Category: Uncategorized

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NURS 112 Clinical

Discuss the nutritional needs of your resident. 

• Are they on a therapeutic diet? If so, why? 

The resident’s dietary requirements are essential to maintaining his health and avoiding complications. The resident’s BMI is 34.3, and he falls under the obese category, placing him at greater risk for many chronic diseases. A balanced diet and controlled calorie count are required to enhance his body weight control and overall health.

The resident is not currently under any therapeutic diet, but in light of his status of obesity, he could be subjected to a structured diet. A therapeutic diet is commonly prescribed to manage a disease, cause weight reduction, or promote overall health. Obesity also comes along with many diseases, and the resident should, therefore, be subjected to a diet low in added fats, refined sugars, and added calories.

A healthy diet should be based on lean proteins like chicken, fish, legumes, and generous quantities of vegetables and fruits. Whole grains like quinoa and brown rice are substituted with refined carbs. It also means regulating the amounts to avoid overeating 

• According to the textbook, what are their daily caloric requirements? 

Based on general nutrition recommendations, the 34.3 BMI adult should consume approximately 1,800 to 2,200 daily calories to maintain the same weight. However, to attain effective weight loss, the diet in terms of caloric content should be 1,500-1,800 calories per day. The reduced diet shall provide the resident with the necessary nutrition to achieve a healthier body weight 

• How do they take in nutrients? Do they need assistance? Are they at risk for aspiration? 

The residents only need assistance with the setup, and they eat independently. This implies the resident eats independently but possibly needs help preparing the meal or setting up the tray. The resident does not exhibit any signs of aspiration risk, indicating that the resident does not experience trouble swallowing and lacks a history of choking. Nonetheless, monitoring the resident’s status regarding safely consuming food is also essential.

• What is the height, weight, and BMI?

Height: 5’4″ (65.0 in)

Weight: 177 lb (89.4 kg)

BMI: 34.3 (Obese category)

• What was their average fluid intake? What % did they eat? 

Fluid intake: 240 ml (without nutritional supplements)

Food intake: 100 %

Fluid intake is minimal, and the failure to document food intake is worrisome regarding whether the resident receives adequate nutrition. Dehydration and malnutrition can lead to weakness, confusion, and other complications.

• Do you think the resident’s nutritional needs are being met? Why or why not? What recommendations do you have? 

The resident consumes 100% of the food, meaning they are meeting their dietary intake and fluid intake Even though the resident is consuming enough food, a confirmation should be made that the resident is consuming balanced meals according to their diabetic diet plan.

The resident uses bed rails on both sides, indicating the need for support and safety while the bed is occupied. They require a full-body lift transfer with a wheelchair sling, which also shows impaired mobility. In addition, using a mechanical device for transfers and a motorized wheelchair with a Roho cushion is evidence of mobility deficits that require assistive technology to move and ensure comfort.

The resident is at significant risk for skin breakdown. Impaired mobility, obesity, and the use of assistive devices all heighten the risk of pressure ulcers. Proper skin care and assessment can prevent infection and slow-healing wounds.

The resident’s food intake appears sufficient, as they consume 100% of their meals. result in dizziness, confusion, and kidney problems. It is vital to address this concern to ensure the resident’s health is maintained.

Recommendations: 

• Continue to encourage balanced meals as per the diabetic diet.
• Educate the resident on portion control and the importance of hydration.
• What education on nutrition would be appropriate for your resident? 

Providing nutrition education can empower the resident to make informed choices about their dietary intake. They must understand the importance of consuming various nutrient-dense foods to maintain health. They must also be taught to restrict unhealthy fats and sugars and to increase fiber and protein intake. Meal planning and mindful eating are some of how sustainable dietary habits can be reinforced.

Analyze your head-to-toe assessment findings in the section above. List three abnormal findings.  Low Fluid Intake (240 ml) – This is less than the recommended daily amount and can lead to dehydration. Elevated BMI (34.3) – The resident is obese, which increases the risk for diseases like diabetes and heart disease. High Risk for Skin Breakdown – The resident risks developing pressure ulcers because of their limited mobility. Determine a second concern for your resident. Explain why you chose this.  Risk of Dehydration Dehydration is a serious problem that results in complications such as urinary tract infections, kidney problems, and cognitive impairment. Since the resident’s fluid intake is only 240 ml, they may be at risk of dehydration. Dehydration may result in constipation, dry skin, and dizziness, which may also result in a high risk of falls.

Create a plan related to your second concern. What is the goal? What outcome are you striving for to promote, maintain, or restore your resident’s health?  Be specific and discuss outcomes you believe are obtainable during your 4-week clinical experience. It should be something you can do or assist with as a student nurse.  Increase the resident’s fluid intake to at least 1,500-2,000 ml daily to improve hydration and prevent dehydration-related complications. The resident should demonstrate improved hydration in four weeks by displaying increased fluid intake, stable vital signs, and no dehydration symptoms.

Take action. Determine three nursing interventions that address your second concern and provide a rationale for how the interventions promote your resident’s health. Discuss how they will be implemented. Monitor Fluid Intake and Output Keeping a daily record of fluid intake and urine output will monitor hydration status and show any trends that should be noted. This will include documenting any signs of dehydration, such as dry skin, dizziness, or low urine output. A hydration chart needs to be maintained, and trends seen should prompt adjustment. Continual assessment will allow early intervention if the resident persists with low fluid intake, avoiding dehydration complications. Encourage Regular Fluid Intake  The resident should be encouraged to drink water and other hydrating fluids during the day. The reminders to drink fluids can be scheduled hourly, with fluids placed in convenient locations. Providing flavored water, herbal teas, or diluted juices can be more appealing to drink. Educating the resident on hydration benefits, i.e., energy and cognition improvement, will also help promote compliance. Family members or caregivers, if necessary, should also be engaged to reinforce the habit of drinking. Provide Hydrating Foods  Feeding foods with high water content, such as watermelon, cucumbers, and soups, can help supplement fluid intake. Incorporating broth-based soups, yogurt, and hydrating fruits into the daily diet can increase fluid intake without requiring the resident to take large amounts of fluid at a single sitting. Popsicles created from natural fruit juice or electrolyte-containing drinks can also be an enjoyable method of increasing hydration. Educating the resident on the value of hydrating foods and making small, sustainable dietary changes can help in long-term hydration control ( ATI 2023)

Evaluate the effectiveness of each intervention for your second assessment concern. Did the intervention promote, maintain, or restore health?  Encouraging Fluid Intake – This intervention is successful if the resident consumes more fluids and responds by saying they feel better. Monitoring Intake and Output – Keeping correct records will determine if additional steps need to be taken to ensure proper hydration. Providing Hydrating Foods – If the resident consumes more high-water-content foods, their hydration status will improve, reducing the risk of dehydration-related complications.

Evaluate the overall progression towards the goal for your second concern for your assigned resident. Was the goal achieved?  Why or why not? Would you keep this goal or change it? Evaluation of the progress toward increasing fluid intake is required to determine the effectiveness of the interventions. The goal was partially achieved as the resident showed some improvement in hydration but did not consistently achieve the expected level of 1,500-2,000 ml of fluid intake daily. This was due to occasional refusal to accept fluids and insistence on solid food. Alterations such as offering more fluids through food and providing fluids in smaller, more frequent amounts may be necessary to promote hydration. The goal remains relevant, and the alteration of interventions will allow the resident to maintain enhanced hydration. Continued education and support are needed to maintain progress and prevent dehydration complications.

References

Sommer, M.S (2023) Davis’s disease & disorders: A nursing therapeutics manual

(7^th ed) F.A Davis company. ATI Testing (2023)

https://www.atiteating/com

Nursing Management

A holistic approach to caring for patients with multiple sclerosis (MS) involves caring for the body, mind, and emotional components of patients. Nursing care following research includes mobility, skin integrity, and continence checks. The primary focus for such a patient is skin integrity, given that incontinence and immobility predispose pressure ulcers. Her incontinence poses risks for a breakdown of skin to cause pressure sores or bed sores. 

Central nursing interventions include:

• Nutritional Support: Encourage high-protein diets to contribute to recovery from wounds and general good health.
• Fall Prevention: Providing for safety in the environment, mobility assistance, and promoting strength exercise.
• Pain Management: Assessing pain regularly and adjusting pain management plans accordingly. 
• Skin Care: Repositioning regularly, preventing moisture breakdown by applying barrier creams, and more frequent diaper changes (Tervo-Heikkinen et al., 2023). 

Collaborative Health Care

Interprofessional collaboration is crucial in preventing pressure ulcers in patients who have MS. Because of incontinence and poor mobility; several health professionals maintain skin integrity and overall wellness. Physical therapists provide strength and flexibility, preventing immobility-related dangers, and promote frequent movement to prevent prolonged skin pressure. Occupational therapists assess the ability of the patient to perform daily living activities and prescribe assistive equipment, such as special mattresses and pressure-relief mattresses, to reduce skin breakdown.

Speech therapists assess swallowing disorders to avoid malnutrition, weakening skin, and impairing healing. Social workers offer emotional and financial assistance, including access to necessary supplies such as incontinence and barrier creams and access to local services for extra help. Case managers arrange for medical equipment, including pressure-relief mattresses, and ensure skin care interventions.

By working in collaboration, such professionals ensure protection strategies for skin, increased comfort, and reduced complications. The staff nurse is crucial in coordinating interventions, monitoring interventions, and educating the patient on skin care. Such collaboration assures an integrated approach to skin integrity, ultimately leading to quality-of-life improvement for the patient. 

Head-to-Toe Assessment

General Survey/Skin	Objective: Warm, dry skin with no rashes.
	Subjective: Incontinence history is a risk factor that increases the chances of skin damage, even though the patient reports no itching issues.
Head and Neck, Eyes, Ears, Nose, Throat	Objective: No abnormalities noted.
	Subjective: No complaints
Respiratory	Objective:  Lungs clear to auscultation.
	Subjective: No complaints of shortness of breath.
Cardiovascular	Objective: Normal cardiovascular assessment.
	Subjective: No chest pain and palpitations.
Abdominal	Objective: Complaints of left lower quadrant pain.
	Subjective: Reports occasional numbness in the leg.
Elimination	Objective: History of incontinence
	Subjective: Reports frequent accidents due to MS.
Musculoskeletal	Objective: Normal range of motion.
	Subjective: Reports difficulty with mobility and muscle weakness
Neurological	Objective: Intact visual fields.
	Subjective: Reports numbness in the leg
Vital Signs/Pain	Objective: Stable vital signs.
	Subjective: Abdominal pain present.
Social, Cultural, Spiritual	Objective: Has two children and three grandchildren
	Subjective: She expresses concerns about being a burden to her family.
Erickson’s Developmental Tasks
	The patient is in the stage of Integrity vs. Despair in Erikson’s psychosocial development theory. This patient might have trouble coping with feelings of reliance on other people and lack of autonomy caused by her MS (Orenstein & Lewis, 2022).
Maslow’s Hierarchy of Needs	Maslow’s Hierarchy of Needs The patient’s immediate requirements are: Physiological Needs: Management of incontinence and pain  Safety Needs: Preventing falling and protecting skin integrity. Belongingness Needs: Emotional support from family.

Nursing Process

Analyze your head-to-toe assessment findings in the section above. List three abnormal findings.  Incontinence, increasing the likelihood of breakdown of skin. Chronic pain in the lower left side that affects daily living. Limited mobility due to MS that leads to fall risk (Montero-Odasso et al., 2022).  Determine a priority concern for your resident. Explain why you chose this:  The primary focus for this client is to stop skin breakdown as a result of incontinence and prolonged immobility. The client, secondary to multiple sclerosis (MS), cannot mobilize on his or her own and thus is applying pressure to skin areas. Incontinence exacerbates the risk by keeping skin wet, and skin irritation and breakdown develop. These conditions, if left unchecked, may progress to slow healing, painful pressure ulcers, and may lead to infections. To prevent such, regular repositioning, dryness, and application of protective barrier creams in nursing care is crucial. The integrity of the skin is crucial in maintaining the health, quality of life, and comfort of the patient. Prevention of skin complications and promotion of healing is through timely detection of skin problems, regular skincare, and interventions (Montero-Odasso et al., 2022).

Create a plan related to your priority concern. What is the goal? What outcome are you striving for to promote, maintain, or restore your resident’s health?  Be specific and discuss outcomes you believe are obtainable during your 4-week clinical experience. It should be something you can do or assist with as a student nurse.  Care Plan and Goals The primary goal is to maintain skin integrity by preventing pressure sores. Due to incontinence and lack of movement, she is at serious risk of developing painful sores and subsequent infections and complications. The course of treatment is to reposition frequently, keep skin adequately moist, and keep skin properly hygienic. Repositioning the person every two hours is also required to take pressure off sensitive areas, promote circulation, and reduce the risk of ulcers. Control of moisture is accomplished by frequent incontinence product changes, application of absorbency pads, and application of skin protection creams to maintain skin free of irritation. Maintenance of skin dryness and cleanliness through good hygiene is also required to promote skin health and healing. In addition, good nutrition and fluids will also contribute to skin health and healing. Expected Outcomes: The patient’s skin is clear and free of any evidence of breakdown. Moisture levels are properly regulated to avoid irritation. The patient feels greater comfort and better hygiene. By implementing such practices, skin harm is prevented, healing is accelerated, and general health is maximized for the individual. Adjustments and frequent evaluation ensure continued effectiveness in skin maintenance.

Take action. Determine three nursing interventions that address your priority concern and provide a rationale on how the interventions promote your resident’s health. Discuss how they will be implemented. These should come from a medical reference.  Nursing Interventions Skin Care Management  Check the skin on a daily basis for redness, sores, or irritation. Reposition the patient every two hours to relieve sensitive areas. Use moisture-absorbing materials and barrier creams to dry and protect skin (Campbell & Samolyk, 2020).  Rationale: Pressure ulcers, common in incontinent and bedridden individuals, are prevented by frequent repositioning and moisture control. Hygiene and Moisture Control Change incontinence underwear daily to keep yourself dry. Keep the skin dry and clean by using soft towels and gentle cleansers. Encourage adequate fluid intake to ensure skin moisture and overall health.  Rationale: Proper hygiene reduces irritation, prevents infections, and promotes overall skin health. Mobility Support and Comfort Assist with transfers by using safe body mechanics to prevent skin shearing. Engage the patient in light physical activity to stimulate circulation.  Use pressure-relieving mattresses and cushioning to reduce prolonged skin contact against surfaces. Rationale: Supporting mobility reduces prolonged skin pressure, boosts circulation, and enhances overall health.

Evaluate the effectiveness of each intervention for your priority assessment concern. Did the intervention promote, maintain, or restore health?  Effectiveness of Interventions Skin Care Management Regular repositioning and moisture control effectively relieved skin irritation and prevented pressure sores. The skin on the patient stayed intact, and no breaks or sores appeared. Continuous monitoring made early redness detection possible, thus enabling timely intervention. Hygiene and moisture control Frequent changes of incontinence garments and application of skin protection creams kept the skin dry and safe. Hygiene practices minimized irritation and kept infections under control, and healthy skin ensued (Campbell & Samolyk, 2020).  Mobility Support and Comfort Using pressure-relieving cushions and transfers relieved prolonged pressure on sensitive tissues. Encouraging light activity helped to improve circulation and skin integrity. The patient complained less and reported greater comfort and less discomfort due to prolonged immobility.

Evaluate the overall progression towards the goal for your priority concern for your assigned resident. Was the goal achieved?  Why or why not? Would you keep this goal or change it?        The goal of maintaining skin integrity was achieved to some extent. The repositioning and moisture control did not allow any development of new pressure ulcers, and the skin of the patient remained healthy. Redness and light irritation were evident on occasions, and hence, regular monitoring and adjustment in treatment strategies were required.       The use of incontinence supplies, barrier creams, and better hygiene practices helped to minimize skin irritation and reduce infection. Mobility promotion also benefited circulation and helped to maintain skin health. As the general situation is better, there is nonetheless a challenge in preventing skin irritation altogether.      Moving forward, skin integrity is always kept a priority, but in addition, fine-tuning skincare interventions, optimizing repositioning regimens, and education on the maintenance of moisture and hygiene are crucial. Re-assessments and individual adjustments on an ongoing basis will provide better overall health and quality of life for the patient.

References

Campbell, J., & Samolyk, M. (2020). Skin injury prevention and treatment in the older person: Reframing our approach in the community. British journal of community nursing, 25(Sup9), S6-S26.  https://www.magonlinelibrary.com/doi/abs/10.12968/bjcn.2020.25.Sup9.S6

Montero-Odasso, M., Van Der Velde, N., Martin, F. C., Petrovic, M., Tan, M. P., Ryg, J., & Masud, T. (2022). World guidelines for falls prevention and management for older adults: A global initiative. Age and Ageing, 51(9), afac205. https://academic.oup.com/ageing/article-pdf/51/9/afac205/52209676/afac205.pdf

Motl, R. W. (2020). Exercise and multiple sclerosis. Physical Exercise for Human Health, 333–343. https://www.awin1.com/cread.php?pref1=groobox.com&awinmid=26429&awinaffid=685769&clickref=lb_mv8b3b0-0-groobox.com&p=https%3A%2F%2Flink.springer.com%2Fchapter%2F10.1007%2F978-981-15-1792-1_22

Orenstein, G. A., & Lewis, L. (2022). Eriksons stages of psychosocial development. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556096/

Soe, Y. N. (2024). Nursing interventions to prevent pressure injuries among elderly residents in nursing homes. https://www.theseus.fi/bitstream/handle/10024/856224/Yee_Soe.pdf?sequence=2

Tervo-Heikkinen, T., Heikkilä, A., Koivunen, M., Kortteisto, T., Peltokoski, J., Salmela, S., & Junttila, K. (2023). Nursing interventions in preventing pressure injuries in acute inpatient care: A cross-sectional national study. BMC nursing, 22(1), 198. https://link.springer.com/content/pdf/10.1186/s12912-023-01369-8.pdf

• Identify a microethical and macroethical dilemma that might occur in health care organizations.
• Provide an example of a legal case law to support your discussion response.

Overview

Health care administrators often face ethical dilemmas and the need to make challenging decisions in their work. It is crucial for them to comprehend the connections and differences between ethical behaviors and legal issues. Ethics committees within healthcare institutions play a central part in safeguarding patients’ rights and protecting the organization and its staff.

Imagine yourself as a health care administrator in a large medical center. You have been assigned to present a paper at a professional conference focusing on medical ethics and caregiver-patient interactions. Your task is to write an investigative brief, examining a significant ethical dilemma between a physician and a patient in a medical setting, defending the decisions and conclusions made.

Preparation

Refer to the linked resource below, which presents various ethical case studies involving patients, families, and the interdisciplinary team. Choose a scenario from this resource or select a case from another source of your choice.

• Medical Ethics and Physician-Patient Encounters: Case Studies and Best PracticesLinks to an external site..

Instructions

Prepare a 3-5-page brief in which you:

1. Present a brief from the perspective of a lead administrator addressing the ethical dilemma involving a caregiver-patient interaction discussed in the chosen case study.
2. Apply ethical and moral theories to the chosen case study.
3. Identify the ethical concerns and potential outcomes associated with the selected case study.
4. Propose a solution to address and resolve the ethical issues raised in the selected dilemma, providing a well-supported ethical justification.
5. Cite at least 3 peer-reviewed articles less than five years old to support your investigation, including in-text citations. Use proper SWS formatting./li>
6. Meet clarity, writing mechanics, and SWS formatting requirements.

Formatting Requirements

• Subheadings: Use bold subheadings to divide the report into sections that correspond to the areas listed in the instructions.
• Length: Ensure that your brief consists of 3-5 pages, plus a title page and sources page, making the total length of the brief 5-7 pages.
• Citations: This course requires the use of Strayer Writing Standards (SWS). The library is your home for SWS assistance, including citations and formatting. Please refer to the Library site for all support. Check with your professor for any additional instructions.

The specific course learning outcome associated with this assignment is:

• Defend a position on an ethical dilemma based on ethical principles.

This week’s focus is on how program evaluations are a part of data-driven decision making, and evaluators systemically collect and analyze data to understand programs.

Engage in a conversation with your course community and respond to one of the following:

• What is your comfort level with data-driven decision making? What do you think of it?
• What is your past experience with data-driven decision making?

As always, if you are relying on someone else’s ideas when presenting yours, you should reference their paper, article, et cetera. This includes sharing references to your fellow students’ ideas

Write a 2-page paper that addresses the following components. Be sure to include references to
Learning Resources, including media.
Explain how immigrants at Ellis Island must have felt when presented with questions that may not
have made any sense to them. (Note: After taking the Chitling and Australian tests, you may be able
to relate.) Discuss whether or not you have ever felt that standardized tests did not accurately assess
your abilities. Why or why not?
Though many common standardized tests, including IQ tests, are considered to be dependable and
valid, is it possible that they are biased simply because they were made with one cultural view of
intelligence in mind? Further explain your thoughts on the issue of bias in intelligence testing based
on your readings and activities this week.
Compare your own view of intelligence with the various perspectives studied this week. What
cultures have perspectives similar to yours?
Do you believe that intelligence can be measured in a way that is fair to everyone? Describe how you
would assess abilities and potential fairly.
Support the responses within your assignment with credited evidence from the assigned learning
resources (including sentence-level citations). Provide a reference list in APA Style for resources you
used in the assignment.

Week 9 Assignment

• Information Systems for Business and Beyond Questions:
• Chapter 9 – study questions 1-10, Exercise 3 &4. 

• Describe the role of a systems analyst.
• What are some of the different roles for a computer engineer?
• What are the duties of a computer operator?
• What does the CIO do?
• Describe the job of a project manager.
• Explain the point of having two different career paths in information systems.
• What are the advantages and disadvantages of centralizing the IT function?
• What impact has information technology had on the way companies are organized?
• What are the five types of information-systems users?
• Why would an organization outsource?

Exercise –

• How is the IT function organized in your school or place of employment? Create an organization chart showing how the IT organization fits into your overall organization. Comment on how centralized or decentralized the IT function is.

• What type of IT user are you? Take a look at the five types of technology adopters and then write a one-page summary of where you think you fit in this model.

2) Information Technology and Organizational Learning Questions

• Chapter 7 – Review the section on dealing with multiple locations and outsourcing.  Review figure 7.2 and note how virtual team communications further reiterate the importance of this model.

The above submission should be one page in length and adhere to APA formatting standards.

**Remember the page length does not include the APA cover page or any references**

Note the first assignment should be in one section and the second section should have the information from the Information Technology and Organizational Learning assignment.  The paper requirements for the two-pages applies to the second part of the assignment directly related to the Information Technology and Organizational Learning assignment.

Text Book –

• Information Systems for Business and Beyond Questions:

Cover

• Text book attached to this.

Discussion

After reading Chapters 1 and 2 of the Preece text, what does interaction design mean to you? You are required to write a statement that is LIMITED to 200 words . This is an opinion question; therefore, research is not required. Should you cite the work of others, please provide the source of your opinion in APA format.

• Explain how your personal, academic, and professional goals align with Walden University’s vision, mission, social change outcomes, and SDoH framework. Be specific and provide examples. 

My Goal aligns with health equality, access to care, and reducing disparities, mental Health Stigma in Minority Populations and cultural competency in mental health care.

• Explain how your personal, academic, and professional goals align with AACN’s The Essentials.
• Explain how you plan to incorporate a commitment to social change into your program of study (DNP) and professional practice

• Reflect on nursing practice to identify issues of particular interest or concern to you and/or your organization. 
• Identify a practice or organization issue (Select something that involves Mental Health, Mental Health Stigma and cultural competency in mental health care).

a. Explain why you chose it.

               b. Select two middle-range theories that you believe are relevant and valuable in addressing the practice or organization issue you selected. Explain why you chose them. 

               c. Explain how you would apply each middle-range theory to the practice or organization issue. Be specific and provide examples. 

• Health Belief Model

 a. Describe the interdisciplinary theory (Health Belief model). 

b. Describe the practice or organizational issues you selected in question one

c. Explanation of how the theories selected above align with and can be applied to the practice or organization issue you selected 

(Be specific and cite at least two recent, peer-reviewed articles—published within the last 5 years—to support your points.)

• a. Describe one example you observed in which evidence-based practice (EBP) has been utilized in nursing- please incorporate something about mental health. Explain why it has been successful.

b. Describe one example you observed in which EBP has not been utilized. Explain why it has not been successful. Then, explain how utilizing evidence could help make the nursing practice more successful.