Documentation and Care of the Deteriorating Patient

Type: Coursework

Subject: Introduction to Professional Nursing: Clinical Course

Subject area: Nursing

Education Level: Undergraduate/College

Length: 4 pages

Referencing style: APA

Preferred English: AU English

Spacing Option: Double

Instructions:The identification of a deteriorating patient has been poorly managed within the healthcare setting. Usually there are discernible physiological changes which occur prior to adverse events such as cardiac arrest, unexpected admission to the ICU and unexpected death. As this is a stressful situation it is easy to omit essential strategies. Patients can deteriorate rapidly or over a period of several hours. Health professional often miss the signs of deterioration as they fail to systematically assess their patients.

 

A set of strategies was developed to identify and manage the deteriorating patient. The first step is to assess the patient using the ABCDE algorithm which is a systematic assessment known as the primary survey and can be used with all patients. The clinical signs of critical conditions are similar regardless of the underlying condition. The initial assessment and treatment are performed simultaneously and continuously.  This would also include taking a full set of vital signs and comparing to previous readings. The patient is assessed in the following order

A:             Airway

B:            Breathing

C:             Circulation

D:             Disability (neurological function)

E:             Exposure

 The approach to all deteriorating or critically ill patients is the same. The underlying principles are:

  • Do a complete initial assessment and re-assess regularly.
  • Treat life-threatening problems before moving to the next part of the assessment.
  • Assess the effects of treatment. 
  • Recognise when you will need extra help. Call for appropriate help early.
  • Use all members of the team. This enables interventions (e.g. assessment, attaching monitors, intravenous access), to be undertaken simultaneously.
  • Communicate effectively - use the Situation, Background, Assessment, Recommendation (SBAR).
  • The aim of the initial treatment is to keep the patient alive and achieve some clinical improvement. This will buy time for further treatment and making a diagnosis. 
  • Remember – it can take a few minutes for treatments to work, so wait a short while before reassessing the patient after an intervention.

First steps

  • Ensure personal safety. Wear apron and gloves as appropriate.
  • First look at the patient in general to see if the patient appears unwell.
  • If the patient is awake, ask “How are you?”. If the patient appears unconscious or has collapsed, shake him and ask, “Are you alright?” If he responds normally he has a patent airway, is breathing and has brain perfusion. If he speaks only in short sentences, he may have breathing problems. Failure of the patient to respond is a clear marker of critical illness.
  • This first rapid ‘Look, Listen and Feel” of the patient should take about 30 s and will often indicate a patient is critically ill and there is a need for urgent help. Ask a colleague to ensure appropriate help is coming.
  • If the patient is unconscious, unresponsive, and is not breathing normally (occasional gasps are not normal) start CPR according to the resuscitation guidelines. If you are confident and trained to do so, feel for a pulse to determine if the patient has a respiratory arrest. If there are any doubts about the presence of a pulse start CPR.
  • Monitor the vital signs early. Attach a pulse oximeter, ECG monitor, and a non-invasive blood pressure monitor to all critically ill patients, as soon as possible.
  • Insert an intravenous cannula as soon as possible. Take bloods for investigation when inserting

Literature Review in Action

Type: PowerPoint Presentation

Subject: Theory Development in Nursing

Subject area: Nursing

Education Level: Undergraduate/College

Length: 1 slides

Referencing style: APA

Preferred English: US English

Spacing Option: Double

Instructions: in this assignment, you will create a presentation that reflects on the prevention and control of healthcare associated infections, particularly prevention of cauti (catheter associated urinary tract infections) and explains the purpose of a literature review as it relates to this problem. step 1: reflect on your proposed problem of interest. critically think about your research question or problem of interest. step 2: consider the following questions: what is the purpose of conducting a literature review? what are the steps a nurse researcher would take to conduct a literature review? what would be the primary and secondary questions regarding the research question or problem of interest? consider the importance of including sources with a variety of results when identifying sources pertaining to your proposed problem of interest. step 3: consider who your audience might be if you were to deliver your presentation in person. what would you want them to know about this topic? what would you expect them to already know? step 4: create a seven- to ten-slide presentation that summarizes the purpose of a literature review. explain the steps in conducting a literature review. in your presentation, describe how you would approach conducting a literature review pertaining to your problem of interest. identify one primary question and one secondary question regarding the problem of interest. step 5: review your presentation. ensure that you are using best practices for formatting slides. include a title screen and summary screen. avoid making slides too text heavy or dense with text. as a guideline, limit text on each slide to five bullet points of six words each. if using graphics, be sure that they are professional, reinforce your points, and are not used merely for decoration. be sure to add what you would say if delivering the presentation to a live audience in the notes section of each slide. cite all sources in apa format.

Staffing Budgets/FTEs/ Variance Analysis

Type: Assignments

Subject: Nursing Leadership Course

Subject area: Nursing

Education Level: Undergraduate/College

Length: 3 pages

Referencing style: APA

Preferred English: US English

Spacing Option: Double

Instructions: see attached

Focus: staffing budgets/ftes/ variance analysis

Structure: form and question

Important notes: please follow rubric and assignment guidelines

Intsructions: Preparing the Assignment

Section One—Staffing Budget and FTEs

Personnel Budget Case Study

Sandra Chambers has recently accepted the position of assistant administrator for the department of nursing at Potter Regional Medical Center where she will oversee the operations of five medical units. As she evaluates the budgets for the different cost centers, she finds that all are being used at near or full capacity. The activity in four of the five has remained steady over the past 2 years. A fifth unit has realized a steady increase in patient volume during that time and is currently at 88% capacity. It has been projected that within the next 12 months the volume of patients moving through that unit will increase by 20%. Sandra needs to determine if the current FTEs for the unit will be sufficient to ensure quality and safe care continues to be provided, and if not, what is the number of FTEs that will be needed to cover a 20% increase in volume.  

  1. Suggest all the information Sandra needs to collect in order to project the FTEs needed for the next fiscal year accounting for the projected increased capacity. Remember, she is new to her position so be sure to include background data on the unit itself as it relates to previous budgets, nursing staff, and the organization. In other words, summarize your approach to this Case Study.
  1. Sandra has collected the following census information on all five units for the last month, in

addition to what was asked in question number one. Calculate the ADC and Occupancy Rate for each unit using the Daily Census/Occupancy Rate table to determine which unit is currently at 88% occupancy rate and projected to increase over the next year.

Endocrine Case study

Type: Nursing Care Plans

Subject: Gerontology Nursing

Subject area: Nursing

Education Level: College

Length: 2 pages

Referencing style: APA

Preferred English: US English

Spacing Option: Double

Instructions: I will enclose some documentation. We are doing the endocrine so we have to use the information that has to do with that. There should be two care plans, priority 1 and 2. We must use the information in the case study and the intervention and rationals. If there are not enough then we can use others but an asterisk mark must be put next to those. 

One point is awarded for each correct response and one point is deducted for each incorrect response. The grade is decided by the total of correct responses, minus the total incorrect responses divided by the total response. The grade cannot be less than zero.

CARE PLAN

The care plan will follow the same format that is available in the Clinical I packet and is graded the same way. Looking at the ENTIRE scenario, students should choose TWO priority concerns in the development. If they choose an incorrect problem, for example Body Image Disturbance and Risk for Injury and there exists a Risk for Aspiration, Body Image Disturbance is completely incorrect and will receive a zero. The care plan grade is the average of the two.

SCENARIO QUESTIONS

Each question is worth 2 points. This allows discretion in grading based on the thought put into the response. Consequently, it is possible that the student may receive only one point. The grading percentage is the number of points awarded divided by the possible number of points. 

Literature Search

Type: Article Review

Subject: Midwifery and Women's Health

Subject area: Nursing

Education Level: BSN

Length: 1 pages

Referencing style: APA

Preferred English: US English

Spacing Option: Double

Instructions: literature search matrix. extract the information for each column category from the 5 studies searched. this is usually found in the abstract or specific areas throughout the study such as the methodology . in the category methodology, note whether the study is quantitative, qualitative or mixed method conceptual framework or theoretical framework are sometimes used interchangeably, however theoretical frameworks usually underpin quantitative studies and conceptual frameworks can be associated with qualitative studies.

Focus: intervention picot question: in women with pregnancy (patient population), how effective are complementary and alternative approaches to pain relief (intervention of interest) compared to conventional treatments (comparison intervention) in controlling pain (outcome) during the labor? i had to develop a research question using the picot acronym, which is “in women with pregnancy, how effective is complementary and alternative approaches to pain relief compared to conventional treatments in controlling pain during the labor? delivery is a natural fact during women experience extreme pain. apart from traditional therapies, such as epidural analgesia and nitrous oxide, many complementary or alternative approaches can reduce pain during labor and delivery. generally, the research question, in this case, will address the method that can be used for mothers who would like to relieve the pain during labor by using alternative or conventional treatments. my great aim in developing this research is to find a way to minimize pain by using alternative and complementary approaches and compare their effectiveness with traditional methods. i chose this question because i am interested in a career to be a labor and delivery nurse. women’s experience of pain during labor varies greatly, and pain control is a major concern for obstetricians. several methods have been studied for pain management for women in labor, including drug and non-drug interventions.

Structure: page 1 title page (your title can correlate with your assignment such as literature search). page 2 rationale/background for picot question in a concise double space paragraph spell out each component of picot write picot question in one sentence (keep it simple) page 3 literature search matrix. extract the information for each column category from the 5 studies searched. this is usually found in the abstract or specific areas throughout the study such as the methodology . in the category methodology, note whether the study is quantitative, qualitative or mixed method conceptual framework or theoretical framework are sometimes used interchangeably, however theoretical frameworks usually underpin quantitative studies and conceptual frameworks can be associated with qualitative studies. again this will be found in your study. both will be further discussed in your 3rd semester research class. page 4 reference page include 5 studies reviewed using apa 7th edition style & format (online library has resources to assist you in compliance)

Important notes: please use my form of matrix and my picot. if you think my picot has mistakes, please change it. my next order will be literature review.