Death And Dying Part 2

Appendix F – Death and Dying

Ticket to class: Place in dropbox prior to the start of class At least 50 words in each response Give the questions some thought and answer honestly Number your answers to correspond with the question Worth 12 points/5%

Questions: What will be important to you when you are dying? What limitations to your physical and mental health would affect the health care decisions you would make? Would you prefer hospice care with the goal of keeping you comfortable in your home during the final period of your life, as an alternative to hospitalization? In general, do you wish to participate or share in making decisions about your health care and treatment? Would you always want to know the truth about your condition, treatment options, and the chance of success of treatments? What are the most comforting and frightening aspects of dying? Give examples.

The Pathophysiology Of Disorders 19497287

you have explored various body systems: neurological, cardiovascular, respiratory, and hematological. These four systems work together along with other body systems to complete a myriad of functions. For this reason, when disorders occur within one body system, it can create potentially devastating effects throughout the entire body. For instance, Parkinson’s disease is a disorder of the central nervous system, yet its alterations actually affect multiple body systems from the cardiovascular system to the gastrointestinal system. In this Assignment, you examine alterations associated with disorders, as well as the impact of the alterations on multiple body systems.

To Prepare From the list below, select a disorder of interest to you: Alzheimer’s disease Asthma in children Chronic obstructive pulmonary disease (COPD) Congestive heart failure Hepatic disease (liver disease) Hypertension Hyperthyroidism and hypothyroidism Seizures Sepsis Identify alterations associated with your selected disorder. Consider the pathophysiology of the alterations. Think about how these alterations produce pathophysiological changes in at least two body systems. Reflect on how patient factors such as genetics, gender, ethnicity, age, and behavior might impact the pathophysiology of the alterations you identified, as well as the diagnosis and treatment of your selected disorder.  Review the “Mind maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology and clinical presentation of your selected disorder.

To Complete

Develop a 5- to 10-slide PowerPoint presentation that addresses the following: Describe your selected disorder, as well as associated alterations. Explain the pathophysiology of the alterations, including changes that occur in at least two body systems. Explain how genetics, gender, ethnicity, age, and behavior might impact the pathophysiology of the alterations you identified, as well as diagnosis and treatment of your selected disorder. Construct a mind map for the disorder you selected. Include the epidemiology, pathophysiology of alterations, risk factors, and clinical presentation, as well as the diagnosis and treatment of the disorder. APA Citation, 4 to 5 References within 5 years.

Professional Development Plan 19485117

  

In a Microsoft Word document of 5–6 pages formatted in APA style, develop a strategic plan to aid your transition into the role of a professional nurse. In your paper:

· Discuss factors influencing your decision to obtain a BSN degree.

· Discuss how the role of the baccalaureate differs from your current role.

· Describe new opportunities that may be available after degree completion.

Examine one of the two models of socialization discussed in your readings and place yourself in one of the stages. Give your rationale for that placement. If none of the models or stages fits your experience, create your own model (or stage).

· Identify two professional short-term goals.

· Identify two professional long-term goals.

· Expound upon the challenges and barriers you face in pursuit of your short- and long-term goals.

· Identify mentors and support systems to aid you in overcoming challenges and barriers necessary to achieve goals.

On a separate references page, cite all sources using APA format.

· Use this APA Citation Helper as a convenient reference for properly citing resources.

· This handout will provide you the details of formatting your essay using APA style.

· You may create your essay in this APA-formatted template.

Wk 10 Discussion 19495511

Sampling and Collecting Quantitative and Qualitative Data

Specific methods of data collection (e.g., surveys, interviews, observations) produce specific types of data that will answer particular research questions, but not others; so here too, as covered in previous weeks, the research questions inform how the data will be obtained.  Furthermore, the method used to collect the data may impact the reliability and the validity of that data.

For this Discussion, you will first consider sampling strategies. Then, you will turn your attention to data collection methods, including their strengths, limitations, and ethical implications. Last, you will consider measurement reliability and validity in the context of your discipline (Healthcare Science).

With these thoughts in mind, use Position A, to complete your discussion.

Position A: Probability sampling represents the best strategy for selecting research participants.

Write a Post: A restatement of your assigned position on sampling strategies. Explain why this position is the best strategy for selecting research participants. Support your explanation with an example and support from the scholarly literature. Next, select a data collection method (e.g., surveys, interviews, observations) and briefly explain at least one strength and at least one limitation. Then, identify a potential ethical issue with this method and describe a strategy to address it. Last, explain the relationship between measurement reliability and measurement validity using an example from your discipline.

Be sure to support your Main Issue Post and Response Post with reference to the week’s Learning Resources and other scholarly evidence in APA Style.

Resources for the week:

Teddlie, C., & Yu, F. (2007). Mixed methods sampling: A typology with examples. Journal of Mixed Methods Research, 1(1), 77–100. 

Mixed Methods Sampling: A Typology with Examples by Teddlie, C., & Yu, F., in Journal of Mixed Methods Research, Vol. 1/Issue 1. Copyright 2007 by Sage Publications Inc. Reprinted by permission of Sage Publications Inc. via the Copyright Clearance Center.

Onwuegbuzie, A. J., & Collins, K. M. (2007). A typology of mixed methods sampling designs in social science research. The Qualitative Report, 12(2), 281–316. Retrieved from http://nsuworks.nova.edu/tqr/vol12/iss2/9

Drost, E. A. (2011). Validity and reliability in social science research. Education Research and Perspectives, 38(1), 105–124.

Walden University: Center for Research Quality. (2015a). Data resources & support: Home. Retrieved from http://academicguides.waldenu.edu/researchcenter/dataresources 

Download the “Sources of Data for Research: A Research Primer” document.

Walden University: Center for Research Quality. (2015d). Research resources: Walden University participant pool. Retrieved from http://academicguides.waldenu.edu/researchcenter/resources/participantpool 

Walden University. (2015a). How do I find an article that reports on research that uses a specific methodology? Retrieved from http://academicanswers.waldenu.edu/faq/72633  

Walden University: Writing Center. (2015). Common course assignments: Annotated bibliographies. Retrieved from http://academicguides.waldenu.edu/writingcenter/assignments/annotatedbibliographies 

Evidence Based Paper 19912705

PRESSURE ULCERS

Goals: While the intervention will not actually be carried out, the student will discuss the plan that could be implemented by a nurse to address the clinical issue. One short-term and one long-term goal of the intervention will be identified. The student will include a description of how attainment of each of the goals would be measured.

Develops a minimum of one short-term goal.

Develops a minimum of one long-term goal.

Includes the ways in which attainment of each of the goals will to be measured.

NO MORE THAN 2 PAGES…

THIS IS A GROUP PROJECT SO THIS IS MY PORTION.

Reflection 19933223

Reflect on the usefulness of principlism as a framework for bioethics in nursing. How have your academic efforts impacted your professional understanding of legal and/or ethical issues?

Week 1 National Practice Problem Exploration 19967649

Week 1: National Practice Problem Exploration

Evidence translation begins with the identification of a problem or concern. Reflect upon the eight national practice problems presented in the Global Burden of Disease Research. Select one of the practice problems to address the following.

· From a global/nationwide perspective, how does the selected practice problem impact nurses, nursing care, healthcare organizations, and the quality of care being provided?

· Identify the national level key stakeholders who are affected by the practice problem and stakeholders involved in resolution.

· Are clinical practice guidelines used to address this problem? Why or why not? If used, provide a brief overview of the CPG. If a CPG is not used, propose an intervention that could be implemented on a national scale to address the problem.

APA Formate 

I NEED A COMMENT FOR THIS POST WITH AT LEAST TWO PAGE ( 4-6  PARAGRAPH AND  SOURCES NO LATER THAN FIVE YEARS

Medscape Assignment

Short, easy! 

 

Medscape assignments: Sign into your Medscape.com account. Search for “Putting GI Risk in Perspective: How Safe are OTC Analgesics?” in the search bar – linked below for your convenience.(You will need to copy and paste url into a new tab).   https://www.medscape.org/viewarticle/931873 (Links to an external site.)

Once you complete  the Medscpae CME, upload your completion certificate to the assignment submission in Canvas. Log back into Medscape, Click on the middle heading of CME and education, in the top right corner will be a box that says view tracker- click that.  If you scroll down you will see your completions listed. One of the options on the right side of the screen will be to view your certificate.  

Theories 19480169

Submit a paper which compares and contrasts two mental health theories: You may choose your theories from the textbook or from other sources. Describe each theory, including some history about the person who developed the theory and the major ideas and applications of the theory. Describe the ways in which the two theories are similar, and how they differ. Include a statement of how each theory could be used in your nursing practice. Include specific patient examples if you have them. You may also critique the theory: Is there anything with which you disagree or are there any problems you can identify? It is expected that this essay will be 2-3 pages in length (not including the title page), double-spaced. Your paper should include an introduction and conclusion and proper APA citations from any source material you use, including your text.

Nursing 19915997

INTRODUCTION

Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event, such as the one described in the scenario attached below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident. 

SCENARIO

It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.

Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, and R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at 10 out of 10 on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. Nurse J finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic back pain. After Mr. B’s assessment is completed, Nurse J informs Dr. T, the ED physician, of admission findings, and Dr. T proceeds to examine Mr. B.

Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of Mr. B’s arrival, the ED staff is caring for two other patients. One patient is a 43-year-old female complaining of a throbbing headache. The patient rates current pain at 4 out of 10 on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight-year-old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by Dr. T and are awaiting further treatment or orders.

After evaluation of Mr. B, Dr. T writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication hydromorphone is administered IVP at 4:15 p.m. After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician’s goal is for the patient to achieve skeletal muscle relaxation from the diazepam, which will aid in the manual manipulation, relocation, and alignment of Mr. B’s hip. The hydromorphone IVP was administered to achieve pain control and sedation. After reviewing the patient’s medical history, Dr. T notes that the patient’s weight and current regular use of oxycodone appear to be making it more difficult to sedate Mr. B.

Finally, at 4:25 p.m., the patient appears to be sedated, and the successful reduction of his (L) hip takes place. The patient appears to have tolerated the procedure and remains sedated. He is not currently on any supplemental oxygen. The procedure concludes at 4:30 p.m.,and Mr. B is resting without indications of discomfort and distress. At this time, the ED receives an emergency dispatch call alerting the emergency department that the emergency rescue unit paramedics are enroute with a 75-year-old patient in acute respiratory distress. Nurse J places Mr. B on an automatic blood pressure machine programmed to monitor his B/P every five minutes and a pulse oximeter. At this time, Nurse J leaves Mr. B’s room. The nurse allows Mr. B’s son to sit with him as he is being monitored via the blood pressure monitor. At 4:35 p.m., Mr. B’s B/P is 110/62 and his O2 saturation is 92%. He remains without supplemental oxygen and his ECG and respirations are not monitored.

Nurse J and the LPN on duty have received the emergency transport patient. They are also in the process of discharging the other two patients. Meanwhile, the ED lobby has become congested with new incoming patients. At this time, Mr. B’s O2 saturation alarm is heard and shows “low O2 saturation” (currently showing a saturation of 85%). The LPN enters Mr. B’s room briefly, resets the alarm, and repeats the B/P reading.

Nurse J is now fully engaged with the emergency care of the respiratory distress patient, which includes assessments, evaluation, and the ordering of respiratory treatments, CXR, labs, etc.

At 4:43 p.m., Mr. B’s son comes out of the room and informs the nurse that the “monitor is alarming.” When Nurse J enters the room, the blood pressure machine shows Mr. B’s B/P reading is 58/30 and the O2 saturation is 79%. The patient is not breathing and no palpable pulse can be detected.

A STAT CODE is called and the son is escorted to the waiting room. The code team arrives and begins resuscitative efforts. When connected to the cardiac monitor, Mr. B is found to be in ventricular fibrillation. CPR begins immediately by the RN, and Mr. B is intubated. He is defibrillated and reversal agents, IV fluids, and vasopressors are administered. After 30 minutes of interventions, the ECG returns to a normal sinus rhythm with a pulse and a B/P of 110/70. The patient is not breathing on his own and is fully dependent on the ventilator. The patient’s pupils are fixed and dilated. He has no spontaneous movements and does not respond to noxious stimuli. Air transport is called, and upon the family’s wishes, the patient is transferred to a tertiary facility for advanced care.

Seven days later, the receiving hospital informed the rural hospital that EEG’s had determined brain death in Mr. B. The family had requested life-support be removed, and Mr. B subsequently died.

Additional information: The hospital where Mr. B. was originally seen and treated had a moderate sedation/analgesia (“conscious sedation”) policy that requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedure and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void). All practitioners who perform moderate sedation must first successfully complete the hospital’s moderate sedation training module. The training module includes drug selection as well as acceptable dose ranges. Additional (backup) staff was available on the day of the incident. Nurse J had completed the moderate sedation module. Nurse J had current ACLS certification and was an experienced critical care nurse. Nurse J’s prior annual clinical evaluations by the manager demonstrated that the nurse was “meeting requirements.” Nurse J did not have a history of negligent patient care. Sufficient equipment was available and in working order in the ED on this day.

REQUIREMENTS

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Explain the general purpose of conducting a root cause analysis (RCA).

1. Explain each of the six steps used to conduct an RCA, as defined by IHI.

2. Apply the RCA process to the scenario to describe the causative and contributing factors that led to the sentinel event outcome.

B. Propose a process improvement plan that would decrease the likelihood of a reoccurrence of the scenario outcome.

1. Discuss how each phase of Lewin’s change theory on the human side of change could be applied to the proposed improvement plan.

C. Explain the general purpose of the failure mode and effects analysis (FMEA) process.

1. Describe the steps of the FMEA process as defined by IHI.

2. Complete the attached FMEA table by appropriately applying the scales of severity, occurrence, and detection to the process improvement plan proposed in part B. 

Note: You are not expected to carry out the full FMEA.

D. Explain how you would test the interventions from the process improvement plan from part B to improve care.

E. Explain how a professional nurse can competently demonstrate leadership in each of the following areas:

• promoting quality care

• improving patient outcomes

• influencing quality improvement activities

1. Discuss how the involvement of the professional nurse in the RCA and FMEA processes demonstrates leadership qualities.

F. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

G. Demonstrate professional communication in the content and presentation of your submission.

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RUBRIC

please the following link to IHI