase awareness among nursing home staff about the incidence and consequences of pressure ulcers in patients.
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