Case Study 1
The main objective of any healthcare organization is to provide its patients with the required medical care and assistance to insure maximum satisfaction. In order to measure the quality of care given to the patients, a quality performance tool, PATH is usedCITATION Oli08 p 157 l 1033 (Oliver Groene 157). This tool consists of various performance indicators which include
Clinical Effectiveness is deduced from the mortality rates, rate of readmission, return to ICU, timely medication administration, responsiveness of the medical staff, and usage of the antibiotics.
Safety which is based on wellbeing of the patient throughout the process of medical checkup and assistance.
Efficiency is evaluated through the competency of the staff and their response time with the patients.
Responsive governance is based on the swiftness in the care provided by the medical staff to the patient.
Patient Centeredness is based on the satisfactory level of the patient according to the satisfaction survey.
Nursing care is one of the most vital factors is raising the satisfactory level of the patients. The patients would be more likely to have a high satisfaction level when they receive high quality nursing care and vice versaCITATION Ton11 p 504 l 1033 (Tonio Schoenfelder 504). However, patient care can be different for different patient. For instance, a COPD patient would require the following evidence based care:
Light workload on the medical staff in order that they may be able to cater to the patient’s needs more efficiently.
Skilled and competent nurses should be given a priority over others during the hiring process.
In case of COPD patients, oxygenation is a vital step which should never be overlooked.
The usage of the antibiotics needs to be appropriate to underlie the infection along with the usage of steroids.
Consent of the procedure and medical actions from the patient should be taken beforehand.
Feedback from the patient should be taken to ensure them that their perspective matters as well.
Case Study 2
The first home care visit would involve three tasks which include checking the patient’s IV, dressing of the wound, and the oxygen saturation levels of the patient. The signs of an IV infiltration include damp dressing, inflammation either at or near the area along with the swollen skin, no backflow of blood into IV tubing, and reduced or completely stopped infusionCITATION McC12 p 13 l 1033 (McCallum 13).
The responsibilities during the home care visit are divided into two categories which include the assessments and the responsibilities of the medical staff. The nursing assessments and evaluations that would be required are categorized into three categories which include:
Inspecting the dressing site for any signs of infection.
Checking the oxygen saturation for its optimal value.
Checking the day to day activities along with any impact they may have on the treatment.
In addition to that, there are also a few managerial tasks involved which the nurses would have to keep account for. These management tasks include:
Using aseptic precautions, providing the patient with the required dressings.
Administration of the patient’s IV Zosyn.
Providing the patient with the right saturation of oxygen.
Providing the patient with a comfortable position.
If needed, perform a chest physiotherapy on the patient.
Recommend the patient to drink as many fluids as possible.
Advice the patient to perform daily routine activities in accordance with the well-being.
If colostomy care is required, provide the patient with it and teach the patient or any other significant accompanying him/her to perform colostomy care.
Teach the patient various breathing and relaxation exercises.
Case Study 2
In this case, four nursing diagnosis are relevant which include the following:
Due to the presence of surgical incision as shown by the reports of pain and facial grimacing, the patient may be experiencing an acute pain.
Due to the postoperative restrictions, inflammation of the peritoneum along the fluid’s sequestration, the patient may experience the risk of deficient fluid volume.
The risk of infection because of appendix rupture, invasive medical procedures, surgical incision.
Information misinterpretation show by questions and verbal concerns of the patient or the lack of professional experience.
When the medical staff agrees on one diagnoses, they can initiate its treatment. The plan of action that contributes to the outcome criteria of the patient’s well-being includes the following steps:
Prioritizing the diagnosis
Determination of the outcome criteria
Based on the evidences given, determine the short-term and long-term goals of the medical staff
Perform a problem-oriented assessment to specify the problem
Check reports, data, and other validations and interpret them
Define a specified and technical plan of action to achieve the plan of action.
The nursing diagnoses and the collaborative problems approach are both used to identify the condition of the patient which would require medical assistance.
Nursing diagnoses is an approach which classifies the health problems based on the domain of nursing. Moreover, it is the second step in the overall nursing process. In other words, it is the clinical judgment of the nurse based on his/her observations, authority, and competency to treat the patient. Usually the patient is involved in this process at every stage.
The collaborative problems approach deals with the physiological problems that the patient is facing or may face according to the patient’s current statusCITATION Eug16 p 129 l 1033 (Eugenia Ercole?Fricke 129). Moreover, the nurses operate in a collaboration with other departments as well when needed. For instance, the nurses would collaborate and manage problems such as paralysis with the medical staff, the nursing staff and the allied health staff.
Case Study 2
Health promotion is the process which involves enabling individuals to gain control and improve their health. It does not merely focus on the individual behavior but also the environmental and social interventions of that individualCITATION Kum12 p 6 l 1033 (Kumar S 6). The purpose of health promotion is to influence individuals and communities to develop a healthier lifestyle by working together. It focuses on both promotion of health and prevention of diseases. In this case, the nurses use this strategy to influence the children to promote healthy activities and changing those behaviors of the children which may put them at risk of diseases.
Becker’s health relief model deals with the relationship between an individual’s beliefs and his actions. Moreover, it promotes health within individuals through four variables which include perceived severity, perceived benefits, perceived susceptibility, and perceived barriersCITATION Jon15 p 567 l 1033 (Jones CL 567).
The four components of health promotion are described below:
Perceived susceptibility: The first component involved the individual’s perception of susceptibility towards the illness. For instance, everyone knows that smoking is injurious to health, but people still smoke because they assume that the percentage of them getting cancer because of smoking is very lowCITATION MJJ04 p 278 l 1033 (MJ 278).
Perceived severity: The second component deals with a person’s perception of the disease and its severity to cause harm.
Perceived benefits: The third components deals with the individual’s perception of the importance of the benefits gained in order to avoid the disease. It also characterizes the change in behavior a person is willing to do for it.
Perceived barriers: The fourth component involves the barriers which may hinder or stop the individual from gaining the benefits. For instance, a person may not be able to part-take in healthy behavior due to a barrier he/she may be facing.
Case Study 1
The first degree relatives of Mrs. Johns include her parents and her two brother. The diseases of each are given below:
Mother: diabetes, hypercholesterolemia, stroke, hypertension, and colon cancer.
Father: stroke, hypertension, smoker, hypercholesterolemia, heart attacks, renal steroids, alcoholism, and adult onset diabetes.
First brother: hypertension, adult onset diabetes, and hypercholesterolemia.
Second brother: healthy (no known or significant diseases)
Based on the information given, the diseases related to the genetics within their family include hypertension, hypercholesterolemia, adult onset diabetes, heart attack, and heart stroke. Moreover, one of the brother in her family is healthy and shows no sign of any such diseases. However, that is because mutation within genetics does not necessarily affect all members rather a ratioCITATION Sch13 p 644 l 1033 (Schäffer 644). The fact that one of her brother remained unaffected is purely coincidental.
The second degree relatives of Mrs. Johns include her maternal grandparents, paternal grandparents, first cousins, and two of her mother’s siblings. The diseases of each of the relatives are given below:
Maternal grandmother: hypertension, stroke
Maternal grandfather: hypertension, heart attack
Paternal grandmother: heart attack
Paternal grandfather: alcoholism
First cousin (Mabel): colon cancer, stroke, hypercholesterolemia, adult onset diabetes, hypertension.
First cousin (George): Hodgkin Lymphoma
Patient’s mother’s sister (first): hypertension, hypercholesterolemia
Patient’s mother’s brother (second): hypercholesterolemia, adult onset diabetes, renal cancer, hypertension, smoker, heart attack.
Based on the information given it can be deduced that the genetic-related diseases among the patient’s second relatives include hypertension, hypercholesterolemia, adult onset diabetes, heart attack, and heart stroke. The diseases are the same as that of the first relatives which shows that these diseases are being carried down within the entire familyCITATION Sch13 p 645 l 1033 (Schäffer 645).
Case Study 2
The local inflammation in Mary’s foot was caused due to the leukocyte cells at the point of injury to fight of any infectious cells from entering the body. This in return causes redness, swelling and inflammationCITATION Pun04 p 2 l 1033 (Punchard 2).
Both histamine and kinin play a crucial role in the inflammatory process of the human body. In the event of an injury as of Mary, the mast cells release pro inflammatory mediators which are histamine and kinin. Histamine is a vasoactive peptide, while kinin is a bioactive peptide when their reaction takes places, vasodilation is given as a result which smooths muscle contractions and eases the body. As a result of that, leaky capillaries are formed which cause edema swelling pain and hyperalgia which cause inflammation on the injuryCITATION Pun04 p 4 l 1033 (Punchard 4). However, histamine is particularly released by the body to the site of contact when the human body comes in contact with a pollen or animal dander.
Mary exhibits the following five cardinal signs of inflammation:
Discharge of a liquid from the wound
Systemic effect of fever should be assessed by the nurse because of the infection and to reduce its chances of spreading.
Case Study 1
Patients who are diagnosed with cancer tend to have heightened emotions because of the fear that they may be dyingCITATION Nat12 p 1 l 1033 (National Cancer Institute 1). It is because of that fear that the process of communication becomes difficult with the patients. In addition to that, Mrs Perez is in her reproductive age which influences the decision of removing her uterus all the more difficult.
Based on the information given, it is evident that the mother should be the ideal candidate for the interpretation because she would have a better understanding with her daughter and also because she is bilingualCITATION Sto14 p 144 l 1033 (Stoner 144). Mrs. Perez would trust her mother completely and that trust would influence the decision making process to run more smoothly in the effort to convince her to get her uterus removed in order to save her life.
Furthermore, Mrs. Perez’s family are devoted catholic which means that she would look for spiritual guidance and pray for a miracle. However, the priest who only speaks Spanish can also persuade her into carrying on with the operation in order to save her life and then devout herself to her prayers later on. Religious individuals such as Mrs. Perez tend to be easily persuaded by their religious leaders in the context that they are not doing anything wrongCITATION RBr16 p 460 l 1033 (R. Bret Leary 460).
In the event that both the mother and the priest are unable to persuade her in order to save her life, the assistance of a fellow social worker from her church can be taken, preferably a woman. Usually, women feel more at ease while talking about sensitive matters with other women which can be used to ease the decision making process as well.
First of all, the nurses would require to arrange an interpreter who can communicate the message effectively due to the patient being Hispanic. Secondly, her cultural aspects should also be taken into account regarding the Ash Wednesday, which is an important day for the Catholics with respect to their religion. Therefore, arranging a priest to guide her would greatly benefit the decision making process. Thirdly, the nurse should avoid giving out any information which may cause panic or misunderstanding due to the language barrier of Mrs. Perez. Lastly, her family and next of kin should be involved in all treatment plans which the medical staff would seem fit.
Case Study 2
Patients that are diagnosed with autosomal dominant disorder have a mutated gene which is the dominant gene and is located on one of the non-sex chromosomes or autosomes. In this disorder, only one mutated gene is required to be affected. For instance, if the father has one recessive gene and one dominant gene while the mother has both recessive genes, the probability of the children being affect is 50%CITATION Genes p 81 l 1033 (Genetic Alliance; District of Columbia Department of Health. 81). This means that at each pregnancy, the chances of the children being affected is almost half. Moreover, it is also not dependent on the gender of the children, rather the number of affected children are usually equalCITATION Genes p 82 l 1033 (Genetic Alliance; District of Columbia Department of Health. 82).
The nurse would be required to inform Mr. Wayne that the probability of his children being affected is 50% because is an autosomal dominant disorderCITATION Genes p 75 l 1033 (Genetic Alliance; District of Columbia Department of Health. 75). Moreover, the gender of the children would not create any difference of opinion within this ratio, rather the male and female ratio is also half-half.
As mentioned earlier in part A that the father would have one dominant and one recessive gene, while the mother has both recessive genes, it is possible that reduced penetrance or incomplete penetrance may occur due to the fact that all of the children would not be affected. Some of the children would not have the mutated allele, rather have both recessive genesCITATION Genes p 76 l 1033 (Genetic Alliance; District of Columbia Department of Health. 76).
Mr. Edwards is diagnosed with paraplegia which requires the patients to receive special treatment in order to heal. However, paraplegia is such a disease whose intensity varies with respect to the location and the extent of the damage done on that locationCITATION Nas15 p 10 l 1033 (Nas K 10). The first assistance that Mr. Edwards would require is to be provided with a comfortable wheel chair since he had left his own wheel chair back to his home. In addition to that, it is also recommended to get an electric wheelchair so that the patient may feel more comfortable. Secondly, the prevention of bed sores and pressure sores is also crucial which are caused by either the inability to properly move or applied pressure on the certain areas of the body. This is quite a crucial step during the process because if left unattended it can become painful for the patient. Lastly, the urinal tract catheter must be clean in order to avoid any infections.
The ideal method to improve Mr. Edwards’s health would be to encourage him to move or develop a hobby. This would ensure that there is constant motion in his body which would greatly reduce the chances of any bed sores or pressure soresCITATION Nas15 p 9 l 1033 (Nas K 9). When patients of paraplegia do not move around much the likelihood of bed sores and pressures sores increase quite significantly. Mr. Edwards would require a thorough prevention education to increase his health. Relying solely on the antibiotics for the health improvement is a very costly and slow method. However, by moving around and keeping the body in constant motion, the healing process would be greatly improved. Moreover, there is also a surgery involved in the treatment plan after which the patient would require guidance in order to increase his health and recover as soon as possible.