...and analysis. Hospital statistics Includes current and historical data on utilization revenue, expenses, person and mush morel Will describe numerical data, numerical count, statically analysis, and four levels of Measurement. Numerical data. Bennett, Briggs, and Troika (2009). Numerical Numerical data is identified, measured, and numerical scale. Numerical data can be Displayed using charts, tables, and graphs. Example I work at medical floor is a busy floor. The Physician is always order many test for the new admit patient. Such as Order the patient, take X-Ray, EKG, CAT scan, GI lab so on. For example, if the patients come back for GI lab.Nurse has To take vital sign every 15 minutes times four, every 30 minutes times two, and one-hour time One. This Vital sign was taken to compare how the vital sign are difference between them. If the vital Sign Drop too low or too high that will nurse alert nurse to check the patient and report to the Physician right away. This entire vital sign nurse has to record in the computer that will show in Line graph. The line graph is easy to compare between the time when the nurses was taken In addition, how different of blood pressure. Bennett, Briggs, and Troika (2009) Numerical count I work at four southwest that has thirty-two beds. All nurses works 12 hours per shift. Before the shift change approximately two hours charge nurse has to count how many patient Do we have and will we get new admit...
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...The patient’s vital signs following the fall are BP: 150/70. HR: 82, RR: 32, SaO2: 88% on RA. To properly interpret these vital signs, we would need to look at the patient’s baseline vitals and trends in his vital signs. In acutely ill patients, this is important as we develop an understanding of what these vital signs mean in terms of oxygen supply and demand (House-Kokan, 2012). Given the patient’s vital signs, we recognize that if this BP is an increase from his baseline, there is a decreased O2 supply due to vasoconstriction and an increased O2 demand as the heart pumps against vasoconstriction (House-Kokan, 2012). With a RR of 32, we suspect an increased O2 supply as minute ventilation increases but also an increased demand of O2 as there is an increase work of breathing (WOB) (House-Kokan, 2012). Given a SaO2 of 88% of RA, we would immediately apply supplemental O2 while awaiting a physician’s order and then titrate O2 to keep his SaO2 >94%, as...
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...MED Rotation Narrative #2 These past four weeks at the hospital, have really helped me. I have been learning new skills, communicating with patients, knowing what the patients need, and getting to know the staff. The Progressive Care Unit, also known as the PCU, can be seem kind of quiet. In most cases it can be busy considering discharging patients, incoming patients, or getting the patient's vital signs. The first day I got to the PCU, I was hesitant on going up because of what I heard from others who already experienced this unit. While I was on the second floor, I got lost until I found someone that redirected me to the PCU. I worked with a CNA who I helped do a lot, such as changing briefs and taking vital signs. The last two days I worked...
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...over and Jay is checking the assignment sheet to see where in the department he is going to be working. At this emergency department, the nurses and techs will work in one of the four sections: A-pod (for the medium acuity patients, and it also houses the psychiatric patients), B-pod (where high acuity patients such as respiratory or cardiac arrest patients go), C-pod (for low acuity patients…it is kind of like an urgent care), or Start. Today, Jay is assigned to the start desk; this is the area that processes incoming patients after they have registered to be seen at the ER. Jay will work closely with a nurse to help triage people coming into the ER, and to watch over patients in the waiting room. Jay’s primary responsibility is to take an initial set of vital signs (blood pressure, heart rate, temperature, and oxygen saturation levels) on every person that comes in for treatment, and notify the nurse if any of those vital signs are abnormal. He will also help to take patients to their room once they are assigned one, help answer any questions, escort visitors, and to perform an electrocardiogram (EKG) on any patient that has a chief complaint warranting such a test. Being at the start desk is not an easy task. “It is a crucial job to be up front, you have to know when a patient’s vital signs are not normal and be able to look at a patient and immediately determine that they are sick or not (M., 2015).” During this shift, the ER is busy but things are going fairly well...
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...demonstrated leadership by taking charge of my preceptor patients. My preceptor stated that since I am soon to graduate, I should be able to handle more patients. She gave me four of her patient for the entire day. During my shift, I was on my own but had to take reports from the off going nurse. I gather all important labs, and wrote down all medication that was due to be administer. I needed to get all of my patients vital signs and to complete that task I delegated it to my cna to make sure she took the vital signs by 8am. Also, I delegated for my cna to be aware of heart failure patients and to monitor intake and output very closely. I felt in charge of the situation, the patients by handling the patients on my own, as well as being a leader to the CNA. However, a good leader sometimes encounter situations where they need help and in this case I wasn't too proud to ask for help from my preceptor when needed. What I have learned from this week demonstrating leadership is you must stay...
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...Regional on July 5th, 2013.Previous history: Diabetes, HTN, UTI, skin cancer, TIA. Subjective: Patient states, “I feel a bit fatigued in the evenings. My doctor said it is a side effect of my dialysis sessions. I don’t like going to dialysis but I know that I have to”.Objective: Patient alert and oriented x4. Vitals signs: BP: 119/72, Temperature: 98.9, Pulse: 82 bpm, respiratory rate: 18, and displays no pain at this time. Breath sounds clear, gag and cough reflexes intact. Bowel sounds present in all four quadrants. Eyes: PERRLA. Skin integrity is not intact; stage 1 pressure ulcer located in right posterior upper thigh, below buttock. Minor bruising on both upper extremities, No signs of DVT. Patient PICC line placement in right upper arm. Patient is easily fatigued primarily after dialysis sessions. Chooses to ambulate by wheelchair due to occasional dizziness. 1 assist when walking.Diagnostic test: Recent CBC done on 07/11/13 showed an elevated WBC count with a result of 14.0.Progress notes: “ Patient readmitted to facility due to noncompliance with dialysis sessions. Experiencing fatigue and occasional anxiety between dialysis sessions. Recent elevated WBC count may be sign of infection. Will continue to monitor”.2) Diagnosis: Risk for infection r/t altered immune functioning3) Diagnosis: Fatigue r/t effects of chronic uremia | Short term goals: 1) Patient will maintain daily urine output within 500 mL of intake through next week July 18th, 2013.2) Patient will remain free of...
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...Gordon’s low oxygen saturation levels. (WebMD, 2005) Her observations show that she is tachycardic. Being ‘Tachycardic refers to an abnormality in rapid heart rate’. (Medical Dictionary, 2009 Farlex and Partners) Tachycardia can really play a major role on increasing blood pressure as “Electrical signals in the heart's upper chambers fire abnormally, which interferes with electrical signals coming from the sinoatrial (SA) node the heart's natural pacemaker.” (Heart Association, 2014) 2. Describe the nursing assessments you would complete on Carole after the total hip replacement, including vital signs, pain, neurovascular observations and pressure area care. (8 marks) The nursing assessments I would complete on Carole after her total hip replacement would consist of the following: Vital signs- Check vital signs and level of consciousness every 4 hours or as needed. Vital signs assess essential body functions, with the following being checked: • Pulse rate • Temperature • Respiration rate • Blood pressure Pain assessment scale- Check Mrs. Gordon’s pain by asking her questions, and to rate her pain on a scale of 0 to 10, with 10 being severe pain. This will uncover any discomfort, and will determine if she needs any analgesics to ease the pain/discomfort. Every couple of hours thereafter I will be reassessing her pain to ensure she is not suffering from major discomfort. (Doenges, Moorhouse & Murr, 2010) Neurovascular...
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...EXPLAIN THE TWO TYPES OF COMMUNICATION: Verbal : What is verbal communication, what is the importance of verbal communication? Non Verbal: What is non-verbal communication, what is the importance of non-verbal communication? How much (%) of or communication is verbal? How much (%) of or communication is verbal? 2. DISCUSS THE TYPES OF COMMUNICATION: One-to-one Group Scenarios – linking to health and social care settings: Formal Informal Between Colleagues * Between other Services** Between Service Users and Practitioners Such examples can be along the lines of: *i.e. Clear communication is vital between colleagues as they may be taking over your shift for care of one of your patients/service users and they need to know what has/hasn’t so jobs do not get done twice or to ensure that a job gets done in the first place. It is vital especially when dealing with the care of a person, such as bathing them for hygiene purposes or giving medication, particularly if they have amnesia and can not remember. ** i.e. It is important clear communication takes place between others services to ensure correct care is given. For example if a patient /service user is moved to another care unit, their details need to be passed over and communicated efficiently to ensure quality of life and care for that person. This can include such aspects as allergies, if a service user for example has a severe nut allergy, giving other service users food with nuts in can trigger...
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...the opportunity to be in the Same Day Procedural area as well as the PACU. When first starting my shift, I assisted my nurse preceptor in calling back patients that had been scheduled for a surgical procedure. When we called the patient back, we first made sure we identified the patient by asking them their name, date of birth, and last four digits of their social. We also made sure to ask the patient exactly what procedure they were there for. Thereafter, I began by taking an inventory of the patient’s belongings. Then, my nurse preceptor asked the patients a series of questions such as, when was the last time they ate or drank, when was the last time they took their medications including aspirin, and what, if any, medications they are allergic to. Additionally, I asked the patients if they currently had any abrasions or bruises we should be aware of. Thereafter, I assisted my nurse preceptor in taking vital signs, placing electrodes on the patient in...
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...recognition of sepsis involves a few steps, tasks, and clinical decisions. The workflow begins with posting vital signs and laboratory data in the EHR. The vital signs are then triggered to the nurses when any two or more of the systemic inflammatory response syndrome (SIRS) criteria are present. The nurse will receive an alert the next time logged into the record. At this point, she/he will need to make a decision related to the suspicion of sepsis. A screening panel is ordered by the nurse when the patient's symptoms, assessment, and history correlates with sepsis. Also, the nurse will page the physician when these steps are taken. The nurse then will watch for the lactate results and monitor for sepsis progression. According to Amatayakul (2011) "recording workflow helps to understand and improve how people work" (p. 130). The steps associated with the early recognition of sepsis will be examined to assess its effectiveness and potentially improve the course of care for patients. Step One Posting vital signs and laboratory data in the EHR is completed by the laboratory technicians, nurses or nursing assistants. The use of an automatic vital sign device for blood pressure and heart rate is used. A hand held temperature device, and an observatory assessment of respirations are completed by either the nurse or nursing assistant. Policies govern the frequency of vital signs per the unit and patient's individualized needs. Information related to patient status and diagnosis...
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...Organizational Systems and Quality Leadership Task 2 LaToya Diaz Western Governors University Organizational Systems and Quality Leadership Task 2 A. Root Cause Analysis The Root Cause Analysis is a technique used to determine what happened, why it happened and determine things to do to prevent a reoccurrence. * At 3:30pm a patient arrived to the Emergency Department with a dislocated hip and was experiencing elevated respiration rate of 32 and a significant pain score of 10/10 * At the patients time of arrival there was 1 RN, 1 LPN, 1 Secretary, 1 Emergency room physician, and an in house respiratory therapist on staff at the time of the patient’s arrival and there were two other patients being cared for. * The physician decides to do a reduction of the patients left hip and need to have the patient at an appropriate sedation level * At 4:05pm the nurse administered Diazepam 5mg IV per the physicians order. * At 4:15pm the nurse gave Hydromorphone 2mg IV per the physicians order. * At 4:20pm the patient is still not sedated enough and the nurse gives an additional Diazepam 5mg IV and Hydromorphone 2mg IV. * At 4:25 Proper sedation is achieved and the physician performs a reduction of his left hip. * At 4:30pm the procedure was complete and the nurses are alerted to another patient in route to the ER in acute repertory distress and the nurse places the patient on an automatic blood pressure machine to monitor B/P and pulse oximetry. ...
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...Delegation Exercise in a Health Care Setting Ana Bergeron University of Phoenix Assignment After rounding on patients the RN made the following assignments. See appendix for a full description of each patient: Assignments | | Macy LPN #1 | Pod 1 | | Mr. Black (UTI) | | Ms. Johnson (Crohn’s) | | Mr. Raynor (diabetic foot ulcer) | | Mrs. Tolento (CHF) Mr. Smith (pneumonia) | | Ms. Swanson (S/P hysterectomy day 2, in pod 2) | Ana RN | Pod 2 | | Mr. Smith (GI Bleed) | | Mr. Moretz (Night sweats, neg pressure room) | | Mrs. Flanco (S/P Colectomy day 2)Mr. Reddington (GSW) | Mike LPN #2 | Pod 3 | | Mr. Smith (Atrial Fib) | | Ms. Harper (s/p breast mastectomy) | | Ms. Levin (s/p attempted suicide) | | Mrs. Walnut (aspiration pneumonia)Mrs. Stewart (Diabetic Ketoacidosis) | | | Gilda CNA | Pods 1-3 | | | Explanation The following is a detailed explanation of the assignments made for this shift: Macy LPN: Macy was given her patients based of her skill and scope. She always volunteers to take on the Spanish speaking patients since she is more comfortable speaking in Spanish. The RN, after moving patients to different pods, she gave Macy one possible discharge today and what would be consider by some a difficult patient that can be abusive and refuses to be take care of be the other LPN on shift today. Macy also had to take on a total of 6 patients instead of six, the RN will cosign her notes at of shift. The patients...
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...University of Phoenix Material Support Tools Worksheet Read the following patient scenarios. Use the tables to identify and explain at least one or two clinical decision support tools that could be used in each scenario. Each explanation should be 50 to 150 words. Example Scenario and Response A physician is asking that a new drug, DRUGx, be added to the formulary. This drug interacts with the drug INTERAx, causing severe convulsions or seizures and even death. Describe how the electronic system might be set up to protect patients from receiving DRUGx if they are already taking INTERAx. Consider the CPOE process you have read about in class. |Clinical decision support tools and explanation | |I would choose to use a Drug/Drug Interaction tool so we would be aware when there could be a severe reaction when a patient is prescribed | |both DRUGx and INTERAx. This tool would notify the appropriate individuals when someone wanted to prescribe both of these medications to a | |patient. I would have it alert the physician as soon as he or she entered the order in CPOE so they could have an opportunity to select | |another drug that would be appropriate for the patient. | Scenario One A patient has a known allergy to penicillin. Describe how the electronic system might be...
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...complication has an incidence of 0.1-1% and most commonly occurs within 3 weeks after tracheostomy.1 TIF may result from pressure against the trachea facilitating erosion into the innominate artery by the tracheostomy tube, cuff, or balloon.1 Early bleeding is common after tracheostomy and attributed to surgical causes; however, delayed bleeding is less common and may be a sign of impending massive hemorrhage. 2 A high level of suspicion and prompt surgical intervention is imperative in the diagnosis and successful management of TIF. 3 Case Report A 49-year-old female with a history of cirrhosis was hospitalized for episodes of hepatic encephalopathy requiring intubation. Patient was extubated and re-intubated for hypercapnic respiratory failure after developing stridor treated with racemic epinephrine nebulizer treatments. Hospital course was complicated by acute respiratory distress syndrome (ARDS) versus hospital-acquired pneumonia (HAP), acute...
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...A Complete Patient Assessment Susan Eisen RN Ramapo College of New Jersey A 63 y/o African American female presents to the emergency room complaining of shortness of breath worsening over the past week. Patient states she becomes severely short of breath while preforming everyday activities and has noticed that her legs have been “getting bigger”. Patient had been sleeping with 3-4 pillows a night for comfort and occasionally sleeping in a recliner. Patient states this evening she got up to use the restroom and had a sudden onset of severe shortness of breath. Felt as though she wasn’t moving any air. Patient called 911. The paramedics on scene established IV access and medicated patient with 40 of furosemide and Nitroglycerin sublingual 0.4 mg times 3 doses. Patient was placed on CPAP and brought to the ER. Upon arrival CPAP was continued, a nitroglycerin infusion was started at 20mcg/min. Additional IV access was established and labs were obtained. Stat EKG and Chest Xray were completed. Additional dose of furosemide 80mg was administered IV push and patient was provided with an indwelling foley catheter which is draining clear yellow urine. Past Medical History is significant for Hypertension, Diabetes, Congestive Heart failure, and Atrial Fibrillation with two unsuccessful cardioversions. Medications: Patient currently taking Furosemide, Lisinopril, Digoxin, ...
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