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21 Apr 2019

Nursing care plan.
1. All NANDA Nursing Diagnoses for patients with diabetes.
2. Expected assessment findings of patients with musculoskeletal care modalities.
3. Diagnostic studies/ Labs expected abnormalities for patients with musculoskeletal care modalities.
4. Develop 3 NANDA pririority nursing diagnosis for musculoskeletal care modalities.
5. State patient goals/ plan nursing diagnosis for musculoskeletal care modalities.

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Bunny GreenfelderLv2

24 Apr 2019

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PLEASE ANSWER ALL THESE QUESTIONS I REALLY NEED THEM.

8- Older women experience bone loss, which makes them more susceptible to hip fracture. How should an environment change after a hip-fracture repair?

A. Sleep only on one side

B. Raise the toilet seat

C. Don't allow use of stair

D. Use a shower

9- A vigorous recent widower visited his primary care team and stated that he was lonely. Which recommendation should the team make for this patient?

A. Finding a new relationship

B. Moving in with his children

C. Taking a sleep pill

D. Taking an antidepressant

10- How often is tetanus vaccination recommended for older adult?

A.every 15 years

B. Every 10 years

C. Yearly

D. Every 5 years

11- Which lighting feature in most nursing homes compromises elder adult's ability to function?

A. Indirect lighting

B. Glare

C. Sunlight

D. Even lighting

12- A spiritual African American elder has terminal HIV. Based on knowledge of spiritual beliefs common in African American communities, why might this patient require careful assessment and monitoring for pain?

A. The patient may understate pain levels because of a belief that the illness is God's plan.

B. The patient may overstate pain levels so that God will be more likely to hear the patient's suffering.

C. The patient may overstate pain levels so that more drugs can be obtained for religious rituals.

D. The patient may understate pain levels because of faith in the doctor's ability to treat the patient.

13- A home-care nurse visits an elder living with dementia whose spouse is providing care. The nurse notices a restraint sitting in the.... What is the most important thing the nurse should do?

A. Find out why the spouse needs to use the restraints

B. Help the spouse plan care without using restraints

C. Report the spouse's abuse to adult protective services

D. Lecture the spouse about the risks of restraints.

14. Which assessment tool can be used to determine activities of daily living ( ADL) independence in older adult?

A. Mini-mental state examination (MMSE)

B. Mini-cog assessment

C. The Karz index

D. Confusion assessment method for the ICU ( CAM ICU)

15. Which nonpharmacologic interventions should nurses counsel patients on when they complain of occasional heartburn, constipation, and low energy?

A. Distribution of fatty meals throughout the day.

B. Two tablespoons of liquid antacid 30 minuts after each meal

C. A hot cup of coffee or tea at each meal

D. Adequate consumption of whole grains, fruits, and vegetables

Blue County Memorial Hospital (BCMH) is one of the largesthealth care organizations in eastern North
Carolina. It serves the eastern one-third of North Carolina andmaintains a 500-bed facility offering 24/7
acute medical and surgical care. The health care facility has over30,000 patient admissions a year, and
its average length of stay (LOS) is about four days.

The health care facility is organized by specialty and staffedwith qualified MDs, physician assistants
(PAs), nurses, and technicians. BCMH contains 12 operating rooms,all with state-of-the-art equipment,
numerous wards for postoperative care, and related ancillaryservices (rehabilitation, testing labs, etc.).
The operating room department has a large challenge in that it mustmanage and allocate equipment
and staff so that surgeries can be performed effectively but alsoin the most efficient manner possible.
In all, the assignment of equipment and staff is a difficultjob.

State regulations require threshold levels for nurse-patientratios, and not meeting these thresholds
may lead to underutilization of available capacity. In turn, thesize and mix of staff are critical decisions
for the workforce planners. Overstaffing, understaffing, orunbalanced staffing leads to issues with
quality of care and increased patient cost. BCMH meets its staffingrequirements with a mix of
permanent staff and an on-call group of part-time staff availableon short notice. There is also
temporary staffing that occurs for nurses with six-month toone-year contracts. Overall, the hospitalâs
staffing needs have been met by 60 percent permanent staff, 35percent temporary staff, and 5 percent
on-call staff.

BCMH provides services to patients, and in turn those patients,either through insurance or by direct
payments, reimburse BCMH for services provided. Although manyservices are provided, surgery is one
area where BCMH adds value and garners profits. However, surgerydemands numerous resources,
including equipment and staff (surgeons, nurses, technicians,etc.). BCMH is also responsible for
preoperative care and postoperative care. Insufficient capacity inany area (surgery, postoperative
wards, etc.) can lead to surgical procedures being turned away orto higher costs if accepted when over
capacity.

Slotting is used for planning and scheduling purposes. Each areawithin BCMH is broken up in half-day
slots, meaning there are 14 slots per week. Slot planning andscheduling is conducted about once a
quarter (once every three months). A plan is developed inconsultation with surgeons; demand for
surgical procedures varies little from year to year, but the demanddoes have a seasonal component,
making some quarters busier than others. In addition, somespecialties have peak demands whereas
other specialties have very stable demand.

The slotting and planning process also encompasses the staffingof nurses. The labor cost of nurses for
surgery is one of the largest and most controllable operatingcosts. Nursing staffing plans are prepared
each month for a monthâs time frame and two weeks in advance. Thenursing schedule is frozen one day
in advance and then resource requirements are matched based on theupcoming surgeries. This type of
planning is efficient for day-to-day operations but gives limitedflexibility in terms of the permanent
staff, temporary staff, and on-call staff. The nurse scheduler mustmany times rely on temporary staff or
on-call staff when demand changes occur in the short term.Subsequently, BCMH must meet its nursing
needs from outside, and in monetary terms the outside staff costsmore, as higher rates are paid to the
outside staff. In addition, the staffing in preoperative andpostoperative wards is done in a similar
fashion.

Q1: 1) What data items are to be collected, and how they areused in operational management of BCMHâs surgical
unit; Also Labor cost has gotten the attention of BMCH Leadership,and they want your team to come up with

options addressing nurse staffing. The team must come up with atleast three options for nurse staffing
to include outsourcing 100% of the nurses. What are theseoptions?

emeraldpug407

Discussion: Assessing the Ears, Nose, and Throat Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test. In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions. Note: By Day 1 of this week, your instructor will have assigned you to one of the following case studies to review for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case. Case 1: Nose Focused Examination Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he's taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous. To prepare: Review this week's Learning Resources and consider the insights they provide. Consider what history would be necessary to collect from the patient. Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis? Identify at least 10 possible conditions that may be considered in a differential diagnosis for the patient. Note: Before you submit your initial post, replace the subject line (âWeek 5 Discussionâ) with âReview of Case Study ___,â identifying the number of the case study you were assigned. Post a description of the health history you would need to collect from the patient in the case study to which you were assigned. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.