What-is-the-trend-of-globalization-What-are-different-modes-of-economy/,What is the trend of globalization?
What are different modes of economic interrelationships used today in health care? ( Use Resources)
Globalization is thus the process by which the world becomes one large village with economic, culture, and social integration. In the health sector, globalization has brought about the export and transfer of health information, ideas, technology, and services creating a globalised health supply. This trend is characterized by several key aspects:This trend is characterized by several key aspects:
Medical Tourism: Cross-border migration for medical reasons has been realised whereby a patient will travel to another area in search of cheaper costs or better treatment plans or shorter waiting time.
Cross-Border Collaboration: There is health care interprofessional cooperation on global level, providers seek to join, exchange knowledge, research, new findings in the field of medicine to enhance the quality of health care services.
Telemedicine and Digital Health: Telemedicine is one area where technology has allowed healthcare providers to reach out and consult, diagnose and even treat patients from the comfort of their homes in the various parts of the world.
Pharmaceutical and Medical Device Trade: Although the globalization of pharmaceuticals and medical devices helps get inventions to a wider publicly, it brings issues of quality and equity of access into perspective.
Types of economic relations in health care
Trade Agreements:
Example: Trade in pharmaceuticals, medical devices, and health service involves some international agreements like WTO agreements. This encourages the availability of health-care products cross the globe hence supporting tariffs and barriers (CDC).
Foreign Direct Investment (FDI):
Example: Health care FDI is defined as the direct investment by international companies in health facilities such as hospitals, clinics and others in other foreign countries. to better facilities and availability of mechanism in medical science or superior health technologies (CDC).
Health Insurance Models:
Example: Some insurance models and frameworks existing in the some country are imported such as the managed care models in the U. S. These are then modified to suit the existing working conditions and hence affecting financing and delivery of healthcare across the world (Drugs. com).
Global Health Initiatives:
Example: Such entities may include the Global Fund, a partnership fund or other cooperative global funding initiatives such as Gavi, the vaccine alliance. Such actions help to fight such diseases as HIV/AIDS, malaria, or vaccine preventable diseases in the world over (Drugs. com).
Outsourcing and Offshoring:
Example: Certain services can be outsourced, for instance radiologic services, transcription services or even such surgical services can be sourced from nations that offer such services at lower costs. This makes a broad health care personnel to address various areas of the world (CDC).
References:
CDC and World Health Organization offer comprehensive guide as to global healthcare and economic connections.
International trade in healthcare services and Foreign Direct Investments being published by the World Bank and the International Monetary Fund (IMF).
What are the characteristics these in the U.S. health care system and the role of each ( Use resources)
No central agency
Multiple payers
Third party payers
Litigation risks
Quality measurement"
No Central Agency:
Characteristic: The United States of America does not have a single authority for the administration of the healthcare systems and policies like United Kingdom (NHs) or Canada.
Role: This leads to system of autonomy where federal and state governments, private insurance companies and different health care service providers all act as different units on their own. This decentralization is helpful in that it encourages uniqueness and variability in the provision of healthcare services, but at the same time it poses a fragmented approach to healthcare delivery and unevenness in services and costs as well as increased costs of administration (CDC).
Multiple Payers:
Characteristic: The U. S has a multi-payer mode of health care systems where insurance companies play a big role, the government through Medicare, Medicaid, and other insurance programs while patients also contribute through ‘out of pocket’ payments.
Role: Note that inasmuch as multiple payers bring flexibility and choice to the consumers, they contribute to unnerving billing anomalies, disparate standards of reimbursement rates and essentially, cumbersome stream of paperwork. This system can bring about inequalities with regard to access to care base on the source of payment (Drugs. com).
Third-Party Payers:
Characteristic: Third party payers are the insurance companies or government programs that pays for the medical expenses on the behalf of patient.
Role: Insurance companies introduce an intermediary between the patient and the healthcare provider and as such, will determine the kind and amount of health care given. Some of the problems are moral hazard which may occur because patients are not charge full price therefore they may misuse the facilities and the measures taken by insurance companies to cut cost and in the process they may reduce access to some services (CDC).
Litigation Risks:
Characteristic: The U. S. health care system is exposed to high risks of litigation hence leading to the practice of defensive medicine in which the service providers order on extra tests or procedures to lessen the danger of being sued.
Role: It leads to increased general health expenditure and could cause people to receive treatments they actually do not need. Litigation may also limit the practice of certain specialties or areas by health care providers thus having an impact on the health care service delivery (CDC).
Quality Measurement:
Characteristic: This concept in the U. S involves a complete suite of measurements: patient outcomes, hospital readmission measures, and patient satisfaction measures linked to reimbursement models such as value based care.
Role: The science of Quality Measurement seeks to enhance the quality of health care and also finds ways to assure the public the quality of services delivered. Nevertheless, it can also result in issues, for example, in the ability to said that it opens the door to ‘‘gaming’ the system or issues arising from reporting of which can shift attention away from the patient.
Which antibiotics treat gram negative bacteria? With references please
Antibiotics that are effective against Gram-negative bacteria include several key classes and specific drugs:
Beta-lactams: Included in this class are carbapenems such as the imipenem and meropenem as well as extended spectrum cephalosporins such as ceftriaxone and ceftazidime. These antibiotics are widely prescribed for severe GN infections often in the hospital environment.
Aminoglycosides: Some of them include gentamicin and amikacin which are normally used jointly with other antibiotics for severe infection.
Fluoroquinolones: Some of the antibiotics used in the treatment of the Gram-negative bacteria are the ciprofloxacin and levofloxacin which are used in the treatment of urinary tract and respiratory tract infections.
Polymyxins: Polymyxin E also known as colistin and polymyxin B are only employed for the treatment of MDR Gram-negative organisms especially P. aeruginosa and A. baumannii.
Monobactams: It is a monobactam antibiotic that is active against Gram-negative organisms and it can be used in patient who have penicillin allergy.
Tetracyclines: Here, doxycycline is occasionally prescribed for specific Gram-negative bacteria; however, it is also possible to experience resistance.
Of all the bacterial types, gram-negative bacteria are difficult to manage with anti-biotics because they can easily develop a resistance. This features E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter species (World Health Organization (WHO)) (CDC) (Drugs. com).
In community health nursing discuss how the community mobilization influence on the health outcomes
Discuss on the following communicable diseases,include the definition, the pathohysiology, the causes, mode of transmission, nursing management, nursing considerations, signs and symptoms
hepatitis b
Hantavirus
Hepatitis a
Ebola
Covid 19
Enterovirus
Measles
What is the difference between public health nursing and community health nursing
What are the roles of each of the above
What are the main concepts involved in engament of a community to adopting health practices
Discuss the main challenges that maybe faced in community health mobilization
What are the four principles of community awareness and universal health education routine"
Community Mobilization and Health Outcomes
Community mobilization is the process whereby the people in a community, their leaders and other stakeholders are organised and encouraged to work with one another in order to manage health problems. It can significantly influence health outcomes through:It can significantly influence health outcomes through:
1. Increased Awareness: Mobilization assist in increase the general knowledge on health, preventive measures and ways to be taken to improve on the state of health.
2. Enhanced Access to Services: Community health promotion empowers the community to mobilise resources and demand for health services that will enhance access to medical facilities and health related products.
3. Behavioral Change: Community health interventions promote positive behaviors that decrease instances of illness in the community and enhances oner’s health.
4. Strengthened Support Networks: Mobilization fosters the development of support structures which can be useful to the mobilized people especially in their times of illness.
5. Policy Influence: Communities that have been mobilized can equally participate in calling for policies that enhance better health on large scale.
Communicable Diseases Overview
1. Hepatitis B
- Definition: Hepatitis B is an inflammatory disease of the liver had has its root with the hepatitis B virus (HBV).
- Pathophysiology: It directly affects liver cells, to capitulate, viral hepatitis can result in chronic liver disease, cirrhosis, or liver cancer.
- Causes: Hepatitis B is therefore an illness brought about by the HBV which is a blood borne virus.
- Mode of Transmission: It is transmitted through the exchange of body fluids including; blood, semen, vagina fluids, and, breast milk. It is spread through contact with bodily fluids through unprotected sexual contact, sharing needles and syringe and from an infected mother, during childbirth.
- Nursing Management: Some of the management strategies that are practice are vaccination in form of hepatitis B, prescription of antiviral in chronic disease management and follow up of liver function.
- Nursing Considerations: Disjunction matrix: Use the safety precautions during sexual relations, including using barriers and correct sterilization of the tools.
- Signs and Symptoms: Hematemesis, icterus, pale or dark colored urine, anorexia and asthenia. The following can also present themselves as asymptotic:
2. Hantavirus
- Definition: Hantavirus is a virus that affect human from rodents, these diseases include hantavirus pulmonary syndrome (HPS) or hemorrhagic fever with renal syndrome (HFRS).
- Pathophysiology: The virus harms capillaries and leads to either lethal pulmonary manifestations or renal dysfunctions.
- Causes: Characterized by hantavirus, spread through direct contact with rodent urine, fresh droppings or saliva.
- Mode of Transmission: Contact with aerosolized rodent excretions, close contact with contaminated surfaces or ingestion of food which had been contaminated by the rodent’s urine or droppings.
- Nursing Management: A nonpharmacological management approach comprises care that is supportive, observation for the development of adult respiratory distress syndrome or renal failure, administration of fluids and oxygen therapy.
- Nursing Considerations: Avoiding contact with rodents and their droppings and wearing PPE in case one is dealing with items likely to have the virus.
- Signs and Symptoms: Tachypnea, fever, myalgia, malaise, headache and in severe cases, hypoxia, dyspnea, and pulmonary congestion.
3. Hepatitis A
- Definition: Hepatitis A is an inflammatory contuably disease of the liver which is due to hepatitis A virus.
- Pathophysiology: For this virus most suffer liver inflammation yet it is not a causative agent of chronic liver diseases. Hepatic cells are affected, but their renewal is normally possible.
- Causes: Hepatitis A is caused by the HAV and food or Water-borne transmission is the most common mode of transmission.
- Mode of Transmission: Through ingestion of food or water contaminated with the feces of an infected person or through contact with an infected individual.
- Nursing Management: Vaccination, supportive care and for signs of Jaundice and liver function is also advised during the post weaning period.
- Nursing Considerations: Promote the use of appropriate label and regular washing hand with soap and water, safe food and water handling.
- Signs and Symptoms: Some are jaundice, abdominal pain, fatigue, nausea and vomiting, loss of appetite.
4. Ebola
- Definition: Ebola as a serious and frequently lethal viral disease of hemorrhagic nature, caused by Ebola virus.
- Pathophysiology: It is known to produce profuse bleeding, acute renal failure, and high case fatality rate. It hinders the immune system and also harms the blood vessels.
- Causes: Brought about the Ebola virus, it is spread through direct contact with the blood and or other body fluids of affected people or animals.
- Mode of Transmission: Through having physical contact with infected human or animals such as through consumption of their meat or body organs particularly bats or non-human primates.
- Nursing Management: These are among the measures such as rigorous infection control measure, supportive care and managing of symptoms. This is where wearing of PPE is deemed compulsory.
- Nursing Considerations: To reduce the risk of transmission, isolate the patient, educate him on the measures to take to avoid further spread of the infection, and take close watch on the patient for more severe manifestations of the disease.
- Signs and Symptoms: Fever, severe headache, muscle and joint pain, weakness, diarrhea, vomiting, had stomache pain, and any unusual bleed.
5. COVID-19
- Definition: COVID-19 is the disease that is produced due to the virus referred to as coronavirus SARS-CoV-2. The COVID-19 virus is in the family of pathogens called coronaviruses that are responsible for causing sickness in human beings.
- Pathophysiology: It affects the respiratory tract and can cause inflammation of the lungs, develop pneumonia and other systemic disorders.
- Causes: A disease caused by SARS-CoV-2 a virus of coronavirus family.
- Mode of Transmission: Airs through droplets and contact, and can be through contact with inanimate objects.
- Nursing Management: These are isolation supportive care, oxygen therapy, and resistance with monitoring. It is apparent that testing and vaccination are important.
- Nursing Considerations: Adhere to infection control measures, put on personal protective equipment, enlighten the patients on quarantine as well as isolation measures.
- Signs and Symptoms: Fever, a new cough, difficulty in breathing, weakness and general loss of strength, muscle aches, and even loss of the sense of smell and taste, and death in severe cases.
6. Enterovirus
- Definition: Enterovirus PC is a virus that at its most severe can cause mild respiratory disease, to severe neural diseases such as meningitis.
- Pathophysiology: It targets the gastrointestinal system, but symptoms can occur in other systems like the nervous system.
- Causes: This stems from enteroviruses that are spread by either through direct contact with feces, or through the air by droplets.
- Mode of Transmission: A way of transmission that is through physical contact with contaminated objects or through contact with water contaminated with the virus as well as by respiratory droplets.
- Nursing Management: Supportive care, management of fluids, and electrolyte balance, regular surveillance for the signs of postoperative complications. The block of symptoms and infections is also relevant.
- Nursing Considerations: Teach on rational use of gloves, hand washing and use of other protective gear to avoid the transmission of the germs.
- Signs and Symptoms: Fever, rash, mouth sores, sore throat and in more severe cases there is likelihood of neurological symptoms like meningitis or encephalitis.
7. Measles
- Definition: It is an acute viral illness affecting mostly children and adolescents with symptoms that include a rash and other flu like symptoms.
- Pathophysiology: It triggers disease activity the immune system and expresses the typical rash and can lead to more serious effects such as pneumonia or encephalitis.
- Causes: An acute, highly communicable disease of childhood that is caused by the measles virus which belongs to the paramyxovirus group .
- Mode of Transmission: Responsible for transmission by respiratory circuits by contact means such as by sharing with other people through coughing or sneezing, or by direct touch with the nose or throat secretions.
- Nursing Management: Houses quarantine, supportive care, and contributions toward immunization of contacts. In some circumstances, antiviral drugs may be prescribed.
- Nursing Considerations: Enlighten on the practices that prevent contraction of the epidemic diseases through vaccination.
- Signs and Symptoms: Sore throat, cough, runny nose, high fever, and rash that at first affects the face and then descends the body.
Difference Between Public Health Nursing and Community Health Nursing
Public Health Nursing and Community Health Nursing are often used interchangeably, but they have distinct focuses:Public Health Nursing and Community Health Nursing are often used interchangeably, but they have distinct focuses:
1. Public Health Nursing:
- Focus: Unlike community based nursing, public health nursing is wider in its field of operation and encompasses the welfare of the people as a whole. It embraces the provision of health care services focusing on the disease prevention and health promotion among extended groups of people.
- Roles:
- Primary level interventions: disease prevention and health promotion to the population.
- Establishing of policies/proposal for the enhancement of health system within the society.
- The special topics include, but not limited to the following: emergency preparedness and response.
- Those that deal with the surveillance and control of spread of communicable diseases.
- Consultation with PHAs to eventually coordinate action on SDH.
2. Community Health Nursing:
- Focus: Community health nursing is more defined to certain community or certain segment of the population. It refers to the systematic intervention approach that seek to enhance health and well being of people in given community setting through intervention at personal and family level.
- Roles:
- Promotion of care giver health education to direct care and health education to individuals and families.
- Screening and treatment of identified heath needs of the community.
- Therefore, active cooperation with local non-profit organizations for the provision of health care services.
- Education to modify the behavior and life styles of those in the community.
- Understanding community health status in terms of disparities and emerging with efficient solutions for these disparities.
Main Concepts Involved in Community Engagement for Adopting Health Practices
1. Participation: Promoting involvement of the community members in the health crises and decision making propositions.
2. Empowerment: Empowering communities to be able to manage their health on their own by giving them the tools they need, information, and skills.
3. Collaboration: Collaboration between health workers, political authority, or leaders, and people of health across a shared health agenda.
4. Cultural Sensitivity: The recognition of the cultures, traditions, and spiritual systems in the incumbent population so as to offer the correct health interventions.
5. Communication: Creating well-defined, reliable, and open communication processes for regardful of the community awareness embracing and engagement.
Main Challenges in Community Health Mobilization
1. Cultural Barriers: Social and cultural barriers are the following to prevent or slow down the acceptance of health interventions:
2. Limited Resources: Resource constraints in the form of inadequate funding, staff, and equipment and supplies limits the ability of the provider institution to delivery on its mandated task of providing health services.
3. Resistance to Change: They may resist the new health practices for some reasons such as fear, lack of information, or obliviousness to other people’s ways of doing things.
4. Mistrust: When one does not trust health care providers or health care system, then community mobilization efforts will not be easy.
5. Communication Gaps: Some of the challenges that affect the teaching and passing of health information to the targeted audiences are Limited English proficiency, Literacy level, and Ineffective communication channels.
Four Principles of Community Awareness and Universal Health Education Routine
1. Inclusivity: Reducing the health inequality gaps so that all the people in the community both young, male and females, low income earners, and people from different background interact with health education and participate in health promotion activities.
2. Sustainability: Promoting the continuation of health education to the extent that communities are also empowered to continue the improvement of health, after the program.
3. Evidence-Based Practice: Coordinating with other departments to make health education and promotion activities evidence based so as to have a positive impact.
4. Continuous Evaluation: Constant evaluation of the results from the health education programs, to enable modifications to be made to the programs and make effects of newly surfacing health complications or changes in the health status of the community.
Scenario:
Jim is a 45-year-old construction company owner. He is brought to the ER from work reporting dizziness, nausea, weakness, abdominal cramps, and a headache. During the admission assessment, the following information was obtained:
Onset of symptoms occurred 3 days ago but were initially mild until today when he stated that he ""almost fell of a building at work"".
He was diagnosed with hypertension about 6 weeks ago.
He has been following a low-sodium diet and has been taking hydrochlorothiazide as directed since being diagnosed.
1. What does the initial data provided by Jim suggest?
2. What questions will you ask him prior to doing your physical assessment?
3. What data do you expect to find on your physical assessment?
4. What do you expect his lab work to show?
5. What discharge teaching would be important to perform?"
Scenario Analysis
1. Now, let us think critically about the information that has been given to us by Jim at the initial state.
Based on the interpatient data, some of the first assumptions made are that Jim may have a serious medical condition associated with hypertension or its treatment. Dizziness, nausea, weakness, abdominal cramps, headache: all of this, along with nearly falling at work, signifies a possible crisis. Several possibilities include:
- Hypotensive Episode: Jim who is on hydrochlorothiazide might be experiencing hypotension that is low blood pressure that results in dizziness and weakness.
- Electrolyte Imbalance: His symptoms can be attributed to electrolyte imbalances such as low sodium or potassium levels due to Hydrochlorothiazide which is a diuretic.
- Hypertensive Crisis: If his blood pressure was not well managed the last few days and he might have been taking his medications or his diet erratically then there is likely a hypertensive crisis.
- Side Effects of Medication: The side effects of Hydrochlorothiazide may be similar to the signs of the conditions listed above.
2. Before the physical assessment what questions will you ask him?
To gather more information and guide your physical assessment, ask Jim the following questions:
- Medication Adherence: “Are you having hydrochlorothiazide and if so are you following the correct dosage regime did you skip any doses?”
- Dietary Changes: “In the last weeks have you change your diet or have had increase or decrease in the use of sodium or fluid intake?”
- Symptom Onset and Progression: ‘’What is new with these symptoms, to your knowledge when did such symptoms develop, and how have they been deteriorating in the last few days’’
- Previous Medical History: “Did you have other disorders or get any diseases that can cause the complaints during the last several months?”
- Lifestyle Factors: The following question was also asked to the patients: Have you made any change in your working or other activity, exercise, or stress in the last few weeks?
- Other Symptoms: “Have you noticed any other symptoms for instance chest pain, shortness of breath and changes in vision?”
3. On a physical assessment what data do you expect to encounter?
During your physical assessment, you might find:
- Vital Signs: It may therefore present a potential of having high or low blood pressure, heart rate problems, or even fever.
- Cardiovascular System: Symptoms of water retention such as oedema, or any abnormality detected in heart rate.
- Neurological System: Some of the leads of dizziness disorientation or other changes in mental status may develop.
- Abdominal Exam: Some may be tender or uncomfortable in some way due to electrolyte levels or other matters.
- General Appearance: Tachycardia, hypotension, breathlessness, cold clammy skin, frequency or dysphagia.
4. What do you anticipate his lab work to reveal?
Lab work is likely to reveal:
- Electrolyte Levels: Hydrochlorothiazide cause side effects like low sodium level (Hyponatremia) and low potassium level (Hypokalemia).
- Kidney Function Tests: Increased level of creatinine or BUN that may be attributed to effects of diuretic or lack of fluid intake.
- Blood Glucose Levels: Features that may differ: if Jim has other diseases such as diabetes.
- Complete Blood Count (CBC): To check further for any signs of anemia or an infection that the patient may be having.
5. What teaching should be given with discharge?
Important discharge teaching for Jim would include:Important discharge teaching for Jim would include:
- Medication Adherence: Place significant value on the necessity to adhere to the regimen of hydrochlorothiazide intake and indicate the actions when doses are omitted.
- Diet and Fluid Intake: Offer counselling on a well balance diet with especial reference to food that contain high sodium and potassium. Inform about the possibility of detecting the signs of dehydration or having an electrolyte imbalance.
- Monitoring Symptoms: Make sure that Jim learns how to take his blood pressure and what signs he should look for that indicate that he should seek medical attention immediately – dizziness for example or chest pain or weakness.
- Follow-Up Care: Make certain that Jim knows that follow-up appointments are required for him, specifically to check blood pressure, kidney function, electrolyte levels.
- Lifestyle Modifications: Identify some of the possible behavior modification that might be adopted in the treatment of hypertension including stress management, physical activity and moderation of diets among others.
- Emergency Instructions: Include details about when to contact an emergency care, for instance; headache, blurring of vision or anew loss of any symptoms.
"Implement fall prevention strategies
CASE STUDY A:
Mrs Brookes is 78yo and has recently been diagnosed with Alzheimer's disease. She has a history of failing, nothing serious to date just severe bruising. Mrs Brookes' family have moved her into an aged care facility as they felt they could not provide adequate care.
Mrs Brookes, on occasion, wanders off and gets lost in the facility. Once the care staff locate Mrs Brookes they validate her feelings and redirect her back to her room.
The family brought some personal and familiar items from home for Mrs Brookes to have in her room.
She was also fitted with soft-shield hip protectors and given both vitamin D supplementation and calcium.
Care team members are checking that Mrs Brookes is wearing the hip protectors and taking her vitamins daily.
Explain why Mrs Brookes was wearing soft-shield hip protectors?
What are the benefits of providing Mrs Brookes with vitamin supplements?
How will Mrs Brookes care team members monitor her progress?
Explain why it is necessary to discuss the care plan with Mrs Brookes and what factors you need to take into consideration.
CASE STUDY B:
Mr Johnston is 90yo and lives in a residential aged care facility. He has dementia and walks under staff supervision. His family requested that the care team raise the bed rails when he is in bed, as they were concerned he would get up without assistance and fall.
The care team discussed with the family the potential for injury if he manages to climb over the raised bed rails as well as informed them of their restraint reduction policy, which targets the reduced use of bed rails.
The care team repeated a falls risk assessment and developed a management plan aimed at reducing Mr Johnston's risk of failing. They addressed the risk factors for failing, including a medication review and reduction in medication. Mr Johnston was also issued with hip protectors, the bed was lowered when Mr Johnston was in it and positioned against a wall. They ensured all he needed was within his reach.
Despite their efforts Mr Johnston's family remained adamant that the bed rails be raised.
Identify the issues in this situation?
Who did the care team discuss Mr Johston's situation with and why?
Why is it necessary to review the outcomes of fall prevention strategies?
Who should be involved with the review and celebration of positive results?
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Last week Mr Johnston got up from bed without assistance, climbed the bed rails and fell onto the floor breaking his hip.
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.5. What process do you follow if strategies have not had the desired results?
.6. Who would you need to consult to determine future strategies?
.7. What documentation and reporting is required to meet organizational policy and
protocols?"
Case Study A
1. What could have motivated Mrs. Brookes to be wearing soft-shield hip protectors?
Purpose of Hip Protectors:
- Fall Prevention: Soft-shield hip protectors intend to armor the hip place and to preserve those parts of the human body from the effect of a falling mass, so they should decrease the threat of hip fractures; this is especially important when it comes to elder individuals and those with osteoporosis.
- Injury Reduction: Due to the fact that Mrs. Brookes has been falling frequently and she was recently diagnosed with Alzheimer’s, which expose her to the risk of wandering and developing disorientation, the hip protectors are helpful in the prevention of the extreme extent of falls.
2. What is to be gained if Mrs. Brookes is encouraged to take vitamin supplements?
Benefits of Vitamin D and Calcium:People also use it to avoid thinking, as a form of distraction, or just to procrastinate on necessary chores.
- Bone Health: Dietary consumption of vitamin D and calcium is for the good health of bone density and strength. Taking these nutrients with others assists in avoiding situation of osteoporosis and fractures which is well embraced by the elderly as they are most likely to fall due to their age.
- Enhanced Absorption: Calcium needs to be absorbed and vitamin D play an essential role in helping the body absorb this mineral hence making the supplementation of the vitamin more effective in enhancing the body bone health.
3. How will the various members of Mrs. Brookes’ care team be able to track her progress?
Monitoring Strategies:
- Compliance Checks: The care team will continually check on Mrs. Brookes and make sure that she is putting on her hip protectors and is taking her vitamin supplements as directed.
- Fall Tracking: They will record any cases of falls or near-falls, determine if the hip protectors and supplements have reduced the number of falls and the consequent injuries.
- Regular Assessments: Take vital signs on her periodically and observe her mobility and safety within the facility in order to determine if she requires increase or decrease in care.
4. ELaborate on the reasons for involving Mrs. Brookes in the care plan discussion and the factors you should consider while doing it.
Importance of Discussing the Care Plan:Here, a red line is drawn at fully scientifically supporting only what has been accomplished in the organizational learning paradigm: >
- Patient-Centered Care: As much as the client has Alzheimer’s diseases, it’s important to discuss the care plan in order to keep checking on her needs and therefore improve on her comfort by considering her views.
- Understanding and Consent: Explaining the care plan to her, even if she may not understand it fully, and getting her consent aids in building trust and make sure she I being given care that is consistent with her belief system.
Factors to Consider:
- Cognitive Limitations: Take her down to her cognitive level, use a simple language and assure her about her care plan.
- Family Involvement: Involve family members also in the discussion as they can offer more support and voice Mrs. Brookes’ best interest.
- Safety and Comfort: Make sure that the care plan covers safety, as well as comfort and is the least invasive as possible.
Case Study B
1. It is necessary to determine what problems can outcome from this scenario.
Issues Identified:
- Family Concerns vs. Best Practices: The power struggle between the family and the care team is brought out by the family raising the side rails regardless of the care team’s alerts on the possibility of the child being injured through the restraint reduction policy.
- Injury from Fall: The current fall precautions in place, it can be seen, were not effective in preventing falls and consisted of such elements as bed rails, to the result such as the situation with Mr. Johnston, nursing a broken hip.
2. To whom did the care team communicate about Mr. Johnston’s condition and why?
Discussion and Rationale:
- Family: Speaking to the family members, the care team described the concerns, educated them about potential dangers of bed rails, and explained the facility’s restraint minimisation plan to Mr. Johnston.
- Interdisciplinary Team: The care team also presumably consulted with other healthcare providers about Mr. Johnston’s case (e. g. medical doctors; occupational therapists) regarding a risk management approach pertaining to his falls.
3. Why is there then the need to review the outcomes of the measures that have been put in place to prevent fall incidents?
Necessity of Review:
- Effectiveness Assessment: The outcomes require reviewing to identify the effectiveness of the strategies used in the prevention of falls as well as whether the strategies fulfill the patient’s needs.
- Identify Gaps: It makes it possible to pinpoint any deficiencies or poor outcomes of existing approaches so as to change or implement other course of action.
- Continuous Improvement: These include: maintaining a schedule for reviews to enhance the perpetuity and efficiency of evaluating and enhancing the protective strategies for the patients prone to falls.
4. To whom should review and celebration of positive results be taken?
Involvement:
- Healthcare Team: Engage the personnel of the care team that actually put into practice and assessed the effectiveness of the measures against falls.
- Family: Engage the patient’s family in order to report the previous day’s accomplishments, discuss any present or potential issues, and promote a multidisciplinary, collaborative environment.
- Patient (if applicable): Incorporate the patient into appreciation as well as recognition of changes in the care plan and the results.
For Mr. Johnston's Fall
5. That’s the procedure you have in mind if strategies have not produced the expected outcome?
Process:
- Re-Evaluate the Plan: Compare the current Fall prevention strategies that are in place to come up with a shortcoming’s or areas of improvement evaluation tool.
- Conduct a Root Cause Analysis: He needs to research on possible gaps that may have been left in implementation of the strategies, or new risks that may have been discovered as the strategies were being implemented.
- Develop and Implement Revised Strategies: Outline and put into practice the new or altered interventions in response to the findings focused on the problems and the risks.
- Monitor and Evaluate: Periodically reviewed the implementation of the revised strategies and further modify the strategies as and when necessary.
6. In other words, who would suggest you be consulted to learn future strategies?
Consultations:
- Interdisciplinary Team: Consult physicians, occupational therapists, physiotherapists and other related medical practitioners for an all round input on the issue of falling.
- Patient and Family: Encouraging the patient and the family to find out how they feel and what they expect especially in matters they understand can become important in the progress of treatment.
- Safety Experts: In the implementation of the said strategies, a safety and risk management consultants should be consulted for the approval of the safety officers and risk management authorities.
7. To what extend and how often does the organisation require documentation and reporting to adhere to its policy and protocol?
Documentation and Reporting:
- Incident Report: Record the process of the fall occurrence, the reasons for the case, and possible complications or symptoms experience by the person.
- Assessment Records: Record new findings of fall risk assessments, alterations in the care plan, as well as the outcomes of strategies that have been applied.
- Care Plan Adjustments: Document any changes to the care plan or any implemented interventions that resulted from the assessment and review.
- Compliance Reports: It can be crucial to make sure, that all the mentioned documentation corresponds to the fall prevention and safety policies and procedures of the organization.
Thus, by targeting these aspects, you can guarantee the applicability of precise fall prevention and management approaches conforming to the best practice and organisational guidelines.
Which of the following behaviors would best indicate the client is experiencing a mental illness?
In assessing behaviors to ascertain whether client may be suffering from such an ailment, reference must be made to the following characteristics of the behavior With regard to the nature of the behavior, one needs to look at the frequency and time frame within which the behavior occurs. Here's an analysis of each option:
a. A reduction in the degree of innovation that a client displays.
- Assessment: A decrease in creativity without the other scenarios that may come with it, and no other symptoms related to a mental illness may not necessarily be a sign of any serious mental disorder. Creativity is not a fixed trait and can be influenced by one’s experience or by state factors, thus; the decline or the enhancement of creativity may not indicate a mental disorder.
b. A rising incidence of other emotional stresses.
- Assessment: It is unlikely that emotional stress emanates from situational factors and thus should clients experience a change in their stress levels, such that it is persistent, seemingly unrelated or prohibitive to the accomplishment of their tasks, this indicates a mental health problem. More context is needed about the length and severity of the stress in order for this to become a viable option
c. Mourning of a key family member, for about a month.
- Assessment: Bereavement therefore always follows a loss and may take a long time to occur or it may be present for some time then fade away. Certainly, grief lasting for a month is not excluded, and if the person is gradually adapting and works, then this does not attract suspicion of a mental illness.
d. Lack of ability to build some tolerance to stress arising from a change in environment.
- Assessment: If stress from environmental conditions cannot be coped with and this causes a considerable decline in functioning then perhaps that is a sign of an illness of the mind. This option is self-attack because stress may be induced by other operational conditions such as anxiety disorders or mood disorders.
What are the benefits or disadvantages of ER diagrams?
Why bother with logical design and not just create tables and columns (physical design) directly?
Although ER diagrams have no explicit connection to nursing, it is possible to make use of them when it comes to designing and managing Healthcare Information Systems (HIS). They assist in structuring and mapping the record management and other related details concerning patients, care provision, overall working schedules of a health care facility, etc. Here’s how ER diagrams can be applied in nursing and healthcare:Here’s how ER diagrams can be applied in nursing and healthcare:
Applications of ER Diagrams in Nursing and Healthcare
1. Patient Records Management:
- Entities and Relationships: Patient files can be represented using ER diagrams; concepts such as `Patient` as an entity, `Medical History`, `Visit`, `Medication`, and `Treatment`. As an example, interconnections between such entities as ‘Patient’ might have ‘Medical History’, ‘Visit’ contains ‘Medication’ can be described in detail.
- Data Integrity: Making sure that data relationships are well understood aids to keep good records of the patients’ data.
2. Clinical Decision Support Systems (CDSS):Clinical Decision Support Systems (CDSS):
- Clinical Data Models: ER diagrams can help to describe the base CDSS and its underlying database, which supports clinical decision making for healthcare practitioners depending on a patient’s data.
- Integration: They assist in the consolidation of different sorts of information obtain from different sources such as lab test results, medical images, and patient record details.
3. Nursing Care Planning and Documentation:Nursing Care Planning and Documentation:
- Care Plans: Through ER diagrams it is possible to represent entities such as, `Care Plan`, `Nursing Intervention`, `Patient Outcome` as well as their associations. It assists in the organization of nursing documentation in addition to providing a check list on the care plans in order to guarantee that they’re well organized and all-encompassing.
- Outcome Tracking: Nursing outcomes are used to analyze the correlation with care plans in order to better monitor nursing interventions.
4. Healthcare Workflow Management:
- Process Modeling: ER diagrams can be applied in understanding flowcharts and applications of operations to health care organizations including admission procedures, discharge procedures and transition.
- Role Assignment: Objects such as `Nurse`, `Physician`, and `Administrative Staff` can be redefined with relation to certain tasks and responsibilities, which can aid in the controllership of work flows and ambiguity of roles.
5. Hospital Information Systems (HIS):
- System Design: There are many levels of applications of ER diagrams in designing the databases for hospital information system which caters many aspects of the hospital operation such as patient management, maintaining the stock, scheduling the employees, etc.
- Data Relationships: They also determine the manner in which various types of information are related, for instance, patients’ files combined with billing profiles and calendar arrangements.
6. Patient Safety and Quality Improvement:Patient Safety and Quality Improvement:
- Incident Reporting: ER diagrams can be used in terms of constructing reporting and analysis databases for patient safety incidents and for incidents tracking including root causes and corrective actions.
- Quality Metrics: It is a way of arranging information that is connected with quality indexes and performance indicators that can be used for enhancing patients’ outcomes and protection.
Example ER Diagram in Nursing
Entities:
- Patient
- Attributes: PatientID, Name, DateOfBirth, Address, ContactNumber
- Visit
- Attributes: VisitID, Date, Time, PurposeVisited
- Medication
- Attributes: MedicationID, Name, Dosage and Frequency
- Nurse
- Attributes: This table shall comprise of the following fields: NurseID, Name, Department
- CarePlan
- Attributes: Longitudinal -,<|reserved_special_token_276|>, Longitudinal -, Shorf
Relationships:
- Patient - Visit: A `Patient` may have many `Visits`, while a `Visit` is connected to a single `Patient`.
- Visit - Medication: A `Visit` can have one or many `Medications` and a `Medication` can belong to one or many `Visits`.
- Nurse - Visit: One `Nurse` may be connected to a number of `Visits` and many `Visits` may be linked to a single `Nurse`.
- Patient - CarePlan: A `Patient’ can have one or more `CarePlans’, and vice versa, one care plan can be linked to only one patient.
Benefits of Using ER Diagrams in Nursing
1. Organized Data Management: Aids in conceptualisation of the multiple components of the JHA so that they can be more easily managed in context of the large amount of data present in healthcare organisations.
2. Improved Communication: Connects the IT professional with health care practitioners as well as assists in communicating the relations of data structures more graphically and effectively.
3. Enhanced Data Integrity: As a result, it helps to proactively identify relationships and constraints of the database and to avoid such problems as the excess of a database table and convergence of essential and unessential data.
4. Efficient System Design: Helps in the development and especially the application of information systems that support needs for health care and related procedures.
Disadvantages of Using ER Diagrams in Nursing
1. Complexity: Drawing ER diagrams for large organization, especially those in the health facilities may not be an easy task and may need certain expertise.
2. Abstraction: ER diagrams emphasize on the logical model and may not depict all physical and operational facts of healthcare information systems.
3. Maintenance: Another disadvantage arises as more changes are made to the health care processes and data needed to be stored, the ER diagrams used need to be updated and this could take a considerable amount of time.
Thus, ER diagrams may prove effective in nursing and healthcare to design and optimize information systems and to augment data management as well as diverse facets of the patient-centered and administrative work.
SITUATION:
Mrs. M. is a 27-y/o gravida 3, para 2, who was admitted at term at 6:30 p.m. She stated that she had been having contractions at 7-to-10-minute intervals since 4 p.m. They lasted 30 seconds. She also stated that she had been having ""a lot of false labor"" and hoped that this was ""the real thing"". Her membranes were intact. Mrs. M.'s temperature, pulse and respirations were normal and her blood pressure was 124/80. The fetal heart tones were 134 and regular. The nurse examined Mrs. M. and found that the baby's head was at +1 station, and the cervix was 4 cm. dilated and 80 percent effaced. She reported her findings to the doctor and he ordered Demerol 50 mg. with Phenergan 25 mg. to be given intravenously when needed.
Answer the following questions with detailed explanation:
1. Do you think Mrs. M. is in false labor? Give reasons for your answer.
2. As Mrs. M. was getting into bed, her membranes ruptured. What is the first thing that you would after this occurs? Why?
3. After her membranes ruptured, her contractions began coming every 4 minutes and lasted 45 to 55 seconds. They were moderately strong. Why is it important for Mrs. M. to relax during her contractions? How can you help her to relax?
4. When do you think Mrs. M. should be given the medication ordered by the doctor? What safety measures should be taken at the time the medication is given? What observations should be made after it is given? Why? What observations would you report to the doctor?
5. How would you know that Mrs. M. has entered the transition phase?
6. A vaginal exam revealed that Mrs. M. is done and +2. What should be the nursing interventions at this time?"
Here's a detailed response to each of the questions based on Mrs. M. 's situation:
1. They would like to know if Mrs. M. is in false labor? Do explain on why you have given your answer.
Assessment of Labor:
- Contraction Frequency and Duration: Mrs. M. continues to have contractions at 7-to-10-minute intervals, each 30 seconds in duration, that could be early labor or even falsely perceived contractions if monitored with continuous Electronic Fetal Monitoring. However, contractions in false labor are often irregular and the pattern does not increase in terms of rhythm as well as the frequency.
- Cervical Changes: On initial assessment Mrs. M. ’s cervix is found to be 4cms dilated and 80% effaced. This is suggestive of active labour since in most cases, dilatation beyond 3 cm is sign of active labour not false labour.
- Fetal Heart Tones: The fetal contracting tones are also within the normal limit and are equally spaced meaning the fetus is intact well with the contractions.
Conclusion: Mrs. M,expressed having lot of false labor pains in the past but basing on the findings of this study she is in true labor not false. Every student knows cervical change in the form of cervical dilation and effacement bring near to delivery.
2. This is a tragicomic real life story of a woman identified as Mrs. M, as she was going to sleep her water breaking. Of the following actions what would be the first to take place as soon as this happens? Why?
Initial Actions:
- Assess Amniotic Fluid: Observe the following characteristics of the amniotic fluid: color, quantity and smell. Iatrosolious clear is expected whereas meconium-stained or smelling foul fluids may signify downwards evolution of the condition.
- Monitor Fetal Heart Tones: It is thus important that FHTs should be monitored continuously following membrane rupture because rupture is known to increase the chance of umbilical cord compression.
- Assess for Signs of Prolapsed Cord: If the fluid is green or the fetal heart tones are irregular check for an umbilical cord prolapse which may be an emergency.
Reason: The primary concern is maintaining the well-being of the fetus and exclude such adverse outcomes as a cord prolapse or infection.
3. Following the rupture of her membranes her contractions were coming every 4 minutes and lasting for 45 to 55 seconds. They were moderately strong. Thus the question how is it that it helps Mrs. M. to relax during her contractions? In what ways can you assist her in having a laid back experience?
Importance of Relaxation:
- Effective Labor Progression: In efficient uterine contractions, relaxation is essential; tension can only slow down the processes. When expecting women get stressed up, the perception of pain, and tension in muscles increases, which may even hamper labour.
- Pain Management: Such techniques can decrease the rating of the pain and therefore help the mother to handle the contractions better.
Methods to Promote Relaxation:
- Breathing Techniques: Use slow, big breaths as a way of reducing pain and bringing about relaxation.
- Comfort Measures: Apply comfort measures that may include positioning the infant in a comfortable position such as with their head supported as well as gentle massaging as well as using warm compress.
- Emotional Support: Give her comfort and encouragement to calm her and make her to concentrate.
4. At what time according to the opinion of the doctor shouldMrs. M. receive the ordered medication? Further measures that must be observed when so administering the medication are? What should be observed, after undertaking has been given? Why? The following would be the observations that I would report to the doctor of the patient:
Timing for Medication:
- Indication: Give the medication when Mrs. M is feeling uncomfortable and would greatly desire to find some comfort, not so close to the time when the baby is due for birth as this may have harms on the baby’s response.
Safety Measures:
- Assess Allergies and Contraindications: Ask Mrs. M. about her Demerol and Phenergan allergies and contraindication.
- Monitor Vital Signs: It is recommended to take Mrs. M. ’s vital signs before taking the medication to make sure that she is fit enough for the treatment.
- Administer as Prescribed: Give the respective medication at the correct frequency, timetable, route if prescribed:
Post-Medication Observations:
- Monitor for Side Effects: Assess for any side effects associated with the medication including; drowsiness, dizziness, or nausea on Mrs. M.
- Fetal Monitoring: The maternal medication should also be observed in relation to fetal heart tones so as to ascertain that the fetus is favored and in good response to the medication.
- Labor Progress: Monitor the advancement in labor and comfort of Mrs. M.
Observations to Report:
- Inform any alterations in the client’s vital signs, fetal heart rates, or any side effects to the administration of the medicine.
5. How would you appreciate that Mrs. M. is in the transition phase?
Indicators of Transition Phase:
- Contraction Pattern: During transition contractions are reported to be very intense, and occur more frequently, every 2-3 minutes, and they also tend to be longer, 60-90 seconds.
- Cervical Dilation: Mrs. M. would be 8-10 cm dilated at this time. It is sudden and involves dilation from 7 to 10 cms.
- Behavioral Signs: Mrs. M. may present: musculoskeletal discomfort, increased anxiety and/or irritability, nausea or vomiting. She might also experience the desire to bear down.
- Physical Symptoms: In some moments, it may be observed that rectal pressure has raised and they have immature pushing desires.
6. On a vaginal examination Mrs M is fully dilated at 10 cm and at plus 2 station. The following are the appropriate nursing interventions that should be developed at this time:
Nursing Interventions:
- Prepare for Delivery: Prepare all equipment for delivery and make certain that all things needed for the childbirth are prepared and positioned.
- Support and Coaching: Encourage and counsel Mrs. M. as she enters the pushing stage. Give her an advice or show her some instances on how to use the proper techniques for pushing.
- Monitor Fetal Heart Tones: Keep on observing the fetal heart tones so as to be certain that the baby is doing well when it comes to the pushing stage.
- Assist with Positioning: Support Mrs. M. to achieve comfort in the position used during labor and delivery.
- Communicate with the Healthcare Team: Inform the doctor and other members of the team that Mrs. M. is ready to deliver and prepare for the same.
Through these interventions, you will assist Mrs. M. to progress through the stage of labor for the last phase to promote the safe delivery and close monitoring of both the mother and the new born baby.
SITUATION:
Mrs. C gave birth 2 weeks ago. Her pregnancy, labor, and birth were uncomplicated. This is her first postpartum clinic visit. Mrs. C has one other child, who is three years of age. She does not want to become pregnant again for at least 2 years. Mrs. C left her baby at home with her mother-in-law, but reports that the baby is well and had a routine check-up by the midwife when the baby was one week old.
Answer the following questions:
1. Before beginning your assessment, what should you do for and ask Mrs. C?
2. What history will you include in your assessment of Mrs. C and why?
3. What physical examination will you include in your assessment of Mrs. C and why?"
In addressing the postpartum assessment for Mrs. C, here’s a structured approach
1. Before Beginning Your Assessment
a. Prepare the Environment:
- Ensure Privacy and Comfort: Ensure that examination room is appropriate for privacy and comfort of Mrs. C.
- Gather Necessary Equipment: If needs be, make sure that all the assessment tools and forms used are available.
b. Engage with Mrs. C:
- Introduction and Rapport Building: For this plan, this nursing student will approach Mrs. C performing an introduction so that she feels comfortable.
- Explain the Purpose: Enumerate a brief on the aim of the assessment together with the course of action to be taken.
c. Ask Initial Questions:
- Current Health and Well-being: Later on, inquire from Mrs. C how she feels physically or whether she has had any feeling of depression after delivery.
- Concerns or Symptoms: Ask her if there is anything particular that she would like to address or complaint about.
- Support System: Enquire about her wellbeing at home; how she is coping with her baby; whether she has anybody’s help or not.
- Birth Control: Ensure she agrees on the decision of avoiding pregnancy and ensure you have an adequate method of preventing pregnancy.
2. General history information that should be incorporated into the assessment ═
a. Postpartum Symptoms:
- Physical Recovery: Ask if the litter has any sign of postpartum recovery including lochia (vaginal bleeding) pain, or any abnormal discharge.
- Emotional Well-being: Its also important to ask about her mood and, whether she has been having any feeling of despair or anxiety in order to rule out postnatal depression.
b. Breastfeeding and Infant Care:
- Breastfeeding: If she is a breastfeeding mother, it will be appropriate to ask her about her encounter, the hard time that she encounters and the feeding timetable of her baby.
- Infant Health: Review the baby’s health and weigh any issues to do with infant care though the baby was recently checked up.
c. Previous Health and Obstetric History:
- Obstetric History: Assess her prior pregnancies, specifically, her previous deliveries to look for any hallmarks that can be related with current postpartum period.
- Chronic Conditions: Record any ongoing medical problems which may complicate after birth healing or caring for the newborn.
d. Contraceptive Preferences:
- Contraception History: Ask about prior use of contraceptive and types of contraceptive options that she prefers in the future. Offer information regarding contraceptives and which of them are suitable for use.
3. Physical Examination to Include
a. General Physical Examination:
- Vital Signs: Take vital details such as BP, pulse rate, temperature and weight so as to get an overall idea of her wellbeing.
b. Breast Examination:
- Inspect and Palpate: This is to ensure that the breast is not irritated, inflamed or show any form of signs of mastitis, engorgement or discomfort. Check the breast for lumps, India recommends that common signs of an infection should not be present.
c. Abdominal Examination:
- Assess Uterine Involution: Feel the abdomen to assess the size and location of the uterus as well as checking if it comes back to normal size after pregnancy.
- Check for Pain or Discomfort: Check for any rash, swelling or pain within the abdominal region or any other unusual sign or symptom.
d. Vaginal Examination (if indicated):
- Inspect for Healing: As for the perineal examination check whether the tear or the episiotomy site has healed and is infected.
- Assess Lochia: Be sure that type and amount of lochia are normal, it is important north and south.
e. Pelvic Examination (if indicated and appropriate):They lauded: Because to raise one’s voice, be politically active, volunteer, participate in rallies, vote, and exercise one’s rights is to embrace the values of the country.
- Internal Examination: It may be done to ensure the structures of the pelvis are viable and that everything is healing as required, though it may not be done if there are no issues of this nature.
f. Psychological Assessment:
- Mental Health Screening: Perform a short psychiatric check with a view to identifying those patients possibly suffering from postpartum depression or anxiety since it is a core aspect of treatment.
g. Education and Counseling:
- Provide Information: Provide information about postpartum care, dangers that can be observed in the next few weeks, and necessity of the follow-ups.
- Discuss Contraception: Discuss various contraceptives available to Mrs. C and assist her choose the ideal one depending on her preferences and requirements.
By dealing with these aspects, you’ll offer all-rounded postnatal care which will ensure Mrs. C’s physical and psychological welfare and include family planning.
