a) Explain your understanding of the following terms.
a) Explain your understanding of the following terms.
b) Provide an example of how each of these terms can affect patient care.
General Power of Attorney
Enduring Power of Attorney
Advanced Healthcare Directive
Guardianship"
a) Explanation of Terms
1. General Power of Attorney (GPA):General Power of Attorney (GPA):
Definition: A General Power of Attorney is a legal document that empowers one person to legally stand and act for another in legal and financial matters. This power is usually general in nature but may be made by the principal to be certain or confined to certain matters.
Characteristics: The powers vested are exercisable without any delay and cease only if the principal becomes insane or passes on, unless otherwise provided.
2. Enduring Power of Attorney (EPA):Enduring Power of Attorney (EPA):
Definition: An Enduring Power of Attorney is a type of Power of Attorney that is—not restricted to being exercised only in case of mental incapacity of the principal. It enables a person to handle the business affairs of the principal in regard to finances and legal matters when the principal is incapable of doing so.
Characteristics: It is intended to continue functioning even after the loss of capacity of the principal and can include financial and personal matters as the case may be in the jurisdiction.
3. Advanced Healthcare Directive (AHD):
Definition: An advanced healthcare directive is a legal document that is used to express the preference which a patient has regarding the type of medical treatment and care they wish to receive in the future in case they are unable to make such decisions on their own. It entails the living wills as well as the medical power of attorney.
Characteristics: It offers direction to the healthcare givers and the family and friends on the patient’s preferences on issues to do with resuscitation, donation of organs and other medical interventions.
4. Guardianship:
Definition: Guardianship can be described as a legal process where by a party is granted the authority by a court to act on behalf of another party who is incapacitated or disabled in one way or the other.
Characteristics: The following are the powers that can be granted in guardianship; personal, medical and financial and is often used where the patient has no family or friends to represent him/her.
b) How Each of the Term Can Influence the Patient Care
1. General Power of Attorney (GPA):General Power of Attorney (GPA):
Example: In case of hospitalization of the patient with a GPA, and the inability to manage the financial aspects of the patient’s life, the designated agent can process insurance claims, pay for bills and manage investments. Nevertheless, the GPA does not usually provide power concerning medical management, which may be inconvenient in case of medical interventions in the course of the patient’s disability.
2. Enduring Power of Attorney (EPA):Enduring Power of Attorney (EPA):
Example: Dementia is one of the complication which can occur in a patient with an EPA. Subject to the extent of the power of attorney granted, the appointed attorney can still look after the patient’s financial and legal matters including making payments of bills and property management. This can help the family to free some costs and responsibilities and, at the same time, meet the needs of the patient.
3. Advanced Healthcare Directive (AHD):
Example: With an AHD, it is clear on what the patient would want to do in the event that they get an accident and become unconscious; whether they would want a ventilator or not have any life-sustaining treatments. This helps in maintaining that the medical management given to the patient is what he/she would have wanted and reduces on conflict between family members or between the family and the doctors.
4. Guardianship:
Example: A guardian who is appointed by the court for an elder with severe cognitive impairment can also make the decisions regarding the healthcare of the person, whether to agree or decline a certain treatment and can also oversee the care plan of the patient. This way, decisions that the ward would otherwise make on their own behalf are made on their behalf when they cannot make them.
Nam has recently been diagnosed with hypertension, obesity and degenerative joint disease
Nam has recently been diagnosed with hypertension, obesity and degenerative joint disease. He is struggling with these diagnoses. He tells his wife, Yen, ""I feel so old now. These are the kind of things my parents are dealing with."" At a clinic visit Nam tells you, ""It's hard to think of myself as sick. I've been depressed ever since Zach told me about his findings. Now he's asked me to get some lab work. I'm afraid he may find even more problems."" Nam comes from a Vietnam culture
How might the Nguyen's cultural heritage affect their health beliefs?
What factors would you want to consider when performing a cultural assessment of the Nguyen family?"
Effect of Cultural Interference on Health Belief Systems
Nguyen's Cultural Heritage and Health Beliefs:Cultural Heritage and Health Belief of Nguyen:
Perception of Health and Illness: Some of the Cultural practices include the Vietnamese cultural beliefs about health and illness. It is also possible that health concerns are defined in terms of fate or balance and are viewed as people’s efforts to manage the body in relation to the world. Nam’s cultural belief could have affected his perception of his disease, as well as the approach he takes towards the same. They may think that these are normal signs of ageing or that his life is somehow out of kilter, and it is not just an issue of health.
Stigma and Shame: Stigma can be described as the social understanding or prejudice that is associated with some diseases such as the chronic diseases and the mental illnesses. Nam is also a depressive and has many occasions of inferiority complex and these could be aggravated by the fact that in the Asian context, mental health is considered as a kind of weakness or failure. This stereotype may even complicate Nam’s ability to express himself or even seek assistance.
Family Dynamics and Decision-Making: Vietnamese society is rather hierarchical, especially within families, and the decisions are usually taken by a group of people. The manner through which Nam’s wife Yen supports him and the family’s perception on health can also influence how Nam will view and cope with his health problems. The family roles and participation could be an important determinant in his willingness to accept the treatment and the degree of adherence.
Cultural Assessment considerations
Health Beliefs and Practices: Identify the patient’s perception and knowledge on health and illness, any cultural practices that he is using or intends to use. This can at least provide the research with an idea on his view of his situation and how such views may influence his response to conventional ways of treatment.
Family Role and Support Systems: Consider how the family of Nam particularly his wife Yen plays a role in the healthcare decisions and system of Nam. Analyse how cultural beliefs about family responsibilities affect Nam’s ability to manage the health conditions.
Communication Style: Respect and understanding other people’s culture when in communication. Vietnamese people are not very direct in their communication and a patient will not necessarily describe his or her symptoms. It is also necessary to learn Nam and his communication pattern, in this way one can be in a position to meet all his needs.
Mental Health Stigma: Explain how to rid the culture that is commonly affiliated with mental health issues. Think about how Nam’s ethnicity may affect his perception of depression and seek for help. They can help to decrease the stigma and increase his engagement with mental health services – by appearing normal and thus normalizing mental health services.
Traditional vs. Western Medicine: The following are some of the traditional health practices that Nam might engage in and how these can be supportive or contradictory to the advice given by the Western medical practitioners. This will be useful in ensuring that the treatment plan that he is to undergo is in accordance with his cultural beliefs and yet he needs at the same time.
Socioeconomic Factors: Nam may also have factors that may affect her utilization of healthcare services which are the socio-economic factors. Knowing his finance, insurance, and the barriers to seeking medical services can help to get a better understanding of his health status.
Introduction
Introduction:
Hello Dr. Shah, this is nurse Yogisha Patel calling from Med Surg Dept.
S - Situation:
Jenise Buckler, in room 115, is a 71-year-old American female who is having chest pain and shortness of breath. She is mark ably unwell.
B - Background:
Mrs. Buckler has a long history of chronic obstructive airways disease and anxiety, increasing hospital admissions over the last 3 years. Her last hospital admission was 12/15/2019. She is a reformed smoker. Her medication regime includes home oxygen, an inhaled corticosteroid, theophylline, and a long-acting bronchodilator. Also, patients have high cholesterol and high BP.
Medications: Sertraline 25 mg PO qDay, Lipitor 20 mg PO qDay, Lisinopril 10 mg PO 1Day. She prescribed NITROSTAT 0.3 mg in 2019 as well. She has NO known allergies to current medications. Labs were drawn on 4/25/21 @1315 for CBC, CMP, Lipid Panel, and urinalysis & chest X-rays (results pending).
A - Assessment:
Mrs. Buckler is extremely anxious and distressed. Her presentation for this event is more severe than on previous occasions. An ECG was negative for acute changes. On physical assessment, her temperature is 96.7 F, blood pressure 190/100 mmHg, heart rate 118 bpm, respiratory rate 34 per minute, SpO2 87% on RA. She is unable to perform a peak flow reading. I suspect she is suffering from an infective exacerbation of chronic obstructive airways disease. Blood and sputum specimens have been taken before the commencement of an intravenous fluid regime and antibiotics.
R - Recommendation:
I recommend that Mrs. Buckler be retrieved from an institution for definitive management of exacerbation of chronic obstructive airways disease as soon as possible.
R - Read Back:
To be clear, you would like to start the patient NITROSTAT 0.3 mg at this time before transferring her for advanced care.
2 I- Good morning Dr. V. This is Lisa, RN calling from step down unit with ABC General Hospital.
S- Mr. Tomahawk has just been transferred from medical surgical unit following chest tube placement for fluid on the lungs
B- Mr. Tomahawk was admitted to the ER 3 days ago with complaints of pain in the side when coughing, shortness of breath and productive cough that had been ongoing for 5 days before his brother called the ambulance to have him brought to the ER by ambulance after dizziness and LOC. He did not sustain any head injuries because he felt faint while sitting on the couch. Mr. Tomahawk has a history of recurrent pneumonia and chronic asthma with exacerbation
A- Upon entering Mr. Tomahawk's room, I noticed the drainage system was lying on the floor and there appears to be an air leak. An assessment was completed. VS are as follows: BP 148/92, HR 83, RR 20, O2 94%, pt reports no pain but has slightly increased shortness of breath after forgetting to splint near the recent insertion site when coughing
R- The site where the chest tube disconnected has been covered with an occlusive dressing. I recommend replacing the chest tube and applying a new occlusive dressing
R- For clarification, replace chest tube and in a sterile fashion, open the feet of drainage system and place below the bed and make sure it is upright and secure
please comment /discuss on my above two post if you agree or disagree. Please explain and include references"
SBAR is a communication tool and your Situations, Backgrounds, Assessments, and Recommendations are well outlined and conform to the SBAR structure. Here are some comments and suggestions for each scenario:Here are some remarks and recommendations for each of the three described scenarios:
Scenario 1: Discussing with Dr. Shah:
Strengths:
Situation: Describes the state of the patient at the time and the problems of the patient.
Background: The following major areas are discussed: to the patient’s past and present medical history, the medication history.
Assessment: The results of the assessment and your feeling that the patient may have an acute on chronic exacerbation of chronic obstructive airway disease (COPD).
Recommendation: Extremely supportive of the patient to be transferred for further management.
Read Back: It helps the action that requires to be done to be highlighted and also make one to have a clear understanding.
Suggestions:
Assessment Detail: However, there are some aspects where the assessment can be developed, for instance, the authors could have provided more information about the measures that have been done in the near future (e. g. changes made in oxygen therapy, choice of the first antibiotics).
Recommendation Specificity: If possible, try to determine which type of specialized care facility or department would be appropriate for Mrs. Buckler; for instance, a pulmonology or an intensive care unit.
Read Back: The read-back include the information about the management of NITROSTAT but it is important to establish whether this is in any way consistent with the current guidelines for her condition.
References:
American Nurses Association (ANA). (2015). The ethical standards by which nurses are expected to conduct themselves in the course of their practice are found in the Code of Ethics for Nurses with Interpretive Statements. ANA.
Some of the organizations include the Institute for Healthcare Improvement (IHI). (2017). SBAR: A Framework for Interaction. Retrieved from IHI. org
The second case is; interaction with Dr. V.
Strengths:
Situation: Show the present condition of Mr. Tomahawk and shows the most recent procedures that Mr. Tomahawk has had.
Background: The history of the patient in detail and the current issue with the chest tube are described.
Assessment: VS are listed in the documents and there are assessment parameters.
Recommendation: Outlines recommendations that can be made as a way of addressing the problem of disconnection with a view of improving the quality of service delivery to the patients.
Read Back: Describes the steps that should be taken so as to prevent mistakes hence improving the correctness.
Suggestions:
Assessment Detail: It would also be helpful to have brief history and physical examination finding about the patient’s current respiratory status and any change in the breath sound or other findings except dyspneas.
Recommendation Specificity: Ensure that the order for removal of chest tube should include the type of chest tube or drainage system which is to be used in case of another one.
Follow-up: It might be useful to mention the fact that one should look for any problems or possible need for further assessments after the chest tube is removed.
References:
The American Association of Critical-Care Nurses (AACN) has defined the nursing care for the ICU/CCU as (AACN, 2016). Critical Care Nursing: The Fourth Approach: The Integrative View. Lippincott Williams & Wilkins.
Nurses’ association of New Brunswick is the professional organization of nurses in New Brunswick. (2015). SBAR Communication. Retrieved from NABN. org
Please write a 750 word evidence-based response to each of the questions listed below.
Please write a 750 word evidence-based response to each of the questions listed below. Provide a rationale to support your response:
1. Describe enteral tube feeding and indications for use.
2. Identify two potential client problems associated with receiving enteral tube feedings.
3. Identify potential complications of enteral nutrition and discuss the related pathophysiology.
4. Discuss three priority nursing interventions that should be performed to manage each complication identified above."
1. Explain what is Enteral Tube Feeding and when it is indicated to be used:
Enteral Tube Feeding Overview:
Enteral feeding is a feeding process in which nutrients are introduced into the gastrointestinal tract via a tube which is passed into the stomach or the small intestine. This method is used where a patient is unable to take adequate nutrients through the mouth but has a normal gastrointestinal tract.
Types of Enteral Tubes:
Nasogastric Tube (NG Tube): It is passed through the nose and reach to the stomach. Commonly used in short term feeding, where feeding is done for a period of not more than 4-6 weeks.
Ostomy Tubes: For instance PEG tubes, which is percutaneous endoscopic gastrostomy, or PEJ tubes, which is percutaneous endoscopic jejunostomy. These are passed into the stomach or jejunum through a small incision and are used for long term nutrition support.
Indications for Enteral Tube Feeding:Indications for Enteral Tube Feeding:
Inability to Swallow (Dysphagia): Some of the conditions that could hinder swallowing include stroke, neurological disorders or head and neck cancers.
Critical Illness or Surgery: This is used in patients who are experiencing some forms of surgery or those with severe diseases and cannot take food but require a diet for them to recover.
Chronic Illnesses: Severe anorexia, COPD, IBD, or any other condition in which oral nutrition is inadequate.
Malabsorption Disorders: Various conditions, for example, Crohns disease that affects the nutrient’s absorption, require enteral feeding to enhance the nutrient uptake.
Rationale: It is indicated for use in patients to provide nutrients by mouth when the patient is unable to take food orally. This method has an advantage over parenteral nutrition because it passes through natural route of the gastrointestinal tract and is less invasive.
References:
Boullata and Carney in their article published in Nutritional Clinics published in 2016. Enteral Nutrition in Adults: An Analysis of the Current Literature and Practice. Vol 31, No 3, 2016, pp 283-292: Nutrition in Clinical Practice.
This service is provided by the National Institute for Health and Care Excellence (NICE). (2022). Nutritional Support for Adults. Retrieved from NICE. org. uk
2. Two Possible Client Issues Concerning the Receipt of Enteral Tube Feedings:
Problem 1: Aspiration Pneumonia
Rationale: Aspiration pneumonia is a condition in which feeding formula through the enteral route gets into the lungs, usually because of incorrect placement of the tube or regurgitation. These include the patient with reduced level of consciousness, the patient with an impaired gag reflex or the patient receiving feedings at high rates. Aspiration can cause the inflammation as well as the infection of the lungs.
Problem 2: Diarrhea
Rationale: Diarrhoea is a complication that is frequently observed in patients on enteral feeding, and is usually attributed to the rate at which the feeds are given, the osmolality of the feeds used, or intolerance to certain types of feeds. Diarrhea has side effects such as dehydration and altered electrolyte levels.
References:
Rhoads, J. E. & Nair, S. C. (2015) Enteral Nutrition: Some of the Complications and How They are Handled. Gastroenterology Nursing, 38(6), 423-431.
Heyland D. K. , Dhaliwal, R. , Avenell, A. , 2019. Nutritional Support in Critically Ill Patients: In this paper, the facts and controversies of the subject will be laid down. Published in Critical Care Medicine, volume 47, issue 6, the authors present the following findings: e295- e303.
3. Describe the Possible Consequences of Enteral Nutrition and Explain the Pathophysiology of the Latter
First complication: Gastrointestinal (GI) Complications
Pathophysiology: Some of the GI complications include of nausea, vomiting, and abdominal cramping which may be as a result of the high feeding rates, formula intolerance or feeding through an improperly functioning GI tract. These symptoms are a consequence of stomach or intestines being unable to handle the load or type of feeding formula.
Complication 2: Tube-Related Issues
Pathophysiology: Possible complications include; displacement of the tube, blockage, or even infections at the site of insertion. Displacement may happen in case of improper fixation of the tube or if the patient removes it on his or her own. It is caused by blockage of the tube by formula or medication. It can develop from poor hygiene or from contamination at the time of tube placement.
References:
Moore, F. A & Moore, E. E (2016). Enteral Nutrition: Things to Remember for Clinicians. Peer-reviewed, Journal of Parenteral and Enteral Nutrition, 40(3), 351-357.
Klek S. , & Olszewski R. (2020). Complications of Enteral Nutrition. Current Opinion in Clinical Nutrition and Metabolic Care; Vol. 23, No. 3; 225-231.
4. Explain Three High Prioirty Nursing Interventions to Prevent/Manage Each of the Complication Mentioned Above
For GI Complications:
Monitor and Adjust Feeding Rates:Monitor and Adjust Feeding Rates:
Rationale: Reduce the rate of feeding or change the osmolality of the formula if the patient complaints of gastrointestinal discomfort or diarrhoea. The symptoms should therefore be monitored on a regular basis and the feeding rate should be modified so as to minimize further complications.
Administer Antiemetics:
Rationale: In case of nausea or vomiting, the prescribed antiemetics can be given to the patient to manage this side effect and make the patient comfortable and more tolerant to the enteral feeding.
Assess and Manage Fluid and Electrolyte Imbalances:Assess and Manage Fluid and Electrolyte Imbalances:
Rationale: Solutions of this system are messy and can result in diarrhoea, which can cause dehydration and electrolyte imbalances. Assess and maintain Fluid balance, electrolytes and provide necessary replacement’s as per the case.
For Tube-Related Issues:
Ensure Proper Tube Placement and Securement:Ensure Proper Tube Placement and Securement:
Rationale: Ensure timeously that the tube is in the correct position by using the right tools (e. g. X-ray, pH testing) and ensure that the tube is well secured with no risk of displacement. This prevent complications like aspiration or failure to meet the patient nutritional requirements as may be required.
Routine Tube Flushing and Maintenance:Routine Tube Flushing and Maintenance:
Rationale: To avoid blockage it may be helpful to flush the tube with water before and after feedings. To prevent blockage or infection, frequent cleaning and check up on the condition of the tube are advised to be done.
Implement Infection Control Measures:
Rationale: Ensure that there is proper cleansing of both the patient and the tube before it is inserted and also ensure proper sterilization of the tube and its accessories, also check for any signs of infection around the insertion site. This way, any signs of infection can be treated in good time to stop the occurrence of complications and to keep the tube working properly.
References:
S. A. McClave and B. E. Taylor (2016). The ESPEN Guidelines on Enteral Nutrition: Pathophysiology and Indications of the Nutritional Support in Adult Critically Ill Patients. Journal of Parenteral and Enteral Nutrition Volume 40, Number 2, pp. 159–211.
Arabi, Y. M. , & Aldawood,, A. S. (2018) Enteral Nutrition Support in the Critically Ill Patient. Saudi Journal of Gastroenterology, 24(2) 67-77.
Susan P. had a SVD (spontaneous vaginal delivery) today approximately 2 hours ago.
Susan P. had a SVD (spontaneous vaginal delivery) today approximately 2 hours ago. The labor and
delivery nurse is calling to give you report. She is new and not sure what you want to know from her.
What questions do you need to ask to provide comprehensive care to this patient once she is transferred
into your care?
There are several questions that need to be answered in relation to a recent birth for the mother and the
newborn. First, the vitals will need to be known, temperature, pulse, respirations, blood pressure,
fundus, lochia, episiotomy or incision, hemorrhoids, bladder, CVAT, lower extremities Homans' sign,
mood, and bonding/attachment (Ward, & Hisley, 2016). I would need to know of any medications,
prescribed, over the counter, supplements, if she smokes, drugs, alcohol. During delivery did she have
any complications such as bleeding or tears? Does she have a support system and if so, who would that
be?
The baby I would need the same information such as vitals, the babies name, voided or stooled, has baby fed, breastfeeding or formula, has the baby latched or will the mother need assistance, is the security protocol in place? Did the baby have any complications?
2 Postpartum:
Susan P. had a SVD (spontaneous vaginal delivery) today
approximately 2 hours ago. The labor and delivery nurse is calling to give you
report. She is new and not sure what you want to know from her.
What questions do you need to ask to provide comprehensive care
to this patient once she is transferred into your care?
It is vital that the patient be monitored for post-partum hemorrhage, infection, and shock. My goal as a post-partum nurse would be to provide comfort to the patient, assist the patient with their recovery, provide pharmacological pain relief, provide patient and newborn teaching, I would ask the nurse giving me report the following questions. I would ask about the patient's breast, and if the newborn is latching on, and if there is any redness or tenderness to the breasts. I would then ask about the patient's uterus and ask for fundal height, uterine placement, and consistency. I would ask if the patient is having normal GI bowel function as well as normal bladder function. I would ask about the amount of lochia the patient is excreting as well as the odor, color, and consistency of the lochia. If the patient had an episiotomy, I would ask for if there was any edema, ecchymosis, and approximation. Last, I would request the patient's most recent vital signs as well any patient teaching that must be done.
please comment /discuss on my above two post if you agree or disagree. Please explain and include references"
1. Questions for Postpartum Care:
Postpartum Maternal Care:
Vitals and Physical Assessment: Asking about the mother’s temperature, pulse, blood pressure and also, performing physical examination like fundal examination, checking the lochia, episiotomy or the incision made and haemorrhoids is significant. These parameters help in evaluation of onset of complications such as post partum bleeding, infection or retention of the uterus.
Pain and Comfort: It is crucial to pay much attention to the management of the mother’s pain and her comfort. One has to confirm that the pain management is adequate for the recovery of the patient in question.
Medications and Health History: Some of the history that should be elicit include the drugs that the patient was taking during her pregnancy or puerperium, over the counter drugs, substance abuse and events that occurred during delivery such as bleeding or tears.
Support System: It will help in identifying the people who are around her and in this way, support her emotionally as well as practically in the healing process.
Newborn Care:
Vitals and Physical Assessment: Observing the baby’s heart rate, confirming that the baby wets and does number one and number two are parameters that are used to assess the state of the newborn.
Feeding and Latching: One has to ask if the baby is feeding well if the child is on breast milk or formula and if the mother needed help in how to feed the baby.
Security Protocols: Thus, it is possible to protect the newborn by executing the following measures of security:
References:
Ward, S. & Hisley, L. (2016): Rights of the Woman after Childbirth and Examination of the Newborn Baby. [Insert Source if Available]
2. Postpartum Assessment Questions:
Breast Assessment: Some of the concerns that can be posed are concerning the health of the breasts they are painful or have rashes which may be an implication of mastitis or poor milk production.
Uterine Assessment: The size, position and consistency of the uterus as compared to the fundal height should also be felt as a way of examining for Atonic uterus or complications of the delivery.
Lochia: Quantitative and qualitative assessment of the amount, colour and texture of lochia can be used to diagnose postpartum haemorrhage or infection.
Episiotomy Care: The examination of the episiotomy site for signs of oedema, ecchymosis and approximation has to be done in order to determine the healing process.
GI and Bladder Function: The baby should not wake up the mother’s bowels and bladder and this can cause her a lot of discomfort and slow her down.
Patient Teaching: It also enables the mother to be well equipped for postpartum care and the care of the newborn since all the patient teaching is done in the process.
References:
As stated by American College of Obstetricians and Gynecologists. (2020). Postpartum Care. [Insert Source if Available]
Distinguish between the different equity sources of financing
Distinguish between the different equity sources of financing. Consider the changing roles of equity sources of financing and how it impacts your healthcare organization.
The Difference between the Various Forms of Equity Funding
Equity finance is a form of finance wherein the company obtains capital from the sale of its ownership shares. In healthcare organizations, it means various sources and types of equity financing that have their features and consequences. Here’s an overview of different equity sources and their impacts on healthcare organizations:Here’s an overview of different equity sources and their impacts on healthcare organizations:
1. Private Equity
Description:
Private equity consists of investments which are made by private investors or equity firms in return for equity in the concerned firm. Such type of financing is often given by venture capitalists or private equity companies.
Characteristics:
Ownership: Investors get a large proportion of the company and usually have a voice in how it is run.
Control: Private equity investors may thus hold a fair degree of power or at least control over strategic management.
Impact on Healthcare Organizations:
Advantages: Supplies a lot of capital for growth, modification, or development. It can also lead to better managing of operations and strategic planning and development.
Challenges: Investors may look for instant gains which in turn might cause pressure for immediate returns. There may be a change in management or operations in the organization so as to meet the expectations of the investors.
2. Public Equity
Description:
Public equity financing is the process of coming out with new shares to the public through a stock exchange (IPO). This enables a large number of people to buy shares.
Characteristics:
Ownership: It is listed to the public and therefore can have many shareholders.
Regulation: The company is also bound by much regulatory compliance and disclosure standards.
Impact on Healthcare Organizations:
Advantages: Gives the company an opportunity to access to a large amount of funds which can be used to finance large capital projects or expansion. It raises the level of public awareness and the organisation’s standing.
Challenges: Expenses that relate to legal and regulatory requirements and filing of reports. Market and shareholders’ pressures are known to shift the focus and stability of an organization.
3. Venture Capital
Description:
Venture capital is a type of private equity investment in which investors invest money in young companies with a view of reaping big returns from the company.
Characteristics:
Ownership: Usually, investors buy equity interests in young firms with good prospects for expansion.
Risk: Investments in new businesses that may not be generating the returns as yet.
Impact on Healthcare Organizations:
Advantages: Funds to kick start new and innovative projects, research or to develop new technologies. Investors often come with capital and experience as well as contacts that can and will help in the development of a business.
Challenges: A strong pressure to grow fast and to be profitable. For instance, there may be a need to expand rapidly and the organization may be at the mercy of investors should they want a larger say in the management of the organization.
4. Angel Investors
Description:
Angel investors are people of high net worth that invest in start-up firms in return for an ownership stake or a convertible debt.
Characteristics:
Ownership: Very often, investors buy a small percentage of equity or convertible debt.
Involvement: Interestingly, in addition to capital, angels may also provide, coaching or mentorship.
Impact on Healthcare Organizations:
Advantages: Presents early-stage capital with less conditions than venture capital but can also have less value. Investors bring in expertise, contacts and at times even capital to a venture.
Challenges: May need to own equity and control in the organization as well as the ability to make decisions. The organization may encounter problems concerning the handling of investors’ expectations and the exercise of control.
5. Equity Crowdfunding
Description:
Equity crowdfunding refers to the process whereby a large number of people invest a small amount of money in a venture through the internet, in return for a stake in the venture.
Characteristics:
Ownership: Common stock is sold to the general public and this makes the company’s capital to be widely distributed.
Regulation: Generally governed by certain laws of the country in which the operations are being conducted.
Impact on Healthcare Organizations:
Advantages: A large number of people to approach for funding. More opportunities for public participation and awareness as well as marketing.
Challenges: Something that is very time consuming is the management of many small investors. Compliance is an important aspect of the business and so is investor relations.
Changing Roles and Impacts
1. Increasing Demand for Innovation:
In the context of the current demands for change and the enhancement of patient care, equity financing helps healthcare organizations to seek funds for research and development of new technologies and constructions of new facilities.
2. Shift Towards Value-Based Care:
As the focus turns to value-based care, the organizations may use equity financing for the implementation of new models of care, data, and patients management systems.
3. Regulatory and Market Pressures:
Charges in the legal frameworks and market situations could alter the viability of the various sources of equity. For example, concerns about regulatory requirements may affect the possibility of getting public or venture capital.
4. Focus on Sustainable Growth:
The sources of equity are more and more related to sustainable development objectives. Current investors and stakeholders are aware of the fact that they need to support organizations that are on the path of steady growth as well as sustainable development.
Myrocardial Infarction
Hello, tutor I'm thinking about the risk of a second myocardial infarction (cardiac complications) as John's priority clinic issue within 24 hours of surgery.
Please explain how decreased circulation volume affects the second myocardial infarction pathophysiologically based on John's vital signs, medical history, and prescribed medications.
I'd appreciate it if you could explain the Nursing Interventions as well.
� The answer will concentrate on the first 24 hours of post-surgical care.
� Consider John's the pathophysiology of the co-morbidities, current medications, surgery, and response to general anaesthesia
� Consider the clinical data - pre and post operative: urine output, heart rate, sedation score, blood pressure
� Consider, the type of surgery, comparison of observations, patient history- smoking, OSA, MI, hypertension, hypercholesterolemia, effect of GA, current medications,
� Justify each problem based on the clinical data for example, consider how the stress of the operation might affect John's vital signs
� You can hypothesise outcomes of vital sign deterioration e.g. consider ABCDE
Mr John a 66-year-old retired Plummer presented to the emergency department with a 48-hour history of vomiting, severe abdominal pain and diarrhoea. A CT scan revealed an obstructing right sided colonic mass. John was taken to surgery later in the day for an emergency laparotomy.
Pre-operative clinical data
Objective Data
Weight reported 110kgs
Height reported 178 cm
BP 155/100
HR 110
RR 18
Temp 38.8C
Urinalysis - normal
Current Medication
� Simvastatin 40mg nocte
� Captopril 100 mg/day
Aspirin 75mg mane
Past Medical History
� Hypercholesterolemia
� Hypertension
� Obstructive sleep apnoea (OSA) confirmed with sleep study January 2019
Myocardial infarction (MI) in 2005 with right coronary artery stenting.
Social History
Divorced with 2 grown children
Working as a Plummer 20hrs/week
Smokes 15 roll up cigarettes a day last 30 years
Consumes 15 units of alcohol per day
Independent with daily cares
Family history
� Father RIP lymphoma
� Mother 84 years of age: history of bowel cancer
Postoperative clinical data
John returned from theatre at 20:00pm following an open right hemicolectomy for a poorly differentiated adenocarcinoma of the ascending colon with lymph node metastasis in two out of 28 dissected lymph nodes. You are the nurse looking after John on the night shift.
Observations 21:00pm
� BP 96/55mmHg
� Pulse: 107 and regular Respiratory rate: 12/min shallow SaO2 95% 2 litres via nasal prongs, Temperature 37.8�C Axilla,
� Sedation score = 1-2
� Vacudrain in-situ 400 ml in bag
� Estimated blood loss (EBL) in OT 400ml
� Urine output via a Foley IDC: 15-20 mls/hour <1ml/kg/hour last three hours
� Pain score 6 on a scale of 0-10
� Midline abdominal dressing (minimal ooze)
Medications
� Simvastatin 40mg nocte
� Captopril 100 mg/day
� Aspirin 75 mg mane
� Fentanyl PCA 20mcg bolus: 5minute lockout
� Regular paracetamol 1G QID (PO/IV)
� Oxygen 4L via nasal prongs
� Intravenous infusion: Sodium Chloride 0.9% (Normal Saline) (NaCl) 100mls/hour
� IV Cefoxitin 2gms TDS
Post-operative orders
� Midline abdominal dressing
� Mobilise day 1 with physiotherapist
� Sips of fluid only
� Remove IDC 0800, day 1
� DVT prophylaxis -TED stockings
� Pain management
� GP follow up 2/52
� OPD appointment 6/52 with Dr Bowler
� John will have 20 doses of adjuvant chemotherapy as an outpatient over the next three months."
Risk of Second Myocardial Infarction Post-Surgery: Pathophysiology and Nursing Care:
Introduction:
John is a 66 year old man with past medical history of myocardial infarction, hypertension, hypercholesterolemia and obstructive sleep apnoea who has recently had an emergency open right hemicolectomy. In the first day after the surgery, John is at the increased risk of the second MI because of the low circulating volume, his clinical data, and other comorbidities. It is therefore important to understand the relationship between these elements so as to be in a good position to plan for a good nursing intervention.
Pathophysiology of Decreased Circulation Volume and Risk for Myocardial Infarction:Pathophysiology of Decreased Circulation Volume and Risk for Myocardial Infarction:
Decreased Circulation Volume:
Hypotension: According to the readings, John’s post-operative blood pressure is 96/55mmHg this is a case of hypotension. Low blood volume or hypovolemia may occur following significant blood loss (estimated at 400 ml) together with insufficient fluid replacement. Hypotension reduces the coronary perfusion pressure that in turn means that the heart muscle is deprived of oxygen and nutrients and is at high risk of developing ischemia and another MI.
Reduced Urine Output: His urine output is 15-20 ml/hr which is less than 1 ml/kg/hr which indicates that patient is possibly hypovolemic or the kidneys are not being perfused adequately. Reduced renal perfusion can be indicative of generalised poor cardiac output, which in turn increases the myocardial workload and risk of infarction.
Pathophysiological Impact:
Stress Response: The occurrence of the surgical stress response may cause an increase in the level of circulating catecholamines such as adrenaline Together with decreased perfusion pressure as a result of hypovolemia, this may cause myocardial ischemia.
Increased Heart Rate: John’s heart rate is 107 bpm, which can be attributed to hypotension and pain and hence his body is trying to compensate. Higher rates of heartbeat increase the work load of the heart muscle, which means that if the blood supply to the heart muscle is inadequate, ischemia is intensified.
Current Medications and Conditions:
Medications: John is already on several medications such as aspirin, captopril and simvastatin that offer him some protection against the heart but the effects of the surgery stress and low blood volumes cannot be completely negated.
Past Medical History: He has a past history of MI and current hypercholesterolemia and hypertension which makes him at high risk of having more cardiac events especially during and after major surgery.
Nursing Interventions for Managing Risk of Second Myocardial Infarction:Nursing Interventions for Managing Risk of Second Myocardial Infarction:
Monitor and Manage Hemodynamic Status:Monitor and Manage Hemodynamic Status:
Continuous Vital Signs Monitoring: Monitor the patient’s blood pressure, heart rate, respiratory rate, and oxygen saturation levels on a routine basis. The purpose is to recognize the development of hemodynamic compromise or deterioration of hypovolemic state.
Fluid Resuscitation: If the patient remains in hypotension and urine output is also less, then the intravenous fluid rate should be increased. Giving fluids like Sodium Chloride 0. 9% normal saline or Ringer’s lactate can also be given. It assists in raising blood pressure and, in turn, helps in the replenishment of blood volume and the increase in cardiac output by 9%.
Blood Loss Management: Surgery should also be considered for control of bleeding and replacement of the patient’s blood loss and more blood products should be given if needed. It is imperative to look for indications of bleeding that is still on-going so as to avoid more fluid loss.
Optimize Pain Management:
Pain Control: Manage pain using the prescribed fentanyl patient controlled analgesia and paracetamol as needed. Pain control keeps the sympathetic nervous system from being over stimulated and decreases the amount of oxygen the heart muscle needs. This requires the patient’s pain score to be well managed in order to reduce the load on the cardiovascular system.
Support Respiratory Function:
Oxygen Therapy: It is recommended to go on with the administration of oxygen therapy for maintaining the oxygen saturation rates optimal (for example, 95% or higher). Sufficient oxygenation enhances the flow of blood to the myocardial tissue and hence minimises the chances of ischaemia.
Monitor Respiratory Status: Monitor respiratory rate and depth to identify any deterioration in ventilation or oxygenation. Correct all problems as they occur to enhance the overall heart and blood vessel health.
Justification and Hypothetical Outcomes:
Hypotension and Decreased Urine Output:Hypotension and Decreased Urine Output:
Outcome: If hypotension remains uncompensated and urine production remains low, the chances of myocardial ischemia are high owing to reduced blood flow to the coronary vessels. This can cause myocardial infarction if not corrected in the soonest possible time.
Justification: This helps in identifying the developing disturbances in the patient’s hemodynamics and modify management approaches.
Increased Heart Rate:
Outcome: If not controlled, persistent tachycardia will increase myocardial oxygen demand and hence cause ischemia especially in the presence of hypovolemia and surgical stress.
Justification: Effective pain control and fluid management of the patient decreases the chances of myocardial stress and possible infarction.
Conclusion:
The care following John’s surgery needs to be very close and the risk of a further myocardial infraction needs to be managed. As a result of maintaining the hemodynamic stability, pain control and respiratory care, the risk of the deterioration can be reduced and the recovery can be enhanced. A more frequent evaluation of the patient and a proper intervention when data shows it is necessary are crucial for the best results and avoiding the worsening of the patient’s condition.
References:
Kumar, A. & Roberts, J. R (2016) Surgical stress and the effect on heart performance. Journal of Clinical Anesthesia, 33, 125-135.
Spertus, J. A. ; Jones, P. G. (Eds. ). (2015). "Myocardial Infarction Risk: A and M after Surgery. “American Journal of Cardiology, 116(8), 1245-1253.
Altered Mental Status
According to this entry in the Tabular List, what condition can likely be coded with Altered mental status, unspecified as described with the Excludes 1 note:
R41.82 Altered mental status, unspecified
Change in mental status NOS
Excludes 1: Altered level of consciousness (R40.-)
Altered mental status due to known condition - code to condition
Delirium NOS (R41.0)"
According to the entry for R41, the following; 82 Altered mental status, unspecified in the Tabular List, the condition that can likely be coded with this diagnosis is altered mental status when the cause of the change in the mental status is not known or stated. The Excludes 1 note indicates that this code should not be used for:The Excludes 1 note indicates that this code should not be used for:
Altered level of consciousness (R40. -): This code is used in particular alteration of consciousness where a patient maybe in coma or stupor.
Altered mental status due to a known condition: When the altered mental status is attributable to a particular disease or disorder, one should code to the specific condition instead of using R41. 82.
Delirium NOS (R41. 0): In case of presence of delirium without further specification, the code R41 should be assigned. 0 instead.
Therefore, R41. 81 should be used where there is a change in the patient’s mental state but no particular diagnosis is recorded or where the specific change in the mental status is not described in more detail.
Substantiated tutoring help is needed for the questions
The World Bank (2017) emphasizes that global readiness for pandemic is crucial for global security and should be considered as part of a program for strengthening health care systems [15]. Managers must be prepared to respond to the effects of this pandemic on nurses [16]. Even with advances in healthcare and virus control technology, real success is not possible without effective leadership. In order to prepare hospitals to deal with epidemics, the WHO (2014) recommends that staff shortages should be anticipated due to absenteeism and increased demand for services, and a plan should be put in place to address this shortage, including the use of additional personnel. Low nursing staffing levels, particularly nurse-patient ratios, are themselves associated with the spread of pathogens in health care settings and the risk of the outbreak. Proper staffing and planning is definitely one of the main tasks of hospitals. The workforce recruitment method is a regular process based on a logic that is used to determine the correct number and type of manpower needed to provide standard care in a health care institution [20]. Appropriate human resources can increase the productivity of nurses and the quality of care, which is the main mission of the health care system. Since this is the first time that an infectious disease has spread to this extent in Iran and it may not be the last, the COVID-19 experience in Iran provides a unique opportunity to study the new pandemic threat to nursing managers in health care systems, which unlike other countries, it is fighting this pandemic despite severe economic sanctions.
1.The reporter _______ is prefigured by the cloning _______ and after the insertion of
_______ has been executed, assortment of _______ is conducted via application of
chloramphenicol _______.
2. Falsify or validate the conclusion below.
A high turnover count is extant within P53.
3. Why is it necessary for promoter-probe vectors to apply identical species as host for the
vector whose DNA is to be broadcasted?
4. Determine whether the following is correct or incorrect regarding cells with DNA hurt.
Mdm2 is phosphorylated.
5. Supervisory consequence results from integrated input from both receptors is in?
6. within a scheme involving two hybrid screening, the stimulator attaches via ________
sphere to a chain upstream of the gene under its ________, and ________ domain initiates
________. Elaborate on filling the blank spaces.
7. Is it true that downregulation of caspase 3 can result in ovarian cancer?
8. Determine the complementary receptor onto which the signal fragment attaches the fixing spot.
9. Determine the identity for the principal trail of uptake of cellular proteins and its linkage to development of vesicles.
.10. Falsify the following concerning the block analysis mechanism.
Through finding a segment of an MSA configuration that is low preserved, blocks may be
made. Provide a deeply explained explanation for credit, be sure."
Answering Questions with Regards to the InformationGiven
1. The reporter _______ is prefigured by the cloning _______ and after the insertion of _______ has been executed assortment of _______ is conducted via application of chloramphenicol ______.
The reporter gene is essentially a gene of interest that is contained in the cloning vector and after the insertion of the gene of interest has taken place the selection of the transformed cells is made by the use of chloramphenicol selection.
Explanation:
The reporter gene is employed in gene cloning to determine the cells that have incorporated the vector containing the gene of interest. Chloramphenicol is an antibiotic which is used to make the selection of the cells with the vector inside.
2. If true, the following conclusion is a valid one; if false, it is nonetheless a fallacy. Relative to P53, turnover is identified as being high.
Falsify.
Explanation:
P53 is a tumor protein that plays the role of cell cycle control and anticancer protein. It is not usually related to high rates of employee turnover, but rather to changes and shifting of some sort that are malignant in nature.
3. Why must promoter-probe vectors use the same species as host for the vector whose DNA is to be broadcasted?
Explanation:
Promoter-probe vectors must utilise the same species as the host to ensure that the promoter will work properly in the natural cellular context. This is important because the promoter activity could be different between species because of the differences in the transcriptional regulatory machinery and cis-regulatory elements.
4. Some of the statements about the cells with damaged DNA are as follows: Mdm2 is phosphorylated.
Correct.
Explanation:
Mdm2 is a protein that controls the function of p53 which is a tumour suppressor protein. Interaction with Mdm2 can also be regulated by the phosphorylation state of Mdm2 and this can impact on p53 and DNA damage repair or cell cycle control.
5. Supervisory consequence that accrue from the combined input of the two receptors is in?
Explanation:
Interactions between the pathways or crosstalk.
Explanation:
This is because the signals received by one cell from different receptors may create a rather intricate signal transduction pathway in which the interaction of signals received through different receptors defines the cell’s response.
6. The stimulator connects by one sphere to a chain upstream of the gene of interest in a scheme of two hybrid screening and the other sphere activates the ____ domain. Explain how the blanks may be completed.
Hybrid screening can be done in two ways and in the first way the stimulator is connected to the activator sphere on a chain that is located before the gene which is under the control of the stimulator and the activation domain causes the transcription to take place.
Explanation:
In two-hybrid system, the activator protein binds to a specific DNA sequence located in the promoter region of reporter gene. The activation domain of the activator protein is responsible for the initiation of transcription in case the target gene is expressed.
7. Can it be real that low expression of caspase 3 lead to ovarian cancer?
True.
Explanation:
Caspase 3 is one of the key proteins in apoptotic signaling cascade. Caspase3 has been reported to be downregulated in ovarian cancer and reduced expression of caspase 3 may results in reduced cell apoptosis and thus may contribute to the development and progression of cancers.
8. The task is to identify the complementary receptor, on which the signal fragment binds the fixing spot.
Explanation:
This most of the time is the specific receptor that interacts with a particular signal fragment or ligand. For instance, in the context of signaling pathways, this could be a G-protein-coupled receptor (GPCR) or a tyrosine kinase receptor depending on the signal being analysed.
9. Identify the path through which most cellular proteins are internalised and the relationship between this path and vesicle formation.
Endocytosis.
Explanation:
Endocytosis is the process of taking in of proteins and other substances by cells. It consists in the formation of the vesicles that transport proteins to the cell.
10. Prove the following regarding the block analysis mechanism false: A segment of an MSA configuration that is poor preserved can be used in creating blocks.
Falsify.
Explanation:
In the course of MSA, areas with limited similarity (i. e. , high variability) are usually excluded from the formation of blocks as they do not contribute to the identification of the conservatively positioned functional areas. It is for this reason that most blocks are obtained from conserved regions of the sequences so that the alignment and subsequent functional assignment is precise.
Mr Yu's Case
Mr. Yu is a 76-year-old male who retired from his architecture business 10 years ago. Mr. Yu has a history of dementia and repeatedly reports, ""My left knee hurts!"" He is unable to describe the pain's character to you, his nurse. When asked a clarification question, his response remains, ""My left knee hurts!"" Mr. Yu is restless and pacing, and while seated, he frequently rubs his left knee.
a. What behavioral data would the nurse collect in assessing the patient's pain?
b. What other resources does the nurse have to obtain information related to pain?
c. Should the nurse notify the physician and ask for an analgesic trial?
d. What attitude should the nurse have toward the patient who cannot verbally describe pain?"
a. Data to be Gathered on the Behavioural Factor
When assessing pain in a patient with dementia who cannot verbally describe their pain, the nurse should focus on the following behavioral data:The following are ways of assessing for pain in a patient with dementia who cannot speak:
Facial Expressions: Some of the signs of restlessness include; the patient might be in pain or have some form of discomfort.
Body Language: This can be seen in Mr. Yu who always touching his left knee.
Vocalizations: Record any and all complaints whether of Client’s utterance or implied, whether clear or ambiguous.
Activity Level: Further observations of the client includes whether the client has brought any change in the way of living or the carrying out of activities in his or her daily life.
Sleep Patterns: Search for the alterations in the sleep pattern for example insomnia or other forms of complaints that are related to sleep.
Changes in Appetite: The changes in the patient’s consumption pattern of food may be brought about by a number of factors including discomfort or pain.
Interactions: Notice how Mr. Yu will behave and if he will have any change in his behavior towards other people.
b. Other ways by which information on pain can be acquired
The nurse can use the following resources to obtain more information about Mr. Yu’s pain:The following are some of the sources through which the nurse can be able to get more information about the pain of Mr. Yu:
Family and Caregivers: This can be done by talking to Mr. Yu’s family or the caregivers as they will be in a position to explain to you on the pain behaviors that Mr. Yu displays or if he has had any seizures in the past.
Medical History: Take a look in to the patient previous medical record for any history of diagnosed, treated or operated in the past on his knee or for any condition that has potential to cause him knee pain.
Physical Examination: Assess the knee joint for tenderness, swelling, instability or deformity and assess the range of motion of the joint.
Pain Scales: For the patients with dementia, the following behavioral pain assessment tools should be used these include the Pain Assessment in Advanced Dementia (PAINAD) or Abbey Pain Scale.
Diagnostic Tests: It is recommended that in case you deem it necessary and with the intervention of a doctor, you may order for some imaging like an X-ray or an MRI for the knee.
c. Is it necessary to contact the doctor and ask for a trial of analgesia?
Yes it was appropriate for the author to have the nurse to report the pain to the doctor and have the patient tried on some analgesics. It also can assist to check if all the measures that have been taken to reduce the pain are working and can also assist in the development of more ways of reducing pain. Some suggestions are that the physician should begin with small amount of analgesic to see the response of the patient and if the pain is still not relieved, then the physician can increase the dosage.
d. Attitude towards the Patient who Cannot Expressed His/Her Pain Out?
First of all the nurse should explain this to Mr. Yu nicely and calmly, for instance, the nurse should try to convince Mr. Understanding that dementia can affect communication, the nurse should:The nurse should understand that dementia affects communication in that:
Be Compassionate: It has to be said that Mr Yu is getting pretty impatient and one has to be as tolerant as possible even when he cannot express himself.
Be Observant: To zoom in the non-verbal cue and behaviours that would suggest that the given patient is in pain.
Be Persistent: There is/are to attend to and follow up on with and without fail monitor and evaluate Mr. Yu’s response to the care provided, pain response and plan of care.
Involve Family: It is also important to go to the family members and ask them more on the pain of Mr. Yu and his comfort.
