Answer the following questions and provide a detailed explanations:
1. What are the component of EINC?
2. What is/are the reasons for EINC protocol?
3. What are the importance of EINC?
4. What is the sequence of routine newborn care?
5. What will if the baby is not breathing or is gasping after 30 seconds of drying?"
1. EINC stands for Examination, Innsbruck, Elements, Initial, Newborn, Care, where EINC Care means drying the newborn, stimulation, clearing the airways, warmth, cord care, initiation of breathing, skin-to-skin contact, and breastfeeding.
2. It is for these reasons that standard newborn care protocols have been established while standard newborn care interventions aim at making every newborn receive adequate quality and equally good care within the first hours of birth. Protocol are put in place to reduce morbidity and mortality.
3. Importance consists of the promotion of the transition of the baby after birth, stabilization of temperature, appropriate timing of cord clamping, and prevention of infection, promotion of touch and skin-to-skin contact, and proper initiation and establishment of breast feeding.
4. A common sequence is: Dry the infant well, handling in terms of touch, observing for proper breathing, syringing the airways, if necessary, after 1-3 minutes clamping of the cord, skin to skin and breastfeeding. Check the Apgar scores after five and fifteen minutes.
5. If the baby is not breathing or is making only occasional gasping following the initial steps, other interventions are required according to the neonatal resuscitation protocol. This may include PPV, supplementation of oxygen, CPR drugs/ chest compressions in the event that the rate remains at zero. If the situation is like this, then the most appropriate thing is to seek medical attention as soon as possible.
Discuss the predisposing factors to pueperal sepsis
Discuss the nursing management of a mother with pruperal sepsis
Formulate atlest five nursing diagnosis for a mother with sepsis
Discuss at least five breast complication and the managent of each include signs and symptoms
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Nursing is a one of the most holistic careers, why do you think it is referred to as a calling
What are the most importance fundamental practice principles nurses should possess in their career
In a unit setup what are the essentials for a nurse unit manager Discuss how the nurse leader utilize the nursing theories in advoca…
Predisposing factors to puerperal sepsis:
- Premature rupture of membranes that lasted for more than 18 hours
- Gender related differences: Women giving birth more than one vaginal examination during labour
- Prolonged labor
- They maybe postpartum hemorrhage secondary to retained placental tissue or products of conception
- Cesarean section delivery
- Contact with carriers of infectious diseases
Nursing management of puerperal sepsis:
- Provide IV antibiotics according to orders
- Provide other supportive treatments for conditions such as high temperature, pain, etc.
- Closely observe the patients’ vital signs and timely report any changes that indicate the progression of sepsis.
- Help to take blood cultures and any other lab investigation required as per prescription
- Do not transmit infections through proper hand washing and utilization of standard precaution measures.
- Comfort/assistive measures – positioning, mattress and covers
- Finally, social support and patient education have also been highlighted on.
Nursing Diagnoses for mother with sepsis:
1. Risk for decreased dietary intake:; Risk for infection:
2. Potential risk for shivering, hyperglycemia, and electrolyte disturbances due to infection response
3. Potential range of dependent variable: Acute confusion due to fever/sepsis
4. This may lead to impaired gas exchange due to the newly developed SIRS/sepsis.
5. Regarding specific pains, this one is related to inflammation and infection of the uterus.
Breast complications:
Mastitis:
- (breast tissue inflammation, fever signs, inflammation signs, pains).
- Treat with painkillers, antibacterial agents, and liberal expression of breasts
Breast engorgement:
- Worse, uncomfortable, overly full feeling of the breast
- Treat with breast compression, cold packs, and analgesia
Plugged milk ducts:
- Soft breast mass nodule, inflammatory change
- Use moist heat, massage and frequent stripping.
Nipple damage/infection
- Nipples cracking, bleeding and soreness
- Use topical creams/ointments, make sure breastfeeding well
Insufficient milk production
- Insufficient breast milk to cater for baby’s needs
- Encourage lactation through skin-to-skin touch, fluids for both the mother and the infant, and lactation specialists.
Inpatient falls is a complicated occurrence primary to nursing (Dolan & Taylor-Piliae, 2019).
Linking a theoretical framework to inpatient falls is crucial to understand the older adult's perspective and aid self-management (Dolan & Taylor-Piliae, 2019).
Dorothea Orem's Self-Care Deficit Nursing Theory (SCNDT) is a grand theory related to global nursing phenomena by outlining what nursing is and who requires nursing (Dolan & Taylor-Piliae, 2019). The SCNDT comprises the theory of self-care, the theory of self-care deficit, and nursing systems theory. These middle-range theories have defined concepts, approaches, and empirical indicators basal for nursing research and practice (Dolan & Taylor-Piliae, 2019). The individual's self-care system is the executed actions that control normal life development and functioning. When confronted with an illness, new self-care demands emerge, and if the individual fails to meet the self-care demands, they unfold self-care deficits with the individual needing nursing care (Dolan & Taylor-Piliae, 2019). Orem's SCNDT can relate to inpatient falls, as being at risk for falling is a self-care demand, and the failure to manage one's own fall risk is a self-care deficit. However, the SCNDT does not concentrate on the individual's health beliefs and possible hurdles that prevent the older adult from acknowledging a self-care deficit. Thus, the SCNDT is not well-matched for inspecting falling in the hospital (Dolan & Taylor-Piliae, 2019).
Meanwhile, the Health Belief Model (HBM) was formulated in the 1950s, trying to recognize why people avoided screenings and preventative health strategies for detecting asymptomatic disease (Dolan & Taylor-Piliae, 2019). Social psychologists made the HBM deductively from learning theories and inductively from practical public health concerns (Dolan & Taylor-Piliae, 2019). The central concepts are focused on the individual's perception of an illness threat and what initiates an action or not towards an illness threat.
Perceived susceptibility is recognized as the individual's affirmation of susceptibility to a condition extending from denial to fear of contracting the illness. Perceived severity is the individual's beliefs about the seriousness of the disease (Dolan & Taylor-Piliae, 2019). Perceived benefits cite the individual's affirmation of their susceptibility and benefits from actions, like medical treatment (Dolan & Taylor-Piliae, 2019). Meanwhile, perceived barriers are the likely negative aspects of health action, like embarrassment or unpleasant side-effects. The barriers can be clashing and incite avoidance (Dolan & Taylor-Piliae, 2019). Indications to action are the internal and external triggers that affect decision-making, while self-efficacy is the individual's sensed ability to perform an intended move in the disease process (Dolan & Taylor-Piliae, 2019).
The HBM relates to the phenomenon of falling in the hospital, as the model is not restricted to preventative behavior or chronic illness (Dolan & Taylor-Piliae, 2019). The HBM can seize the wide range of emotions and reactions linked with falling or being at risk for falling in the hospital. The model relates to older hospitalized adults who may not yet understand or accept their susceptibility to falling out of acute illness (Dolan & Taylor-Piliae, 2019). The HBM also applies to hospitalized older adults who are afraid of falling, understand their own fall risk, and contemplate perceived barriers and benefits linked with fall prevention (Dolan & Taylor-Piliae, 2019).
According to Ott (2018), the HBM eases creating an educational program aiding fall reduction lifestyle changes. Different components of the HBM include clients' points of view when reviewing frequency, severity, and perceived risk factors of falls. Additionally, likely benefits and recognized barriers to fall prevention interventions are ascertained (Ott, 2018). A correction in health behaviors happens by the patient's perceptions of susceptibility, seriousness, benefits, and barriers to a behavior (Ott, 2018). The educational component is adapted to the individual recipients, carries possible outcomes, and encourages independence to raise compliance (Ott, 2018).
On speaking with my preceptor, she also said of using Health Belief Model to change patient behaviors successfully. Thus, we believe that HBM will also create the best results in my specific EBP intervention.
References
Dolan, H., & Taylor-Piliae, R. (2019). Selecting a theoretical framework to guide a research
study of older adults' perceptions and experiences of falling in the hospital. Applied Nursing Research, 47, 38-40. https://doi-org.lopes.idm.oclc.org/10.1016/j.apnr.2019.04.004
Ott, L. D. (2018). The impact of implementing a fall prevention educational session for
community-dwelling physical therapy patients. NURSING OPEN, 5(4), 567-574. https://doi-org.lopes.idm.oclc.org/10.1002/nop2.165
Explain the risk factors for osteoporosis. What can a nurse do to help manage this health condition to restore the patient to optimal health?
- Age – Bone mass reduces throughout a person’s lifetime, with a faster rate of loss after 50 years for women and 70 years for men. Another factor that has been pointed out to boost osteoporosis risk is older age.
- Gender- it is well known that women have a higher risk of osteoporosis than men, especially if they are post-menopausal women. These hormones are replaced when the body is deficient, and estrogen decline is said to speed up bone loss.
- Postmenopausal women – Osteoporosis is common among women who have passed through menopause than those who are still menstruating. There is also genetic predisposition to the strength of bone mass.
- Less bone density and greater risk - People with small thin built are more prone to the disease due to having less bones.
- Low calcium and vitamin D, vitamin K, and protein – These nutrients are vital for bone formation and therefore, their absence leads to bone depletion.
- Lack of physical activity and decreased muscle mass – Mechanical loading through physical activity, especially those involving weights, helps to maintain and develop bones. Some of them include; being a bed-ridden patient, having disuse and muscle loss.
- Medications - Steroids for long periods, and other drugs that inhibit the body’s ability to develop bone mass are also causes of secondary osteoporosis.
- Smoking and excessive alcohol – These can all be detrimental to the health of bones.
As a nurse, important ways to help manage osteoporosis include: As a nurse, important ways to help manage osteoporosis include:
- Teach patients about a proper diet, exercises that are safe on the bones and joints, how to prevent falls and not to take up smoking/drinking. In this case, you should suggest the calcium, vitamin D and protein servings that the patient should take. If needed consult dietitians, ideally before making such plans.
- If bone density medications have been prescribed, promote compliance to take the prescribed drugs as required. Give thorough instructions.
- Promote self-monitoring for home hazards and recommend walking aids which include grab bars to avoid fall and fracture prone situations.
- The follow-up should also be done frequently and the symptoms of a new fracture should be checked frequently. Specific areas to address include pain management and other related issues to recovery.
In helping the patient achieve the best possible care and treatment of osteoporosis, the nurse is central in education, management of lifestyle changes, risk control, and support.
"Why is it important to review claims prior to submission? If a resubmission is needed, how do you determine the method to resubmit?"
There are a few key reasons it is important to review claims prior to submission:
1. To double check the information submitted – This is in cases where there is an extra opportunity to ensure that all the necessary information has been availed, correct billing codes are used, all the necessary documents are attached among others, thus decreasing chances of the claim being rejected or delayed due to lack of information or wrong information.
2. To complement revenue – This way, you get to scrub the claims to check the correct billing codes and modifiers, which will help you to enhance the reimbursement for the services offered. This enables you to get your maximum possible entitlement for the trip.
3. To prevent fraud and abuse – This makes it easier to eliminate some mistakes that a client might have made in a claim that may be looked at as fraudulent or abusive in billing practices and might lead to an audit or penalties later.
To what factor do you base how to resubmit the work in case of a resubmission?
If a claim is denied and needs resubmission, there are a few factors to consider in determining the best resubmission method:
1. Explanation of denial - Assess the denial of the benefits and find out that the reason why the claim was denied is what will help one to know how to refill it in the best manner.
2. General information about the payers - Look up in each of the payer’s provider manuals to understand how they want resubmission if at all – be it on paper, electronically or through appeal.
3. Additional Documentation required – Determine if there is necessary information from the patient record that needed for the resubmission and add as necessary.
4. Time limit – Submit the claim within the agreed time frame for claiming by the payer to be regarded as on time. It typically takes 30 to 90 days for corrections to be made depending on the payer.
The physician orders urine C&S on a patient. The patient asks why it is necessary to do this test
How would you, the medical assistant, clearly explain this to the patient?
A patient is asked to bring in a first-morning urine specimen for testing. The medical assistant provides the patient with a container for the collection and explains that it needs to be refrigerated if they cannot bring it to the office right away. How do you explain to the patient the need for a first-morning specimen and the request to refrigerate?
A patient is being treated for diabetes. This patient asks you, the medical assistant, why a urine specimen must be collected each time they come for an office visit. What would you tell this patient?
Explain why it is important to initially do a physical analysis of urine, including reporting the color and appearance."
1) First-morning urine explanation:
“The first morning urine is best because it has been gradually concentrated in your urinary bladder all night without you taking any fluid or passing urine.” This is because some elements present in the urine such as proteins and glucose form deposits in the bladder which are easier to identify on a lab test if present Hence, if you cannot bring the sample immediately to the lab, you should refrigerate it since this will help preserve the elements in the urine that will be tested in
2) Urine testing for diabetes patient’s explanation:
“We ask you to provide urine samples every time you come in to check your kidney health and to look for the presence of protein in the urine, which might suggest the early signs of kidney disease often associated with diabetes… We take a urine sample every time you come in to ensure we track how efficiently your kidneys are managing your blood sugar levels and to be able to identify any problem areas at the earliest stage possible. ”
3) Importance of initial physical urine analysis:
When we first receive a urine sample, we look at the basic physical attributes of the sample such as the color and the formation: color is important in that it shows the concentration of the urine, as well as any possible signs of blood or other abnormalities in the formation The formation may reveal other features such as cloudiness resulting from infections or buildup of waste products
Describe an ethical situation you have witnessed or potentially could experience within your nursing practice.
Compare two ethics concepts discussed in week 2 content.
Describe an ethical theory or principle that could guide you in this process.
Please use this reference
Beth Perry Black, P. R. (2020). Professional Nursing. St. Louis, Missouri: Elsevier Inc."
One possible ethical dilemma that may occur to the nurses is the treatment of a patient who has nursing unable to make decisions for himself/herself and the patient has no durable power of attorney, no living will or next of kin. For instance, an 85-year-old man is transferred from a nursing care facility suffering from aphasia and confusion secondary to a stroke. A patient needs a procedure but cannot give his/her consent. Since the patient did not have a written directive or an appropriate surrogate, the nurse has to decide what is best.
Two fundamental ethical imperatives that may be used as a framework are respect for autonomy and beneficence. Again, the aspect of autonomy means that the nurse should look at what the patient would prefer if he or she were capable. But the principle of beneficence holds the view that the nurse should do well to the patient, and this may include going ahead to perform a suggested procedure. There is an ethical dilemma and conflict of interest that has to be analyzed before making decisions about patients and ethical standpoints.
Other ethical frameworks such as principlism could also be used to analyze the situation. Principlism refers to the four medical ethics principles outlined in Beauchamp and Childress' framework: The four values of clinical practice that should be followed are: self-governance, do good, no harm and fairness. If the weight and application of each of these principles regarding the best moral decision to be made in response to this particular helpless patient was to be compared, then it would be possible to make a more ethical decision. Evaluation of ethical issues involving ethical theories in routine enables the enhancement of ethical decision making.
When nursing is confronted with what Horn (2013) refers to as ‘the tough cases’ the ethical models serve as a means of assisting the nurse in determining the right thing to do according to core ethical principles inherent to the profession. Feel free to ask me anything else if you need to know more.
Describe an ethical situation you have witnessed or potentially could experience within your nursing practice.
Welcome to Samples page
Define culture, traditions. Moral, language, cultural competency and its relevance in health care and nursing
Determine the cultural diversity of country (your country of origin or specific area of practice)
Establish culturally-safe practices or approaches to culture and diversity in nursing practice"
Culture and Traditions
Culture encompasses the set of norms, attitudes, behaviors, and activities that are acquired and adopted within a certain population and are enduring in nature. Cultural practices are the practices performed by the people of a particular culture and are intended to maintain culture, including ceremonial activities like festivities and ceremonies, holiday customs. For instance, the Filipino people value family, especially elderly people, being hospitable, and having an appropriate cultural carnival, for example, the Pahiyas harvest festival, where Filipino houses are decorated, and festive meals are prepared.
Morals, Language and Relation to Health Care
Morals can be defined as standards of conduct that are acceptable in the society or have been set by the society. Attitudes with regards to matters of morality such as euthanasia may also differ greatly across culture. Language is an essential aspect of culture and cultural affiliations. This position suggests that due to language barriers, communication is poor and therefore can harm the health of the patients. Healthcare cultural competence therefore refers to the capacity to appreciate and manage difference in culture in relation to values, beliefs, and practices in communication and behavior with the aim of enhancing health outcomes. Cultural competence eliminates disparities and gaps, encourages patient access to care, facilitates good medical provider and patient interactions, and results in enhanced compliance with treatment regimens and consequently, better health.
Cultural Diversity is a very important topic especially in countries like the Philippines which is a melting pot of different cultures.
The Philippines has got a rich culture that has got hints of South East Asia, Spanish and American influence. Today there are more than 175 ethnolinguistic groups which are Tagalog, Cebuano, Ilocano and Bicolano peoples. The value placed on family and community is paramount, and there is a system of generational interconnectedness. Religion is also significant in Filipino culture, specifically the Roman Catholic faith, which is practiced by a large majority of the population. Elders are respected. Although there is a relative increase in the involvement of women in the civil population, gender roles are still quite conventional. As for the cultural differences, some general Filipino culture aspects can be noted, such as hospitable, hierarchal, familial, and joyful. Another related issue is that of superstition, which is also regarded as rather widespread. The cultural beliefs and practice concerning health, illness and death are different across the world therefore to cater for Filipino patients, the care provider should have adequate information on the cultural practices of the Filipino and adjust where necessary.
Culturally Safe Nursing Practices
The concept of culturally safe nursing care must encompass acknowledgement of a patient’s social, cultural or religious affiliation, built trust and not undermine the patient’s cultural status. Examples include:
- Exploring patients’ beliefs, traditional and culture practices
- The need to ensure that the patient and providers can understand each other in cases where there is a language barrier by providing interpretation.
- In other words, there are cultures that tend to feel more at ease with providers of the same gender.
- Identifying and evaluating potential health beliefs and co-establishing suitable health plans
- A process of defining sociological factors that could potentially influence the state of health
- Promoting the right policies and care models for individuals from diverse cultural backgrounds in an organization
Adherence to these recommendations results in effective healthy encounters and health outcomes for ethnically diverse patients.
In general, cultural competence, understanding, and respect are crucial for nurses involved in the care of multicultural patients and the elimination of disparities—especially regarding the patients in this area that may require special attention according to regional demographics.
5. Importance and purposes of Geriatric care models
Differentiate among:
Clinical Video Telehealth (CVT) model
GERI Pact
Home-Based Primary Care (HBPC) model
Return to Community Initiative (RTCI) model
STRIDE model
ACE model
Case-finding for Complex Chronic Conditions in 75+ model
Project RED (Re-Engineered Discharge)-based model
Improving access and quality of care for dementia
Role of nurse in transitions of care
Identify barriers to social support and financial resources
Define care coordination"
The Clinical Video Telehealth (CVT) Model
- This is a technology that facilitates access to medical and health care services for senior citizens through the use of video conferencing.
- Enables elderly people, including those in the rural areas, to receive additional care and professional services while being comforts of their homes.
- The advantage of removing geographic barriers and transportation issues that may hinder access to care.
GERI Pact Model
- Houses an emphasis of post-hospital care in lowering readmissions once again to the home setting.
- Hire nurse practitioners and social workers to follow up on patient’s status after discharge and offer further support at home.
- Aims are to educate the patient and to achieve adherence in the subsequent follow-up appointments and medication regimen.
Home Based Primary Care Model
- Focused on delivering primary care to the elderly in the comfort of their homes, with input from multiple specialties.
- Beneficial for elderly people who hardly attend clinic visits either because they are ill or cannot move around due to old age or other related complications.
- For instance, it can decrease cases of ER visits and hospitalization since people with chronic diseases are better monitored when given home visits.
Return to Community Initiative (RTCI) is a model.
- It aims at providing support for elderly persons who need to go home after being hospitalized or after receiving any form of medical treatment that required close or constant monitoring.
- Entails integrating services which are provided at home and community level to address medical, functional and psychosocial objectives.
- The goals of the service are to re-establish seniors in the community residing preference and minimize hospital admissions.
STRIDE Model
- STRIVE: A Multi-State intervention to decrease emergency department utilization.
- Screens all high risk seniors and offers complete clinical interventions focused on areas of need.
- They aim at enhancing health care and decreasing avoidable ED and hospitalization.
ACE Model
- Ambulatory intensive Caring for Elders employs a senior care coordinator who is located in a primary care office setting.
- Patients are enrolled into care coordination, facilitated access to necessary resources, coordination between different providers, and handle of barriers.
- Can be applied to decrease the level of burden and enhance the level of functioning and well-being among caregivers.
Case-Finding for Complex Chronic Diseases
- Conducts a health risk assessment survey followed by the MDS assessment to target seniors with multiple chronic conditions.
- Intends to enhance the interdisciplinary model of care delivery, encourage completion of an advance care plan and focus on efforts to promote healthy behaviours.
Project RED
- Uses time and motion study to identify changes that need to be made to the hospital Discharge processes to enhance patient experiences.
- Stresses the continuum of patient education, proper referral and transfer of care.
- It is also important to mention that goals are set to decrease the number of readmissions and enhance patient’s prognosis.
Challenges seen in care are transport, financial constraints with health and medications, loneliness, stress from caregiving, and finding their way. The specific tasks in this domain include assessment, care coordination, patient education, and transition management, and these are predominantly carried out by nurses.
Care coordination is a deliberate attempt to design and integrate patient care across the various health care entities and settings.
