Samples

The purpose of this consultation is to identify an area of opportunity for improvement within the organization. The organization chosen for this consultation is ThedaCare Regional Medical Center Neenah. The Nurse Leader I selected to interview was Tabitha Uitenbroek, Trauma Program Manager (T. Uitenbroek, personal communication, April 5, 2019). During our interview conversation, several needed opportunities were explored and discussed as were strengths of this organization.

Evidence-based practice (EBP) providers focus on enhancing the patient’s outcome as well as improving the care process. EBP providers also focus on the provision of quality and safety enhancement in care. Notably, for the EBP to become successful, it must be sustained and adopted by both the nurses and other health caregivers. For its adoption, the federal, state, and local actions are essential to EBP providers. Studies indicate that nurses possess a positive attitude towards EBP providers and are prepared to acquire the knowledge and skills that are required for the adoption of EBP.

The case scenario of the 16 year old represents a person that is possibly suffering from a pre-existing condition of bronchial asthma. This is a serious allergic disease that is usually most common among children in developed nations (Aasbjerg, 2018). The condition is characterized by increased responsiveness of the tracheobronchial tree to a number of stimuli, increased infiltration of different types of inflammatory cells into the airways, the airway smooth-muscle hypertrophy, epithelial damage, constriction and the obstruction of a variable airway which is often associated with the inflammation in the lung airways conditioning and mucous hyper secretion around the bronchial walls (Aasbjerg, 2018).

A 49-year-old patient with rheumatoid arthritis comes into the clinic with a chief complaint of a fever. The patient’s current medications include atorvastatin 40 mg at night, methotrexate 10 mg po every Friday morning, and prednisone 5 mg po qam. He states that he has had a fever up to 101 degrees for about a week and admits to chills and sweats. He says he has had more fatigue than usual and reports some chest pain associated with coughing. He admits to having occasional episodes of hemoptysis. He works as a grain inspector at a large farm cooperative. After an extensive workup, the patient was diagnosed with Invasive aspergillosis.

PICOT Question: What is the effectiveness of intensive oral care on preventing ventilator-associated pneumonia among patients 65 years and above in the Intensive Care Unit (ICU) as compared to prophylactic probiotics intervention?Patients: ICU patients of 65 years old and above.Intervention: Intensive Oral Care.Comparison: Prophylactic Probiotics Intervention.Outcome: Reduce ventilate-associated pneumonia.Time: The study will include a three months follow-up. Peer-Reviewed and Systematic Reviewed Research

1. What factors may have contributed to the development of PUD?
Peptic Ulcers are open sores that often develop on the inside lining of the stomach and upper part of the lining of the small intestine. In the case study, the possible factors that may have contributed to the development of PUD include frequent sinusitis infections, continuous use of ibuprofen, and Zyrtec medicines all year round.

76-year-old female patient complains of weight gain, shortness of breath, peripheral edema, and abdominal swelling. She has a history of congestive heart failure and admits to not taking her diuretic, as it makes her “have to get up every couple hours to go to the bathroom.” She now has to sleep on two pillows in order to get enough air. Illnesses of the cardiovascular system often pose a challenge to the nurses and physicians involved in the day-to-day care of patients.

Base on the critical appraisal, the best practice that emerges from the research reviewed is the use of oral care to prevent ventilator-associated pneumonia (VAP) (Zhang et al., 2017). Research indicates that VAP is one of the common preventable healthcare complications of a patient's hospital stay. Besides, research suggests that incorporating oral hygiene may decrease VAP as much as by 60% (Haghighi et al., 2017). Studies also indicate that among mechanically ventilated patients, oral health often deteriorates quickly. The majority of the patients often sustain injuries to their oral mucosa during the intubation, and afterward, the patients are often prone to dry mouth.

PICOT Question: What is the effectiveness of intensive oral care on preventing ventilator-associated pneumonia among patients 65 years and above in the Intensive Care Unit (ICU) as compared to prophylactic probiotics intervention?

1. The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polydipsia.”
Polydipsia is the increase in thirst as a result of high blood glucose that raises the osmolarity of the blood, thus making it more concentrated. In most cases, it is often an early symptom of Type 1 diabetes. The onset of Type 1 diabetes can explain the pathophysiology of Polydipsia. The onset of diabetes mellitus causes the blood sugar levels to get too high, increasing the concentration of blood sugar and make one feel thirsty, respective of how much water one drinks. In the case study, the patient has been experiencing unquenchable thirst, an indication of an imbalance in the osmotic concentration due to the loss of a significant amount of fluid.

Kaneoka, A., Pisegna, J. M., Miloro, K. V., Lo, M., Saito, H., Riquelme, L. F., ... & Langmore,S. E. (2015). Prevention of healthcare-associated pneumonia with oral care in individuals without mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials. Infection control & hospital epidemiology, 36(8), 899-906.

This Knowledge Check reviews the topics in Module 5 and is formative in nature. It is worth 20 points where each question is worth 1 point. You are required to submit a sufficient response of at least 2-4 sentences in length for each question.

Currently, research indicates that most medical decisions are made by physicians with minimal input from patients. However, shared decision-making for the provision of excellent-quality care recognizes that treatments, procedures, and tests should not only be medically appropriate, but also preferred by the patients and that decisions be informed by available clinical evidence (World Health Organization, 2016). Notably, clinical decision-making in nursing entails application of critical thinking skills to choose the best available evidence-based option to manage risks and address the needs of patients in the provision of high-quality care.