Category: Nursing homework help

Not all Evidenced Based Practice projects result in statistically significant results. Define clinical significance, and explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project?

Your patient is a 23-year-old female with a history of headaches. This morning she was experiencing a really bad headache as her boyfriend was driving her to the university. He thought she was sleeping and by the time they got to the school, 45 minutes later, she was not waking up. She was diagnosed with a cerebral aneurysm and you are taking care of her in the Neurological ICU.
What testing do you expect to be performed to diagnose brain death?
What is the procedure when a patient is determined to be brain dead?
Who should approach the family about organ donation?
The family is approached about organ donation. The patient indicated on her driver’s license that she wanted to be an organ donor. Her mother refuses to consent for organ donation.
Do you think donation should happen anyway? Why or why not?
What will be the ethical consequences of your decision?

ANSWER

Testing to Diagnose Brain Death

To diagnose brain death, a series of tests will be performed to confirm the irreversible loss of all brain function. These tests may include:

Clinical examination: A thorough neurological examination will be conducted to assess the patient’s level of consciousness, brainstem reflexes, and pupillary responses.

Brainstem apnea test: This test assesses the patient’s ability to breathe spontaneously. If the patient does not breathe when carbon dioxide levels rise in their blood, it indicates a loss of brainstem function.

Ancillary tests: Additional tests may be performed to confirm brain death, such as electroencephalography (EEG), which measures brain activity, or cerebral angiography, which visualizes blood flow in the brain.

Procedure for Determining Brain Death

The diagnosis of brain death is made by a team of experienced medical professionals, typically neurologists and intensivists. The team will carefully review the patient’s clinical history, physical examination findings, and results of the diagnostic tests. A consensus diagnosis of brain death is reached when all neurological functions are determined to be irreversibly lost.

Who Should Approach the Family About Organ Donation

The decision to approach the family about organ donation typically falls upon the hospital’s organ procurement organization (OPO) team. The OPO team is responsible for identifying potential organ donors, educating families about organ donation, and coordinating the process of organ recovery and transplantation.

Family Refusal of Organ Donation

In the case of the 23-year-old patient, her mother’s refusal to consent for organ donation poses a challenging ethical dilemma. While the patient’s driver’s license indicates her wish to be an organ donor, the decision to donate ultimately rests with her next of kin, in this case, her mother.

Ethical Considerations

The ethical considerations surrounding this situation involve respecting the patient’s wishes, honoring the family’s decision, and recognizing the potential benefit of organ donation to save lives.

Respecting Patient Wishes: The patient’s clear indication on her driver’s license to be an organ donor suggests her desire to contribute to saving others’ lives. However, her wishes cannot be imposed upon her family, and their decision must be respected.

Honoring Family Decision: The patient’s mother’s decision to refuse organ donation reflects her own beliefs and concerns about the situation. Her autonomy as the patient’s next of kin must be acknowledged and respected.

Potential Benefit of Organ Donation: Organ donation has the potential to save and improve the lives of individuals awaiting transplants. Denying this opportunity can have significant consequences for those in need.

Conclusion

The decision to proceed with organ donation in this case is complex and involves balancing the patient’s wishes, the family’s decision, and the potential benefit to others. Ultimately, the decision rests with the patient’s mother, and her choice must be respected.

Final journal
Be sure you address all of the bulleted items. Use each bullet as a heading for your journal entry.
Explain what most excited and/or concerned you throughout your pediatric clinical experience.
Discuss how your personal definition of family and family roles has changed or stayed the same.
How has your understanding of family and family roles influenced your assessment of children and their families?
Explain how your understanding of culture (both the culture of the provider and that of the child and his or her family) has changed and how it may have influenced the assessments you conducted during your practicum.
Assess how you did with accomplishing the goals and objectives you developed in Week 1 for the Practicum experience.
Based on your Practicum experience, refine your existing goals and/or develop new goals for your continued education and professional practice. Be sure to consider the NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice Found in the Week 1 Learning Resources. See link below
National Association of Pediatric Nurse Practitioners, Professional Issues Committee. (2019). NAPNAP position statement on age parameters for pediatric nurse practitioner practice Links to an external site.. Journal of Pediatric Healthcare, 33(2), A9–A11. https://doi.org/10.1016/j.pedhc.2018.10.007

Report Instructions:
In your readings from the Catechism of the Catholic Church and the Compendium of the Catechism of the Catholic Church you gleaned a better understanding of the what the Catholic Church’s teachings are on specific theological topics.
You will now use the information gleaned in the text to delineate the teachings listed below in a concise manner:
Catholic Understanding of God as Trinity
Salvation is Achieved through the Paschal Mystery of Jesus Christ
Eschatology – Death and the Afterlife
Freedom
Virtues
Sin
Submission Instructions:
When completing this report, the following guidelines must be followed. Failure to do so will result in points being deducted from your grade:
This report must be typed in any 12 point non-ornamental font.
Each section of the report must include a section title on a separate line (ex: Freedom, Virtues, Sin, etc.).
Incorporate at least 2 direct quotations with appropriate footnotes in each of the 6 sections.

First quotation must come from the specific section of the Catechism of the Catholic Church in the required readings.
Second quotation with accompanying footnote must come from the specific section of the Compendium of the Catechism of the Catholic Church in the required readings.

The report should be formatted per current Chicago-Turabian style (CMOS) and at least 3 pages in length (at least .5 pages per section). A Works Cited page is not required.

Case Study
AJ is a 22-year-old male, whose family has recently located to south Florida from Colombia. AJ has had a high-speed motorcycle crash and sustained life-threatening injuries, including multiple rib fractures, a pelvic fracture, and a severe traumatic brain injury (TBI). He had difficulty breathing at the scene and was endotracheally intubated by paramedics en route, but only after much difficulty during which he experienced a 5-minute hypoxic period. He arrived at the trauma center with a Glasgow Coma Score (GCS) of 3. He is admitted to the intensive care unit with respiratory distress, anemia related to bleeding from his pelvic fracture, and altered mental status from his TBI. His primary nurse is Kevin, a Caucasian male from upstate New York. Kevin has 10 years of experience as an RN in critical care, and 5 years in his current position. Kevin is keenly aware of the long and complicated hospital course that AJ will likely experience.
AJ’s family arrives at the trauma center. They are brought to the intensive care unit to see AJ for the first time. His family consists of his mother, 52, his father, 54, two younger sisters ages 12 and 14, and an uncle (his father’s brother). They speak only Spanish, as they have been in the country for only 6 months. AJ’s parents do not allow his sisters to see him, as they are afraid they may be overwhelmed and faint. His father, mother, and uncle proceed to the bedside. They are shocked by the sight of AJ, whose body is swollen and has multiple severe skin abrasions and lacerations. AJ’s family is greeted by Kevin, his nurse. Kevin speaks some Spanish and he is able to communicate basic information to the family. AJ’s mother is very emotional, crying, and unable to focus well on what Kevin is telling them.
Kevin, NP B, the social worker, an interpreter, and AJ’s mother, father, and uncle meet in the unit conference room. NP. B, through the interpreter, describes AJ’s prognosis, multiple injuries, and what needs to be done at present. The prognosis for functional recovery is very poor, because of anoxic brain damage from the prolonged period when AJ was not able to breathe well. His other injuries are severe but likely survivable in a young healthy person. His pelvic fracture would need surgical repair, but because of AJ’s poor neurological prognosis, NP B recommends not doing the surgery. He explains that this is because AJ will not walk due to his brain damage and the surgery would be extensive and has risks. AJ’s family appears overwhelmed and tearful, and his mother is repeating prayers aloud in Spanish through her tears. Kevin provides emotional support. NP. B, knowing that the family will need time to process the prognosis, says he must leave but schedules another meeting in 2 days. The family asks if they may bring other family members to the next meeting, and the team agrees to the request.
AJ’s father has been appointed his health care surrogate. Further diagnostic testing has confirmed that AJ has significant anoxic brain damage, and his prognosis for neurological recovery is nil. As the interpreter relays this message from NP. B to the family group, many break out in tears and exclamations. AJ’s mother repeats, “No, no, no, it is not true” in Spanish while wringing her hands over and over. AJ’s father appears stoic but grim faced.
Who will make decisions about AJ’s care in the above scenario? Support response
Identify 2-3 factors that may influence the health care decision making in AJ’s situation?
Describe and apply provider decision-making behaviors that would be useful in the above situation.
What plans of care should be presented to the family and why? What priorities or elements should be the goal of care conferences for seriously ill patient’ such as AJ?
What are some effective communication strategies the APN should employ and consider in this situation?
Identify sources of conflict in health care decision making
Might the APN experience moral distress related to AJ’s family’s decision in the above scenario? Why or why not?

To Prepare:
Review the Congress website provided and identify one recent (within the past 5 years) proposed health policy.
-https://www.congress.gov
Review the health policy you identified and reflect on the background and development of this health policy.
Post a description of the health policy you selected and a brief background for the problem or issue being addressed. Which social determinant most affects this policy? Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples.
please include 3 references
APA format

Post a total of 3 substantive responses over 2 separate days for full participation. This includes your initial post and 2 replies to classmates or your faculty member.
Due Thursday
Respond to the following in a minimum of 175 words:
What is the most important reason to disseminate research? Explain your rationale and give specific examples from your experience.
Due Monday
Post 2 replies to classmates or your faculty member. Be constructive and professional.

1. When taking care of patients, why do you think it is important to utilize the appropriate resources?
2. How do you think evidence from nursing journals affects patient care?
3. What role does using the right evidence play in being a professional nurse?
4. What role does understanding plagiarism and academic integrity play in being a professional nurse?

You are working in a long-term care facility with your client Mr. M that experienced a stroke leaving him paralyzed on one side with expressive aphasia. His health insurance coverage for long-term care is only 180 days (total) per calendar year. When Mr. M arrived, the team met to coordinate services with the goal to discharge him home before the180 day limit was reached. Evaluating and measuring his progress has been difficult as they have experienced multiple problems. This has led to Mr. M. being readmitted on one occasion then returning to the long-term care facility. You are the care coordinator and need to be current on what is, and has been, happening across all settings to make sure his care is equitable and of high value to his outcome.
Address the following question and provide evidence to support it from our course materials or outside readings in your main post.
1. Mr. M’s problems required a readmission to the hospital within the first 20 days at your facility. What are the economic issues for him? Could this be a breakdown of the care coordination team? What steps could have been initiated to maintain Mr. M’s health so as not to have to be readmitted?

NITIAL POST: COMPREHENSIVE HEALTH ASSESSMENT PATIENT #2
The patient profile I have been assigned is a 35-year-old white male with a history of morbid obesity with disabilities in a rural setting. This is a new patient whom I am assuming I have never met before. The first step is to build a relationship with the patient, this fosters trust between the nurse and patient. “A primary objective is to discover the details about a patient’s concern, explore expectations for the encounter, and display genuine interest, curiosity, and partnership. Identifying underlying worries, believing them, and trying to address them optimizes your ability to be of help” (Ball, J. W., et al. 2019). A thorough health history is important as it lays the groundwork to not only build a relationship, but to efficiently diagnose a health issue or illness, and treat these health issues and illnesses.
Communication with this age group needs to include non-medical jargon so the patient will understand the information presented. Medical jargon can be used but needs to be followed up with what the medical term means. Open ended communication is important to use, this gives the patient the ability to “fill in the blanks” with pertinent information. For example, asking the patient why they came to see you today, what health concerns they want to talk about, and keeping the conversation going by asking if there is anything else they would like to talk about. This can be added numerous times during the assessment to keep the patient talking about issues they may have.
Information needs to complete a health assessment can include, past medical history, family medical history, social history, present medications, lifestyle considerations like alcohol, drug use, and smoking history. A head-to-toe assessment also needs to be completed to determine if there are any other issues needed to address. This patient would need education regarding lifestyle changes needed related to obesity. A referral to a dietary consultant may be needed if the patient is ready to make changes to their diet. Patients who reside in rural areas have less access to nutritious foods due to distance needed to get to a store where they can buy these foods. Many rural areas have quick marts where people can get fast food, not necessarily nutritious foods.
Obesity can cause many other health risks including HTN, Diabetes, Joint issues, difficulty breathing, Sleep Apnea, skin issues like yeast infections, wounds, and Stroke. Obese patients can also have trouble with ADLs as the inability to care for themselves is common due to decreased energy and inability to complete personal cares. This patient is noted to have disabilities; this can be related to joint issues and inability to ambulate, bend, reach, and general muscular and joint problems.
In relation to a risk assessment, I would use preventative care including personal history, laboratory screening tests to rule out Diabetes, Prostate Cancer, Hypercholesterolemia, Infection, and a Comprehensive Metabolic Panel to determine if the patient had any blood related abnormalities and determine if the patient had any problems with kidney or liver function. I would also determine if the patient had any issues with Alcohol, Tobacco, or drug use as use of these can lead to disease. In my communication with the patient regarding these issues I would be sure to tell him I ask all my patients these questions. Sullivan, D.D. (2019) states, “Approaching these matters in a nonjudgmental, professional, matter of fact manner should enhance patient disclosure of sensitive information.”
Questions I would be sure to include in my health assessment:
1. How are you feeling today?
2. What would you like for us to do today?
3. What do you think is causing your symptoms?
4. What are your coping mechanisms when you feel sad, scared, or angry?
5. Do you have people in your life whom you can talk to?
I feel it is important to not only assess a patient’s physical well-being, but to also assess if they are happy with their lives and feel heard, happy, and involved in their own care.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). 1(1-21). St. Louis, MO: Elsevier Mosby.
MediLexicon International. (n.d.). Morbid obesity: Symptoms, treatment, and outlook. Medical News Today. https://www.medicalnewstoday.com/articles/320460#complicationsLinks to an external site..
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). 2(19-29). Philadelphia, PA: F. A. Davis.