...occurs is that the hospital does not replace the old technique or decrease the quantity with the new. The hospital has six of the intra aorta balloon pumps, IABP, which are older technique and the individual that we would have used the IABP in the pass; we are now using the Impella. The IABP use to be place in all patients who had coronary artery bypass graft, CABG, (open heart); during surgery, but it is now rare to have a patient with one. The hospital could at less decrease the cost by half and decrease the quality to three instead of six, because in the last three months the hospital has not used an IABP. The Impella has been used on 10 patients in the last three months. The equipment makes no money for the hospital unless it is used on a patient. The hospital is acquiring a large amount of cost for equipment that is not being used and is depreciation. The hospital keeps budgeting for the IABP for the fear that the Impella will need repair or the need to use the IABP instead of the Impella. The hospital does not look at the cost of decreasing the number of IABP that the hospital has on hand and that with most of our contracts for equipment the company sends a replacement if the Impella was to need repairs. The hospital is so focus making sure that we have the equipment that they can not see that if the number of IABP is decrease...
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...ADN versus BSN: What are the differences? Leanne Vaughan Grand Canyon University Professional Dynamics NRS-430V-O500 Chris Bartholomew January 25, 2015 ADN versus BSN: What are the differences? First, I would like to provide an overview on the background of three types of RN nursing degrees available to nursing students. The first baccalaureate nursing program was established in 1909 at the University of Minnesota and until the mid-1950’s was a five year program. The first diploma program in the United States was established in 1873, at Massachusetts General Hospital and was a 4-month hospital-based program. It was intended to emulate Florence Nightingale’s model that she established in London in 1860. Designed by Mildred Montag in 1952, the first associate degree in nursing was another program option for those desiring to become RNs. This program was initially created to respond to the nursing shortage after World War II. It was an alternative to the hospital based program and four year university degree. (Creasia & Friberg, 2011) There has been a topic of debate since 1965 about the desirability of the BSN prepared nurse versus the ADN/Diploma prepared nurse, when the American Nurses Association published an opinion paper, advocating that the baccalaureate degree should be the minimum standard for entry-level nurse. The major focus of the associate degree program is to prepare the ADN nurse with technical nursing skills and considerable clinical experience to be...
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...REACTION: (Paget’s Disease) This article entitled “A Tour Around Paget’s Disease of Bone” basically talks about everything you need to know about this certain disease. First, it talks about the origin of this disease and who discovered it. According to this article, it is discovered by Sir James Paget and that the first recorded evidence of this disease happened about 1000BC and it is the second leading skeletal disorder affecting the aging population that time. It is delightful to know the etymology of this disease and who discovered it because it gives us more knowledge about the disease. Second, it talks about the pathophysiology of the disease, its diagnostic evaluation and the clinical manifestations of the disease. These are important to know for us to able to assess the patient very well in order for us to give the appropriate nursing interventions for the patient and for us to establish a proper and efficient nursing care plan for the patient. Third, it mentioned the causative microorganisms that cause the disease. This is also important to know especially for the doctors for them to be able to evaluate the disease better and for them give the appropriate medical interventions for their patients. With this, they would be able to provide the proper medications their patients’ need that would react effectively on a certain microorganism. Lastly, it talks about the different kinds of treatment the patient will undergo or the pharmacological therapy that the patient...
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...Leader can help the ICU can run more efficiently. The critical care department is composed of a joint eight bed intensive care unit (ICU) and a four bed coronary care unit (CCU) in a horse shoe design. Because Tanner’s provides highly complex medical care requiring precision, synchronization, and coordination of multiple services and personnel, the ICU functions as a closed unit that is self sufficiently ran. Because we are a closed unit, our nursing staff is required to take 36 hours of call every 6 weeks and work every other weekend. The nurse to patient ratio is 2:1. Patients that require more intense focused care have a 1:1 nurse to patient ratio. Illnesses requiring such a ratio include: patients placed on an Intra-aortic Balloon Pump (IABP), Continuous Renal Replacement Therapy (CRRT), induced hypothermia and suicidal or overdosed patients. Tanner also uses charge nurses to help provide extra care and support to staff, patients and families to help promote...
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...Pulmonary Problems Chapter 10 Pneumonia is inflammation of the lungs resulting in consolidation Obstruction in gas exchange on the alveolar level Aspiration most common cause 2nd most frequent cause is droplet inhalation Least likely cause is blood borne Protein rich fluid move into the alveoli- complicated by production of the organism- result is decreased alveolar surface area-resulting in elevation of pco2 and a decrease in po2 Inspection-tachypnea and central cyanosis Percussion-dullness Palpitation-tactile fremitus Auscultation-crackles, rhonchi, wheezing, or egophony Diagnosis-labs, chest xray Ct not recommended unless anthrax is suspected Bronch-immunocompromised individuals and patients who have not responded to treatment Xrays Focal- bacteria Interstitual-viral Rapid progression/ multifocal- legionella, pneumococci, staphylococci Medialstinal widening without infiltrates- inhalation anthrax Tamiflu within 48 hours to be effective HAP-received care in a health care institution for at least 2 days in the last 90 days prior to infection VAP- pneumonia within 48 hours of intubation HAP more difficult to treat compared to CAP COPD- include emphysema, chronic bronchitis, and small airway disease Emphysema-structural change via destruction and enlargement of alveoli Chronic bronchitis- chronic cough and mucous production Small airway disease-generalized narrowing of bronchioles, may include asthma COPD-4th leading cause of death in United States ...
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...I. Introduction - Shock (Chapter 11) A. Review of anatomy and physiology B. Pathophysiology Initiation | * Decreased tissue oxygenation * Decreased intravascular volume * Decreased Myocardial contractility (cardiogenic ) * Obstruction of blood flow (obstructive) * Decreased vascular tone (distributive) * Septic (mediator release) * Neurogenic (suppression of SNS) | No observable clinical indications Decreased CO may be noted with hemodynamic monitoring | Compensatory | * Neural compensation by SNS * Increased HR and Contractiliy * Vasoconstriction * Redistribution of blood flow from nonessential to essential organs * Bronchodilation * Endocrine Compensation (RAAS, ADH, glucocorticoid release) * Renal reabsorption of sodium, chloride, and water * Vasoconstriction * Glycogenolysis | * Increased HR (EXCEPT NEUROGENIC) * Narrowed pulse pressure * Rapid, deep respirations causing respiratory alkalosis * Thirst * Cool,moist skin * Oliguria * Diminished bowel sounds * Restlessness progressing to confsion * Hyperglycemia * Increased specific gravity and decreased creatinine clearance. | Progressive | * Progressive tissue hypoperfusion * Anaerobic metabolism wih lactic acidosis * Failure of sodium potassium pump * Cellular edema | * Dysrhythmias * Decreased BP with narrowed pulse pressure * Tachypnea * Cold, clammy skin * Anuria * Absent bowel sounds * Lethargy progressing...
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...The Future of Nursing Grand Canyon University; NRS 430: Professional Dynamics Josh Lake April 26, 2013 The Future of Nursing Introduction The United States is facing the largest health care reform in recent history. Nursing, along with other disciplines, will be at the fore front of this enormous transition. Up to this point nursing has played an essential role in the delivery and management of care. To continue to play a pivotal role nursing must elevate its practice to meet the needs of an ever changing health care delivery system. Advances in nursing practice will aide in changing and making health care more affordable, safe and effective. This paper will discuss how nursing, as a profession, can rise to the occasion through elevation of education, primary care practice, and leadership as outlined in the Institute of Medicine (IOM) report: The Future of Nursing: Leading Change, Advancing Health. This paper will also discuss how the author will alter personal practice to meet the goals of the IOM report. Education Advancement The Need for Advancement Since its inauguration nursing education has progressed and reformed to meet the needs of the client and the health care delivery system of the time. Issues in health care have influenced the role of education in preparing nurses to deliver safe and effective care and advocate for their patients. Nursing shortages have prompted multiple levels of education for entry level nurses. There are three pathways that have...
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...Acute Biologic Crisis General Description: This concept in N-302 deal with clients in acute Biologic Crisis. The nurse, utilizing the nursing process, focuses in assisting and giving immediate care and attention to the client to restore life processes to a state of dynamic equilibrium. • Attend to specific needs of patient under ABC • Identify types of data needed for care • Prioritize NCP • Alleviate physiologic stressors specific to patient • Describe and appreciate the role of a critical care nurse The Topics A. Concept of Critical Care Nursing B. Application C. Definition Pre-term Post-term Acute MI Thyroid Storms and Crisis Hepatic Coma ARDS Diabetic Ketoacidosis CVD End Stage Renal Stage The Concept of Critical Care Nursing Delivery of specialized care to critically-ill patients with life-threatening such as major surgery, trauma, infection, and shock as well as prevention of potential life-threatening conditions. The critical care nurse is responsible for ensuring that all critically-ill patients and families receive optimal care. Common Illnesses and Injuries seen in ICU: 1. GSW (Gunshot Wounds) 2. Traumatic Injuries (car collision & falls) 3. CV D/O (heart failure, acute coronary syndrome, unstable angina, MI) 4. Surgeries (abdominal aortic aneurysm repair and endarterectomy) 5. Renal D/O (acute and chronic renal failure) 6. GI and Hepatic D/O (acute pancreatitis, acute UGIB or Upper Gastro Intestinal Bleeding, acute...
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...PHYSICAL FACILITIES OF ICU: Physical facilities can be classified as: * Patient Area. * Auxilary Area. * Entrance to the ICU. * Ancillary Area. 1.ENTRANCE TO THE ICU: 2.PATIENT CARE AREA: 3.AUXILLARY AREA: 4.ANCILLARY AREA: LEVELS OF ICU: There are five different types and levels of ICU defined according to three main criteria: the nature of the facility, the care process and the clinical standards and staffing requirements. All levels and types of ICU must be separate and self-contained facilities in hospitals and.The five types of ICU are briefly described below: * Adult intensive care unit, level 3: must be capable of providing complex, multisystem life support for an indefinite period; be a tertiary referral centre for patients in need of intensive care services and have extensive backup laboratory and clinical service facilities to support the tertiary referral role. It must be capable of providing mechanical ventilation, extracorporeal renal support services and invasive cardiovascular monitoring for an indefinite period; or care of a similar nature. * Adult intensive care unit, level 2: must be capable of providing complex, multisystem life support and be capable of providing mechanical ventilation, extracorporeal renal support services and invasive cardiovascular monitoring for a period of at least several days, or for longer periods in remote areas or care of a similar nature (see ACHS guidelines). * Adult intensive...
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...Cardiovascular Case Study Mr. Smith is a 56-year-old Caucasian man who is being evaluated in the emergency room with progressively worsening chest pain that began 2 hours ago. The patient describes the pain as pressure in the center of his chest. He rates his pain 7/10. He reports the pain is now radiating down his left arm and through to his back, he is diaphoretic, and complaining of shortness of breath. He denies nausea or vomiting. Mr. Smith reports no previous history of chest pain or pressure. He smoked one pack of cigarettes daily for 13 years but quit smoking last year. He denies a family history of heart disease. Upon initial examination he did not have jugular venous distension, no carotid bruits, normal S1 and S2 with an S3 present. No S4 or murmurs auscultated. Lung sounds clear to auscultation bilaterally, bowel sounds normal, all pulses palpable 2+/4, no edema present. Diagnostic data: BP: 165/98 mmHG HR: 96 bpm RR: 30 breaths/min Temp: 37 C SaO2: 96% with 2L/min O2 per nasal cannula Wt:100 kg A 12-lead ECG was performed in the emergency room showed: Normal Sinus Rhythm (NSR) with frequent premature ventricular contractions. ST segment elevation in Leads 1, aVL, and V2 through V6 (3mm). ST segment depression in Leads III and aVF. Q waves in V2 through V4. The chest X-ray revealed slight cardiomegaly with mild congestive heart failure. An echocardiogram reveals an ejection fraction of 30% and mild mitral valve regurgitation. Mr. Smith’s...
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...Darren & Jenny’s Nursing Study Guide Darren & Jenny Nursing Study Guide Nursing Formulas and Conversions Drugs and Dosage Formulas and Conversions Volume 60 minims = 1 dram = 5cc = 1tsp 4 drams = 0.5 ounces = 1tbsp 8 drams = 1 ounce 16 ounces = 1pt. 32 ounces = 1qt. Weight 60 grains = 1dram 8 drams = 1 ounce 12 ounces = 1 lb. (apothecaries') Household 1tsp = 1tsp = 3tsp = 1tbsp = Household 1tsp=5cc 3tsp=1tbsp 1tbsp=0.5oz or 15cc 2tbsp=1oz or 30cc 1pt.=16oz or 480cc 1qt=32oz or 960cc 1/60 grain=1mg 15 grains=1g 2.2 lbs.=1kg Apothecary 1 dram 60 gtts (drops) 0.5 ounce 0.5 ounce Metric 5cc=1tsp 15cc=1tbsp 30cc=2tbsp(1oz) 1cc=16minims Apothecary 1fl.dram=4cc 4drams=0.5oz 8drams=2tbsp(1oz) 16minims=1cc 500cc=0.5L or 1pt. 1000cc=1L or 1qt. Temp. Conversion C= F-32/1.8 F= 1.8*C-32 2 Darren & Jenny Nursing Study Guide NOTES CARDIOVASCULAR Arterial Ulcer – Pale, deep base, surrounded by tissue that is cool with trophic changes such as dry, soluble skin and loss of hair. Cause by ischemia from inadequate arterial blood supply of oxygen and nutrients . Venous stasis Ulcer – Dark, red base, surrounded by skin that is brown in color with edema. Caused by the accumulation of waste products of metabolism that are not cleared due to venous congestion. Stage I Ulcer – Reddened area with intact skin surface. Management of DVT – Bed rest, limb elevation , relief of discomfort with warm, moist, heat and analgesics (Tylenol, not narcotics) prn. Ambulation is contraindicated...
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...Darren & Jenny’s Nursing Study Guide Darren & Jenny Nursing Study Guide Nursing Formulas and Conversions Drugs and Dosage Formulas and Conversions Volume 60 minims = 1 dram = 5cc = 1tsp 4 drams = 0.5 ounces = 1tbsp 8 drams = 1 ounce 16 ounces = 1pt. 32 ounces = 1qt. Weight 60 grains = 1dram 8 drams = 1 ounce 12 ounces = 1 lb. (apothecaries') Household 1tsp = 1tsp = 3tsp = 1tbsp = Household 1tsp=5cc 3tsp=1tbsp 1tbsp=0.5oz or 15cc 2tbsp=1oz or 30cc 1pt.=16oz or 480cc 1qt=32oz or 960cc 1/60 grain=1mg 15 grains=1g 2.2 lbs.=1kg Apothecary 1 dram 60 gtts (drops) 0.5 ounce 0.5 ounce Metric 5cc=1tsp 15cc=1tbsp 30cc=2tbsp(1oz) 1cc=16minims Apothecary 1fl.dram=4cc 4drams=0.5oz 8drams=2tbsp(1oz) 16minims=1cc 500cc=0.5L or 1pt. 1000cc=1L or 1qt. Temp. Conversion C= F-32/1.8 F= 1.8*C-32 2 Darren & Jenny Nursing Study Guide NOTES CARDIOVASCULAR Arterial Ulcer – Pale, deep base, surrounded by tissue that is cool with trophic changes such as dry, soluble skin and loss of hair. Cause by ischemia from inadequate arterial blood supply of oxygen and nutrients . Venous stasis Ulcer – Dark, red base, surrounded by skin that is brown in color with edema. Caused by the accumulation of waste products of metabolism that are not cleared due to venous congestion. Stage I Ulcer – Reddened area with intact skin surface. Management of DVT – Bed rest, limb elevation , relief of discomfort with warm, moist, heat and analgesics (Tylenol, not narcotics) prn. Ambulation is contraindicated...
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...CHECKLIST FOR NABH ASSESSMENTS Issue No. 1 Issue Date: 03/ 11 Page 1 of 53 NABH Assessment Checklist Introduction This checklist will facilitate cross functional audits throughout the hospital as NABH standards are applicable Vertically as well as Horizontally across the hospital and its various functions. The checklist has 2 components namely: i. Primary: Essentially pertaining to area specific point ii. Secondary: Common requirements for the area This checklist can be used for practical guidance. The assessor should not limit the assessment only to this checklist and can add more points based on their experience and observations. This will help out in updating this checklist and making it more comprehensive in the 2nd version Version 1 Issue Date: 17/05/11 Page 2 of 53 NABH Assessment Checklist CONTENTS Clinical Areas S. No Department/Area Page Number 1. Emergency and Ambulance 5 2. Out Patient Department 6 3. Wards 7 4. Specialized wards 11 5. Palliative Care 12 6. Dialysis Unit 13 7. Intensive Care, Neonatal/ Paediatric ICU and High Dependency Units 14 8. Operation Theatre 17 9. Recovery Room 19 10. Endoscopy 20 11. Rehabilitation 22 12. Imaging: X Ray/ USG/ CT Scan/ MRI 22 13. Nuclear Medicine 24 14. Cardiac Catheterization lab 25 15. Laboratory: Haematology/ Microbiology 16. ...
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