...Change Paper Nursing 427 By Jennefer Grady Table of Contents Introduction………………………………………………………………..3 Lewin’s Theory……………………………………………………………..4 Problem Statement………………………………………………………….5 Proposed Solution…………………………………………………………..6 Moving Forces………………………………………………………………7 Restraining Forces…………………………………………………………...8 Change Integration…………………………………………………………..8 Refreezing Process…………………………………………………………..9 Introduction On patients requiring bipap masks, what is the effect of applying duoderm to bridge of nose compared to not using any barrier to prevent skin breakdown while in the hospital? This paper is about a problem that has been identified in the nursing field and the change process. Patients who need to wear a bipap mask for better oxygenation are having complications with the mask causing a pressure ulcer on the bridge of the nose. This is not only painful to the patient but also increases health cost. This paper is about Lewin’s change theory and how to implement this new change and overcome resistance. It will talk about the freezing, moving and refreezing process, changes that need to be made and how to implement this plan. As well as what is necessary to enforce this change so that it becomes status quo. Lewin’s Theory Kurt Lewin was born in Germany and immigrated to the US in August of 1933, after Hitler came to power. He had originally been involved with schools of behavioral psychology before changing directions and going into research. He is well...
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...USER Manual 1038585 JR 10/02/06 Important! Fill in the information below when you receive the BiPAP Auto M Series system. Serial No.: _______________________________ (located on the bottom of the device) System Prescribed for: __________________________________________ Date of Purchase or Rental: ______________________________________ Pressure Setting: _____ cm H2O Mask Type: __________________________________________________ Mask Size: ___________________________________________________ If you have any questions concerning the system, contact: • Home Care Company: _______________________________________ • Telephone Number: _________________________________________ Telephone Number: _________________________________________ Respironics, Inc. 1001 Murry Ridge Lane Murrysville, Pennsylvania 15668-8550 USA Customer Service Telephone Number: 1-800-345-6443 (US and Canada) or 1-724-387-4000 • Health Care Professional: _____________________________________ The BiPAP® Auto M Series with Bi-Flex® system is covered by one or more of the following patents: 5,148,802; 5,313,937; 5,433,193; 5,632,269; 5,803,065; 6,029,664; 6,305,374; 6,539,940; 5,535,738; 5,794,615; 6,105,575; 6,609,517; 6,837,260; 5,645,035; 6,286,508; 6,550,478; 6,752,150; 6,615,831 5,970,975. Other patents pending. BiPAP, Whisper Swivel, Encore Pro, and Encore Pro SmartCard are trademarks of Respironics, Inc. © 2006 Respironics, Inc. and...
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...In addition, I administered lovenox, and calcium gluconate. Furthermore, I did oral swab suction, partial bath, and linen change. Patient was on epidural at 10ml/hr. she was on BIPAP due to acute respiratory failure which she developed after surgery when I entered the room to introduce myself. After our assessment, we discovered that her lower extremities were swollen. In addition, her CT result reveals congestion failure and enlarging left basilar effusion. Her intake was 3498ml while her output was 1073ml with IV NACL0.9% fluids infusing at 140ml/hr. We called the nurse practitioner and she advised us to reduce her continuous NS to 70ml/hr. A pulmonologist did rounding in the morning and he advised us to discontinue infusion of NS. Anytime we reposition the patient, from lying to sitting or standing position, we discovered that her blood pressure usually drops about 20mm Hg. However, we usually monitor her BP & heart...
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...Executive Nurse Leadership Program Hospital Department Rotations: Respiratory-Essay #3 Equipment and supplies obtained through contract services consist of ventilators, bipap machines and cough assist devices. The hospital has sixteen ventilators on-site which are hospital owed; however there must be two ventilators onsite to serve as back-up. When the need for greater then fourteen ventilators arises, contracted ventilators must be brought in-house. The hospital currently owes one bipap machine, therefore whenever it is use a contracted bipap machine must be brought in. The cough assist device is when patients are unable to produce an effective cough and is rented as needed for patients. Supplies for this contracted equipment may also be obtained on an as needed basis. Staffing is based on respiratory therapy hours per patient day (HPPD) and the acuity level of the respiratory patients in house. Must days there are two respiratory therapists per twelve hour shift and the Director of Respiratory Therapy is counted in staff for day shift. Occasional on weekends an extra respiratory therapist maybe added for an eight hour shift in place of the Director of RT, however this is only when the census is high and the patient acuity is high as well. Patients are weaned from the ventilator according to the established weaning protocol. The pressure support weaning protocol is initiated as ordered by the pulmonologist and will be conducted between 8:00 am and 8:00 pm...
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...180,000/mm3 potassium of 5.0 Mmol/L, sodium of 135 Mmol/L, INR is 2.2 and the BNP levels of 600 pg/ml. The blood culture results are pending. A chest x-ray shows significant pulmonary congestion, and cardiomegaly. The echocardiogram shows an EF of 40%. The ABG shows pCo2 of 54 with pH of 7.32. The ER physician decided to place Anna on a BiPAP and sent to progressive care unit (PCU). The physician ordered repeat ABG after 2 hours, steroids, nebulization treatments, and beta blockers. Anna is admitted to...
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...a prestigious healthcare community. * * CURRENT WORk Experience * Respiratory Therapist June 2013 – Current * Howard County General Hospital Columbia, MD * Experience with ICU, SCU, ER (Adult & Pediatric), and NICU. * To perform vent management, regular checks with troubleshooting, weaning protocols and extubation. Also perform inline, NT and oral suctioning. * To assist in intubation and bronchoscopy procedures. * Response to all codes and rapid responses requiring cognitive skills. * To transport critical patients with transport vent to CT scan, CATH lab, MRI, O.R., and I.C.U. * Set up, maintenance and troubleshoot BIPAP and CPAP. Also include but not limited to floor therapy such as HHN, MDI, DPI, CPT, Incentive spirometry, cool mist aerosol, O2 therapy, Overnight Pulse OX, and peak flow measurement. * To perform bed-side...
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...did not take any action at any point to stop the physician from taking these incompetent actions. Implications Rule # 1000-01-.13-1r applies because, as mentioned above, the nurse failed to take any action to prevent the physician from performing a number of incompetent acts related to the healthcare of the patient. First and foremost, the patient likely does not even need to be placed on the ventilator. The physician’s decision to place the patient on the ventilator is based on an oxygen saturation of 88%. Although the patient’s oxygen saturation does need to be increased, the physician could consider BiPAP to adequately ventilate the patient without violating the patient’s wishes. BiPAP (bilevel positive airway pressure) is a non-invasive ventilation device that can increase the volume of air that enters the lung when a patient breathes in. Studies have proven that BiPAP has been used effectively to prevent the need for intubation and it is...
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...went into pulseless electrical activity. His heat was signaling to beat without any mechanical contraction. CPR was initiated and he was intubated with and endotracheal tube. He stabilized and the ET tube was later removed. The patient was experiencing chest pain at about a 2 related to the chest compressions when I assessed him. He did have some slight bruising around the sternum. Hemodynamic monitoring for this patient included continual pulse oximetry monitoring, blood pressure checks every hour, and ABGs checked twice a day. Maintaining a patent airway is essential for this patient due to his recent exacerbation as well as coarse lung sounds throughout. He was on 4 L O2 nasal cannula during the day, and he uses a Bipap at 6 L when he goes to sleep. The bipap is set to make him take at least 16 breaths a minute,...
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...Family Values Paper Tiffani Lee NURS/542 July, 9 2012 Felicia Rohrbaugh Family Values Paper Family is defined differently by each individual, based on one’s personal experiences. Family is not always individuals related by blood. In health care not only do we take care of the patients, we take care of their families as well. Families defined in health care would be the support system of the individual whose health is compromised. In the health care setting family roles can defer based on the patient’s condition. In a step down unit the patients are more so stabilized, so the families play a major role in providing care, and making decisions for those patients who cannot care for themselves. As a health care provider, it is important to know and understand the role of the family system in health promotion, the concept of family in nursing practice, and application of the appropriate family nursing theory. Family System in Health Promotion The United States Census Bureau defines family as “two or more people (one of whom is the householder) related by birth, marriage, or adoption residing in the same housing unit” (“United States Census Bureau,” 2011, para 2). The Census Bureau definition is inclusive of a variety of household structures to allow large, small, married adults with our without children, single parent, gay and lesbian, heterosexual, and adoptive families. The family plays a large role in the health of its members. According to Friedman...
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...Do Baccalaureate- Prepared Nurses have Higher Level of Clinical Competency and Care Delivery over Associate Degree Nurses? Susan Olson Grand Canyon University Professional Dynamics NRS-430 Dr. Monica Kidder June 10, 2016 Do BSN nurses have higher level of clinical competency and care delivery over ADN nurses? The American Association of Colleges of Nursing has compiled a fact sheet: “Creating a More Highly Qualified Nursing Workforce”(Rosseter, 2015, p.1). This fact sheet is a very extensive list of worldwide research connecting education to outcomes. This list is compiled of about twenty-four major research studies with very compelling evidence to support the overall claim that having more baccalaureate-prepared nurses(BSN) in the workforce will increase patient safety and decrease patient deaths. The numbers are consistent throughout all the research provided in the fact sheet. Basically, a 10% increase in the proportion of baccalaureate-prepared nurses decreases the mortality by roughly 10%. (Rosseter, 2015). Associate Degree Nurses (ADN) are equated with entry level nursing, and BSN nurses are considered more advanced because of the higher level of education. Education, being the key word here, not necessarily that BSN is better than ADN. After reading the research, an ADN could come away feeling like they are in some way, not as good as the preferred BSN graduates. The American Organization of Nurse Executives state this push for higher education is preparing...
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...Memo Assignment Sharon Casalotta HCS514 September 10, 2012 Norma Wright Memo Assignment MEMORANDUM TO: John Doe, CEO FROM: Sharon C DATE: September 10, 2012 SUBJECT: Organization Design and Functionality CC: Norma Wright This memorandum is to supply an insight of the design and functionality of (ORGANIZATIONS NAME). Its purpose is to provide a simplified overview of the facility’s services and in what way the staff members work together to provide patients with the best services possible. Organization Design (ORGANIZATIONS NAME) is a durable medical equipment company within one of the largest not-for-profit health care organizations on Long Island; (ORGANIZATIONS NAME). In the past the company was known as (ORGANIZATIONS NAME) and stood alone, until joining forces with other health care providers under the umbrella of (ORGANIZATIONS NAME). This movement has brought about the centralization of financial decisions, the requests to increase the number of staff members, and personnel rules, regulations, pensions, and insurance benefits. The company is also decentralized allowing management and staff within the company to design internal process and procedures. The company office and warehouse is in a prime location, right of the Long Island Expressway in Hauppauge. This location provides an easy exit and entrance for the patient service technicians (PST) and for the patients who visit the facility. Organization Functionality The company provides services...
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...Hazel Grace, 17 a girl that has survived cancer. She has lung cancer, she has to have big tank of oxygen with her all day to breath. She has had to have the tank almost all of her live. When she goes to sleep she gets BiPAP which is, Bilevel Positive Airway Pressure. She also goes to the Support Group that helps her through her cancer. She has met so many people through her Support Group. Hazel is also very quiet and shy, but when she met the “love of her life” Augustus Waters. I would call him the love of her life, she wasn’t quiet around him and also she was herself the whole time. They had met through the Support Group. When they met they both locked eyes and Hazel just felt so in love. I just love love so of course it was the most cutest...
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...Is it hard for you to fall asleep or stay asleep though the night? Do you wake up feeling tired or feel very sleepy during the day, even if you have had enough sleep? You might have a sleep disorder. There are several different ones but yet the most commons ones are insomnia, sleep apnea, restless legs syndrome, and narcolepsy. Nightmares, night terrors, sleepwalking, sleep talking, head banging, wetting the bed and grinding your teeth are kinds of sleep problems called parasomnias. These sleep disorders are caused by normal things such as back pain, anxiety, neck pain, or chronic pain. Going into detail with each disorder will help you better to understand why they are caused and how they can be cured. According to the U.S. Department of Health and Human Services in year 2007, approximately 64 million Americans suffer from insomnia on a regular basis each year. Insomnia occurs 1.4 times more commonly in women than in men. Although insomnia was the most common sleep problem among about one half of older adults (48%), they were less likely to experience frequent symptoms of insomnia than their younger counterparts (45% vs. 62%), and their symptoms were more likely to be associated with medical conditions, according to the 2003 poll of adults between the ages of 55 and 84. Insomnia is a symptom of sleep disorder of having difficulty falling asleep or staying asleep. It is usually followed by functional impairment while awake. People who have insomnia complain about being able to...
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...DIFFERENCE IN COMPETIENCIES BETWEEN ASSOCIATE DEGREES VERSUS BACCALAURATE DEGREE LEVEL ANIT ALEXKUTTY GRAND CANYON UNIVERSITY Difference in competencies between Associate Degree versus Baccalaureate Degree It is a difficult question to answer. Which one is good? One or other day all has to face this sometime. I believe both degrees make better nurse, but still there are difference in the programs that makes them unique. Associate Degree Nursing Associate Degree Nursing otherwise known as ‘entry level tertiary education nursing degree’ was started in 1952 at Fairleigh Dickson University. This type of degree is awarded by community colleges or hospital based nursing schools in US. To graduate as ADN nurse, one has to study 2 years and earn 72 credit hours. The core curriculum based on adult health, community health, maternal, newborn, pediatric and geriatric nursing. After completing the course, to work as Registered Nurse (RN), one has to pass basic requirements such as NCLEX RN test and other continuing education depending upon the nursing board. There are some advantages of ADN programs, that is, they are less expensive, low time consuming and easy way to entry level nursing jobs. ADN degree is based on practical bed side nursing like patient teaching, communicating, provider of care and manager of care. But scope of ADN nurses are limited to certifications. Baccalaureate Degree Nursing Baccalaureate Degree Nursing also known as Bachelor of Nursing...
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...Charting / Documentation Guide Nursing documentation should be clear, timely, accurate, reflective of observations, permanent and legible. This is a guide and not a complete list. Always follow policies in place at your facility. Medicare Documentation • Must reflect need/reason for skilled care • Must reflect Standard of Care • Describe intervention(s) • Describe resident’s response to intervention(s) • Daily evaluation of progress or lack of progress • Resident response to skilled therapy • ADL function • Changes in condition • Change Care Plan ASAP after change in condition • Notification to MD and family Respiratory/Pneumonia Medicare Documentation • Must reflect need/reason for skilled care • Daily vital signs • Daily and PRN O2 sat level • Daily and PRN lung sounds • SOB with exertion, when sitting at rest or when lying flat • Resident’s response to interventions and skilled therapy • Progress or lack of progress • Change in condition • Change Care Plan ASAP after condition change • Notification to MD and family Bladder and Bowel • Indicate status: always continent, occasionally incontinent, frequent- ly incontinent, always incontinent • Indicate if has catheter (indwell- ing or condom, intermittent), uri- nary ostomy, or no urine output • Toileting program in progress or attempted and outcome • Constipation? Which interventions used, and results? Anticoagulant Therapy Medicare Documentation...
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