To look through patients MAR in order to administer the scheduled medication.
How my Personal Objectives Were Met
My first objective was to assess different patients independently and give them the targeted medications using phyxis. I also wanted to administer such medicines accordingly based on each patients MAR. I began by asking my preceptor if it was possible to carry out all the assessments and administer the right medications. I then examined the medicines and analyzed their specific side effects. For instance, I observed that beta-blockers should be administered when the blood pressure is around 90/50. Digoxin is usually given as a cardiac stimulant (Eizenberg, 2010). Before administering this drug, it is appropriate to assess the apical for a minute. Pain assessment should also be done after administering the drug. The effectiveness of the medicine should also be checked after every hour.
After completing all these assessments, my preceptor indicated that I had made several errors. By the end of the day I was able to chart all my assessments and findings correctly. My preceptor was also happy because I was able to administer medications and use phyxis independently. It was also my opportunity to use the concept of evidence-based practice throughout every drug administration process. I achieved my objectives by ensuring that the right medicines were administered to the selected patients. I also collaborated with different patients and workers to promote the most appropriate medical practices (Eizenberg, 2010).
Use of Nursing Processes and Development of My Clinical Decision-Making Skills
Nurses should embrace the power of different processes to support the health needs of their respective patients. Evidence-based practice in nursing is something embraced by many practitioners. During my clinical practice, I followed the five nursing processes in an attempt to achieve my objectives. I completed the assessment process by collecting the best information from my patients. The gathered information was used to dictate the most appropriate nursing diagnoses (Dason, Dason, & Kapoor, 2011). The third process was to prioritize the best goals based on the targeted patients outcomes. I developed a proper care plan for every patient. The best interventions were embraced to treat every patient. This objective was achieved by integrating my clinical expertise with the diverse needs of the targeted clients. The right medicines were administered to the patients. The final stage was to evaluate the health progress of every patient. This practice was critical towards realizing the targeted health outcomes. These processes made it easier for me to administer the right medicines to the identified patients.
Discussion of Leadership
Leadership remains one of the core pillars of nursing. My clinical practice gave me the opportunity to understand effective leadership can transform the nature of healthcare practice (Eizenberg, 2010). The supervisor supported my practice by encouraging me to remain focused. The preceptor also made it easier for me to outline and rectify various mistakes. The individual also used desirable skills to influence my performance. I was able to offer quality and consistent care to every patient. The individual became my role model during the period. The actions undertaken by this leader explain why it was easier for me to achieve the above objectives. As well, most of the nurses were ready to empower one another. They helped each other thus recording the best results. My instructor also informed me about the importance of administering complete doses for urinary tract infections (UTIs). Such lessons explain why appropriate leadership is relevant towards supporting the objectives of both patients and nurses (Dason et al., 2010).
Topic: Evidence-Based Practice
APA Format
Dason, S., Dason, J., & Kapoor, A. (2011). Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Canadian Urological Association Journal, 5(5), 316-322.
Article Summary
The article begins by acknowledging the fact that urinary tract infection (UTI) is a major problem affecting women. More often than not, treated UTIs tend to reappear in many women. Bacterial infection and persistence are some of the leading causes of recurrent UTIs. The common symptoms of recurrent UTI include repeated pyelonephritis, low uroflowmetry, trauma, and bladder calculi (Dason et al., 2010). Conservative measures used to prevent such UTIs include modification of various predisposing factors such as sexual activities. Low-dose antibiotics can also be taken continuously. Dason et al. (2011) argue that post-coital antibiotic prophylaxis can be used to prevent UTIs (p. 320). Vaginal estrogen and self-start antibiotics are also useful whenever managing recurrent UTIs.
Standards of Practice and My Nursing Approach
My nursing practice in caring for someone with this condition met the current evidence and standards of practice. This is true because I was able to administer appropriate antibiotics. As well, my instructor explained how UTI recurrences should be treated using complete doses. Moreover, the article presents new approaches that can be used to support women with recurrent UTIs. Evidence-based practices are useful in my nursing care (Eizenberg, 2010). I now understand how to use the best processes in order to support the health goals of my patients.
Reference List
Dason, S., Dason, J., & Kapoor, A. (2011). Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Canadian Urological Association Journal, 5(5), 316-322.
Eizenberg, M. (2010). Implementation of evidence-based nursing practice: nurses personal and professional factors. Journal of Advanced Nursing, 67(1), 33-42.
The work of a clinical or medical office worker is characterized by a combination of a large number of administrative operations with medical activities. Primarily, these professionals are office assistants filling out paperwork and interacting with staff ( How to become a medical office assistant, 2021). As a result, I will be approaching interviews for this job in a professional business style. While the fitting suit can be expensive, I already have the proper formal attire. Using my black formal suit, shoes, and minimal accessories, I can make the right impression without reducing my budget. In warm weather, I can go to an interview right in a suit, and in cold weather, I can add my usual outerwear, for example, an overcoat.
Work clothes, theoretically, may require additional investments and purchases. All healthcare workers, including office workers, must wear a special uniform called scrubs, consisting of a short-sleeved shirt and trousers. This uniform is relatively cheap, and a single set of scrubs can be found on Amazon for about $20-$40 ( Medical assistants uniform, 2019). Most of all, in this context, one needs to take care of shoes since these specialists sometimes have to stand or walk a lot. A good pair of closed-toe shoes can cost around $100, but I have tennis shoes that fit the dress code ( Medical assistants uniform, 2019). However, it must be taken into account that many medical institutions issue uniforms on their own, considering them as consumables, so the choice of purchasing a uniform will depend on the rules of a particular hospital. In any case, it is simple and easy to wear, so it will not entail high costs.
Reflecting on the points studied and prepared, I want to note that the new information will affect my budget and life plan very little. In the best case, if the hospital issues uniforms, I wont have to spend any money at all, as I can wear my existing suit for the interview and shoes for work. In the worst case, I will still be within the budget when I have to buy everything for work. Therefore, I can put that $200 aside and mentally prepare for possible demands from my interviewers. In addition, this study showed that the issue of clothing for interviews and work is not a problem for me, and I am already prepared for it in many respects.
References
How to become a medical office assistant. (2021). Eagle Gate College. Web.
Medical assistants uniform. (2019). Dorsey College. Web.
It goes without saying that changes in the performance of health care providers and in the process of health care delivery are eventually required to improve the general quality of the public health care system affected by unpredictable circumstances. At the same time, local medical facilities aim to implement changes according to their clients needs. In order to evaluate the necessity of specific changes, consultations with health care practitioners are constantly required.
Purpose of Consultation and Overview of the Consultation Process
This work implies the analysis of the interview taken from a public health nurse (care coordinator) of the Hennepin County Mental Health Center to evaluate the general state of this medical facility and identify the necessity of changes.
Organizational Analysis
The Hennepin County Mental Health Center (HCMHC) is a medical organization that provides high-quality and low-cost mental health services for people in Hennepin County, Minnesota. It serves adults with serious mental diseases and related substance use disorders. HCMHC serves children and adolescents with severe emotional disturbance who have been neglected, abused, or court-ordered for evaluation, as well ( Clinics and services, n.d.). The center is licensed as a DHS Rule 29 Community Mental Health Center by the State of Minnesota ( Clinics and services, n.d.). In general, in Hennepin County, there are four health departments that serve a population of 1,224,763 people in an area of 554 square miles (CountyOffice.org, n.d.). Every health department is designed for 306,190 people within the territory of 138 square miles (CountyOffice.org, n.d.).
Located in the Nicollet Exchange Building, 1801 Nicollet Avenue, Minneapolis 55403, HCMHC provides a comprehensive and client-oriented treatment that aims to promote patients self-efficacy, general wellness and recovery, and life enhancement. Its experienced team of qualified health care providers understands recovery as an individual process and personalizes treatment according to a persons needs. Professionals develop a plan of treatment and care for every client with the focus of his or her person-specific goals and initiate the participation of the patients support system or other service providers if necessary ( Clinics and services, n.d.).
As a county-supported facility, HCMHC provides medical help for the residents of Hennepin county or individuals for whom it has financial responsibility. Despite the fact that the center prioritizes patients referred by Hennepin County Departments, it helps people who may encounter particular barriers to care, as well. In general, HCMHC is a safety net provider that primarily serves citizens without commercial insurance or citizens who are underinsured or uninsured ( Clinics and services, n.d.). Moreover, the center welcomes all clients who are regarded its flexible service model as beneficial. In order to be accessible and completely responsible for patients needs, HCMHC offers walk-in visits as well as scheduled appointments.
In order to provide high-quality mental health care, the center uses a multidisciplinary approach and offers a wide range of medical services that include the following categories:
Assessments and evaluations (Psychological and psychiatric evaluations, combined (parenting and psychological evaluations, diagnostic assessments);
Therapy and education (Individual and group therapy, consultation, psycho-education, general health and wellness education);
Whole-person care (The delivery of primary mental health care to adult patients, outreach to persons experiencing homelessness, treatment for co-occurring substance use and mental disorders, resource assistance and care coordination, collaboration with service providers and community partners, the creation of Access employment program with Rise) ( Clinics and services, n.d.).
Primary Needs of Organizations Population
It goes without saying that Hennepin County Public Health defines the health data collection, review, and analysis as its highly significant function ( Public health data, n.d.). It uses the Community Health Assessment in order to monitor the health condition of adults and children of Hennepin County. This tool serves as a specific recourse for an ongoing conversation about policies and programs to enhance health in the county ( Public health data, n.d., para. 1). In general, the organization of collected health data into relevant fact sheets and community health assessment may be regarded as an efficient way to share this data and inform the public and stakeholders about the communitys health problems and concerns.
It goes without saying that the persons mental health is highly essential for his or her interpersonal relations, family, and individual well-being. It plays an important role in the ability of any citizen to contribute to society. According to the Community Health Assessment, in Hennepin County, 8% of adults aged 25 and older have frequent mental distress (FMD) on a constant basis ( Frequent mental distress, n.d.). At the same time, FMD rates vary from 5% to 14% across the regions of Hennepin County, and the highest rates belong to Minneapolis Central and Minneapolis North ( Frequent mental distress, n.d.).
Moreover, education, socioeconomic status, health, and the social perception of sexual orientation have a considerable impact on residents mental health. In other words, US-born Black people of low education and low income reported a disproportionately high rate of FMD compared to other residents in Hennepin County ( Frequent mental distress, n.d., p. 2). Adults with diabetes or disabilities and obese people suffer from FMD more frequently than other community members. Current smokers and individuals with a lack of physical activity have significantly higher rates of mental distress than other citizens as well. In addition, the FMD rates of residents identified as LGBT are reportedly twice as high as FMD rates of non-LGBT residents ( Frequent mental distress, n.d.).
Concerning the mental health of adolescents, collected data demonstrate disturbing results. In 2016, approximately 24% of 11th graders in Hennepin County, especially in suburban areas, reported having particular signs of depression ( Adolescent mental health and treatment, n.d.). In turn, more than 17% of 9th graders reportedly had long-term emotional, behavioral, or mental health problems ( Adolescent mental health and treatment, n.d.). In general, race, gender, and poverty are directly connected with the occurrence or absence of anxiety, depression, and other disorders. Low-income students, girls, Hispanic, and Black adolescents of any grade report having chronic mental health issues more frequently in comparison with non-low-income students, boys, and students of other nationalities ( Adolescent mental health and treatment, n.d.).
Depression, along with other mental disorders, feeling alone, drug or alcohol use, and family history of mental illness are regarded as common risk factors that may lead adolescents to suicide. It is identified as the third leading cause of death among adolescents in Hennepin County and across Minnesota ( Adolescent suicidality, n.d., p. 1). In 2016, at least one in ten 9th graders in Hennepin County, especially in suburban areas, seriously considered suicide during the past year ( Adolescent suicidality, n.d.). Approximately 3% of students of 8th, 9th, and 11th grades reportedly attempted suicide within the past 12 months ( Adolescent suicidality, n.d.). Similar to the previously described situation related to mental disorders and depression, socioeconomic status, race, and gender influence adolescent suicidality low-income, Hispanic, and American Indian students consider and attempt suicide more frequently that other graders ( Adolescent suicidality, n.d.). In addition, girls of any grade are almost twice as likely as boys to consider suicide ( Adolescent suicidality, n.d., p. 1). However, according to collected data, in Hennepin County, males die by suicide at disproportionally high rates.
Nurse Leader Interview Summary
Role of the Nurse Leader
The role of public health nurse and care coordinator in HCMHC implies constant assistance, coordination, and intercommunication in order to provide a high quality of health care in medical settings. A public health coordinator works with patients and their family members to ensure that they receive all necessary information concerning health conditions and potential treatment. In addition, a health coordinator episodically follows up with pharmacies, case managers, patients who miss appointments, group home staff, and personnel who miss patient-related medical forms or other paperwork. The duties of public health nurse additionally include the arrangement of outside laboratory work, the obtainment of results, and assistance with setting up appointments for outside referrals, the identification of case management teams, date tracking, and coordination with the County Attorneys office. Moreover, the participation in care conferences that involve multiple health care providers and agencies both in Hennepin County and other states is obligatory as well.
In general, the role of public health nurse and care coordinator in HCMHC aligns with the defined role of a competent health care professional and leader. A masters-prepared nurse should know how to apply decision-making and leadership skills in the provision of culturally responsive, high-quality nursing care, healthcare team coordination, and the oversight and accountability for care delivery and outcomes (American Association of Colleges of Nursing, 2011, p. 12). In addition, a qualified health care professional assumes his or her leadership role for the efficient implementation of quality improvement initiatives and uses effective communication skills, improvement science, and quality processes to ensure patient safety for individuals and the community in general. Moreover, the role of a nurse leader may be characterized by multitasking, the availability of time management skills, and stress resistance.
Organizations Characteristics
As a matter of fact, the main strength of HCMHC is its highly efficient performance and the provision of high-quality health care delivery. The center efficiently serves its target population and uses the whole potential of its staff that annually participate in quality improvement programs. In addition, HCMHC successfully implements evidence-based practice that traditionally includes problem formulation, the search and appraisal of relevant data and literature, the implementation of evidence, and the evaluation of its results in order to modify the intervention for better health outcomes. At the same time, the inferiority of the organizations technological infrastructure may be defined as the major weakness of HCMHC. At the same time, this organizational drawback is highly essential in the present day. Due to the pandemic, communication with patients is substantially limited, however, the majority of clients have no access to video and phone services of the center due to technological constraints.
Recommendation for Organization Change
It goes without saying that HCMHC currently requires certain organizational changes to improve its performance. Moreover, these changes are highly essential for patients and fully correspond to their actual needs as the majority of basic services currently become unavailable. First of all, the COVID-19 Access Solutions QI workgroup should identify barriers to engagement in the centers care during the pandemic. Clients for whom current practices are inaccessible should be identified as well, and if they cannot use video or phone services, they should have an opportunity to come to the center and use an iPad placed there as an exception. Moreover, electronic health records should be available for patients as well for control over their health conditions. In general, implemented changes are expected to improve the peoples access to the centers services by at least 10% in the next months as measured by appointment completion data. The HCAHPS survey is applicable to measure patients updated perspectives of patients care as well.
Conclusion
The Hennepin County Mental Health Center (HCMHC) is a medical organization that serves children, adolescents, and adults with severe emotional disturbance, depression, serious mental diseases, and substance use disorders. It provides high-quality and low-cost mental health services for the residents of Hennepin County, Minnesota, and individuals who may encounter particular barriers to care. With the help of a highly experienced team under the supervision of competent leaders, HCMHC provides a comprehensive and client-oriented treatment that aims to promote patients self-efficacy, general wellness and recovery, and life enhancement. It goes without saying that the persons mental health is highly essential for his or her interpersonal relations, family, and individual well-being. However, such factors as racial discrimination, poverty, health, education, gender, and the social perception of sexual orientation have a considerable impact on the mental health of adults, children, and adolescents. In general, HCMHC may be characterized by efficient performance and the provision of high-quality health care to the countys residents. At the same time, the center currently requires certain organizational changes to improve its performance and provide access to its services for all patients.
This work will gradually tell the audience about the essential consequences of inactivity and its pathophysiology. Further, it is impossible to do without the morbidity and mortality statistics among the adult population. Such data is important because it reflects modern statistics, which deteriorate every ten years. The work will be completed by preventive measures that greatly impact the human body. The urgency of the problem attracts a lot of attention in the scientific community, leading to discoveries in physical inactivity.
Excess body weight
Reduced physical activity and excessive nutrition can quickly lead to obesity. Obesity is usually divided into primary and symptomatic, when excess weight is a symptom of another disease. The causes of primary overweight are genetic predisposition, excessive food intake, and physical inactivity. Regarding heredity, scientists agree that there is a greater or lesser genetic predisposition to weight gain, but hereditary factors are always closely connected with a persons lifestyle. Excess weight is often the cause of a violation of many body functions. First of all, being overweight increases the risk of cardiovascular diseases. Excess body weight hurts the musculoskeletal system, causing deformity of the foot. Also, excess weight leads to various metabolic disorders, resulting in atherosclerosis and diabetes mellitus can develop.
Weakening of heart activity
Movement is a natural need of our body. Heavy physical exertion negatively affects human health; their absence also affects it. Due to a low-activity lifestyle, our muscles weaken and gradually atrophy. It adversely affects the state of the cardiovascular system, reducing its efficiency. Over time, a person begins to notice the appearance of shortness of breath, weakness, headaches, and irritability. People with low physical activity develop CVD 1.5-2.5 times more often than people who lead a physically active lifestyle. The human body has a large reserve; only 35% of its functional capabilities are used in daily activities. New functions without training atrophy gradually, resulting in the bodys reserves being depleted. A person loses the ability to adapt to changing living conditions. The absence of systematic physical exertion leads to the respiratory and cardiovascular systems beginning to age at 12-13. The harm of physical inactivity to health lies in the fact that simultaneously with a decrease in physical performance, resistance to powerful influences decreases oxygen starvation, a sharp change in atmospheric pressure, cold, and heat. Regular physical activity supports the immune system, allowing the body to resist cancer development.
Prevention of physical inactivity
When physical activity is normalized, the risk of cardiovascular complications and critical conditions is significantly reduced. In patients who follow all medical recommendations, the duration increases, and the quality of life improves. Preventive measures should be aimed at increasing physical activity in each person. Children should be taught to perform daily morning exercises and active outdoor games from early childhood. Compulsory attendance of physical education classes at school is very useful for visiting sports sections. Recently, fitness clubs have become widespread; regular attendance is an excellent prevention of physical inactivity. Nevertheless, the inability to attend sports complexes should not be the reason for insufficient physical activity. Every person can take daily walks and jog in the fresh air. It is useful to have any simulator at home, not necessarily expensive and large; there is a place for a simple jump rope, an expander, or dumbbells in every house.
It is possible to prevent the development of inactivity with the help of movement. Measures to prevent hydrodynamic disease today are much more; one of them is the water regime. Every day a person should drink at least two and a half liters of water. It doesnt have to be just water. It is quite possible to use juices, compotes, teas, and other liquids. It is worth noting that the intake of fruit and vegetable juices can guarantee anti-inflammatory and immunomodulatory effects. Prevention of physical inactivity includes the observance of a special diet. A person should eat as many vegetables and fruits as possible, vegetable oil, and honey with lemon. Physical activity and rest will also help prevent the development of this disease (Stevo & Dusco, 2018). It is best to give your preference to swimming over physical activity. Do not forget in this case, about the water procedures that should carry out in the morning and evening. The shower should be cool in the morning but warm in the evening. An important point in preventing physical inactivity is considered to be the observance of a healthy lifestyle. It is very important in this case to normalize your working day and equip your home.
Final take
Scientific studies have convincingly proved that one of the serious consequences of physical inactivity is a decrease in the overall resistance of the human body. Prolonged inactivity contributes to the development of infectious diseases, complicating their course and slowing down the recovery processes in the body. The above is quite enough to realize the danger of physical inactivity for human health. Over the past hundred years, technology has actively entered human life: robots and computers in the production of household appliances at home have saved humanity from physical exertion. The movement for a healthy lifestyle is growing all over the world. More and more people understand that physical activity is necessary to maintain health. Adults first of all, this should be understood and put some effort. The foundation of good health is laid from an early age, and a lot depends on physical activity. Developed motor stereotypes help to preserve the achieved result for a long time.
Reference
Stevo, P., & Dusco, B. (2018). Effects of physical inactivity on body composition of older people: A meta-analysis. Journal of Physical Activity and Health, 15(10), 212-213.
The managed care plan (MCP) is a type of healthcare insurance which is designed to deliver medical services to its clients at a lower cost. The providers of managed care solutions analyze the market, comparing the rates charged by different physicians, hospitals, and clinics, and then sign contracts with the ones who offer the lowest prices. They can successfully negotiate with the healthcare providers and obtain considerable discounts since these organizations have a large number of clients. These companies build large networks which include various hospitals and doctors and pay them an annual fixed fee. It is different from another insurance model, fee-for-service, which implies that the healthcare providers are paid for each of their consultations separately. Despite its major advantage of affordability, managed care plans are often criticized by the public for their limitations concerning the choice of physicians and the lack of insurance coverage for the out-of-the-network cases.
One of the primary reasons why Americans oppose the MCP model is because they believe it to be aimed strictly at the reduction of costs. For example, managed care plans imply that a client will be able to consult only one physician who is a part of the insurance providers network (Pinkovskiy, 2020). Many perceive such a situation as a desire of the managed care organizations (MCOs) to make their customers overpay for healthcare services. Moreover, the cost restrictions of the MCP solution mean that some vulnerable groups will not receive proper care. People who are constantly in need of assistance with their daily activities such as dressing, feeding, and bathing may not be eligible for these services under their managed care plan (Jones, 2018). Thus, the limited number of opportunities is the main cause of the publics backlash against the MCP model.
These are not the only problems which accompany the insurance option in question and are often reported by the clients. According to one study, MCP clients reported that they consistently experienced disorganization in the administrative processes, issues concerning communication with the MCOs, and declines in the provision of certain services (Arora et al., 2020). It demonstrates that there are significant challenges which the managed care providers have to address to improve their quality of operations. Apart from being unable to choose different physicians, individuals may not receive full insurance coverage for the services of a medical specialist who is not a part of the network (Duijmelinck & van de Ven, 2016). This creates a situation when a person, despite having an MCP, is forced to pay for themselves. Therefore, many people decide not to use a managed care plan, choosing other options, or avoiding being insured.
The MCP presents an affordable insurance solution, yet due to its strict limitations and certain problems, it frequently becomes a target of criticism. The general public often opposes this type of insurance, saying that its primary goal is to decrease the price of healthcare by depriving the clients of the right to choose their doctors. Other problems reported by clients of this insurance solution concern communication with the plan providers, organizational issues with the administrative activity, and the lack of coverage for people with special needs. Also, if an individual decides to visit a doctor who does not have a contract with the insurance provider, they may incur all the costs of the specialists services. Thus, the MCP model can be suitable for those who do not have serious health-related conditions and do not want to spend a large sum of money on insurance.
References
Arora, K., Rochford, H., Todd, K., & Kaskie, B. (2020). What can Europe learn from the managed care backlash in the United States? Disability and Health Journal, 13(3), 18. Web.
Electronic nicotine delivery systems cause the same harm to the human body as other tobacco products. Plus, polyhydric alcohol solvents kill cell membranes. All this can lead to severe illnesses. If the main harmful effect of conventional cigarettes comes from tar and combustion products, here it comes from solvents (Dinardo & Rome, 2019; National Institute on Drug Abuse (NIDA/NIH), 2018). It is severe harm to health, so creeping because not only the membranes and cells of the lungs are dissolved, but also the brain and heart.
In 2019, the discussion about the negative impact of vaping on health intensified in the United States. In August of that year, the Illinois Department of Public Health reported what was believed to be the first death in the country due to a severe respiratory illness dubbed EVALI. This acronym stands for lung injury associated with the use of e-cigarettes or vaping products. By the end of the year, doctors were already talking about almost forty dead (Irusa et al., 2020). In total, the countrys authorities have identified several thousand cases of such diseases. The age of the dead varies from 17 to 75 years.
Consequently, e-cigarettes must be subject to laws governing the sale and distribution of traditional tobacco products. Making them available to young people is dangerous for the reasons mentioned above. The absence of tar and an unpleasant odor is the only external differences between a regular cigarette and a vape, while in reality, all the harm is contained within the composition of the products themselves and the inhaled vapor (Kennedy et al., 2022). Sales should also be restricted in some cases to persons over the age of 18. As smoking can affect the lungs and some other chronic diseases, the damage to health is already proven and evident. At the legislative level, it is recommended that people be able to buy a vape only if, after a medical examination, the doctor concludes based on which the risks of illness from vaping will be reduced. According to the certificates, electronic cigarettes will be sold, reducing their consumption.
The present case scenario examines the story of a 46-year-old woman who had been experiencing RUQ pain for the past 24 hours. Notably, the pain started one hour after dinner, with episodes of nausea and vomiting already present in the patients history before the visit. The womans baseline vital signs (temperature, HR, BP) and neurological patterns are normal, although she suffers from grade II diabetes and gout and has several allergies, including medications.
Based on the above information, it can be assumed that one of the causes of these symptoms, given the location of the pain, is biliary colic. Evidence suggests that biliary colic is caused by eating large quantities of fatty foods, which leads to the formation of gallstones in the cystic duct, resulting in obstruction (Sigmon et al., 2022). Causes for stone formation are excess cholesterol and bilirubin in the patients diet; when the gallbladder contracts, bile is released into the duodenum for further emulsification. If gallstones have been formed, the release causes them to become stuck, forcing sharp but constant pain (Sigmon et al., 2022). It can be concluded that the woman has probably already suffered from gallstones for some time, and the pain increased after consuming fatty foods. Increased levels of ACT in the blood may indicate damage to the liver structures, including the gallbladder, which allows confirmation of this diagnosis (Robinson, 2021). It is possible to rule out other disorders related to alcohol or drug use, or psychological illness based on tests and the patients history. The patients skin condition also allows ruling out acute cholangitis, as there is no history of jaundice or pruritus.
It is worth clarifying that biliary colic is a temporary painful condition, which can progress as dietary prescriptions are not followed. Treatment is based on laparoscopic cholecystectomy, surgery to remove the gallbladder (Sigmon et al., 2022). After removal, the woman must follow a strict diet for several months, minimizing fatty foods and increasing drinking water intake. Indeed, the patient can refuse surgical intervention in favor of drug therapy. However, it is worth warning her that the gallbladder may contain several stones, which increase the likelihood of recurrence. Drug therapy uses symptomatic medications, including antiemetics and pain relievers, as well as ursodeoxycholic acid (Actigall, Urso, Urso Forte), which dissolves gallstones (Ursodiol, 2019). Using this drug therapy will reduce pain and gradually dissolve gallstones without surgery.
Many people are reported to complain of abdominal pains that are accompanied by blood in stool and fever. The situation commonly occurs will the elderly people who are said to be above 70 years in most cases (Burch & Tort, 2018). Diverticulitis is the swelling of the left side of the colon due to the presence of bulges. This paper aims to discuss the contrast between diverticulosis and diverticulosis by answering the questions given. The questions to be answered include the findings that support the diagnosis, the risk factors associated with diverticulitis, and why antibiotic and intravenous antibiotics and fluids are mentioned in the case.
When comparing and contrasting between diverticulosis and diverticulitis, it is important to consider the stage. Diverticulosis is the presence of one or more bulges in a body organ such as the colon wall, while diverticulitis is the swelling and infection of one or more bulges in a body organ (Thompson, 2016). Diverticulosis is a common issue and rarely causes symptoms and needs no treatment. On the other hand, diverticulitis can be treated by distortion of antibiotics, and surgery can be an option if the condition is severe. Both diverticulosis and diverticulitis share a feature known as diverticula, a situation where one or more bulges form in the wall of a patients large intestines.
Diverticulosis is commonly reported in the western world and may occur in different ways. It is noted in 10% for people aged 40 and above and 50% for people 60 years and above (Thompson, 2016). The rate of diverticulosis rises as the persons age increases and affects nearly everyone at 80 years and above (Thompson, 2016). The two diseases are caused by what scientists assume is of consuming enough fiber. However, diverticulitis is yet to be analyzed on what may lead to specific conditions, but researchers relate to bacterias presence in the stool that gets attached to diverticula.
The other key feature to compare is the symptoms with diverticulosis having tenderness and moderate abdominal pain. Additionally, patients who have diverticulosis have reported swelling and constipation (Burch & Tort, 2018). Diverticulitis symptoms include severe pain in the abdomens left side, which can start randomly or develop gradually. Fever, chills, nausea, and rectal bleeding are other forms of symptoms that a patient can have when suffering from diverticulitis.
Clinical findings from the case study that support acute diverticulitis diagnosis include various types of complications that the 84-year-old patient has. First, the patient has left lower quadrant abdominal pains accompanied by nausea, fever, and vomiting. From the research, it is reported that the symptoms are likely to be associated with diverticulitis. Acute diverticulitis is present in the patient because diagnoses done in the clinic have shown that there is blood in her stool (Thompson, 2016). The findings support the diagnosis of acute diverticulitis and not diverticulosis because there are severe symptoms that reveal that the condition is serious.
Several risk factors lead to the development of diverticulitis. First is age, as it is reported that as the persons age increases, do does chances of having diverticulitis (Thompson, 2016). Secondly, obesity is a common factor that may lead to this condition. When a patient is seriously overweight raises the chances of developing the condition. The third risk factor is consuming a diet that is high in animal fat and has low fiber (Thompson, 2016). If a person consumes a low fiber diet and combines that with a high intake of animal fat, there may be risks of getting acute diverticulitis. Other factors that may lead to these conditions include if the patient is under certain medications associated with risks of getting the condition. For instance, steroids, nonsteroidal anti-inflammatory medication, and others may increase the chances.
The inclusion of antibiotics in the case study is because diverticulitis has not yet developed to complicated levels. Treatment f diverticulitis has been associated with antibiotics with oral agents for patients with moderate infection. Intravenous antibiotics and fluids are useful to treating the condition if it deteriorates (Burch & Tort, 2018). Delivering antibiotics through IV is relevant because bacteria formation and survival will be minimized. The intravenous antibiotics will be helpful if the diverticulitis will be resistant to oral administration. It is also important to note that diverticulitis at some stages may require a high dosage that would not be administered orally (Thompson, 2016). When intravenous antibiotics are included, it is possible to switch the oral administration after a while if the condition does not turn positive.
From the analysis, diverticulosis is different from diverticulitis because it does not show symptoms and requires no treatment. It means diverticulitis is a development of severe diverticulosis. The discussion shows that the condition is mostly associated with the older group. The risk factors for acute diverticulitis infection are age, obesity, and low intake of fiber foods. The disease can be diagnosed by scanning, and antibiotic administration aids in treatment. However, if the condition is resistant to oral antibiotics, intravenous antibiotics and fluids can be used. People can prevent diverticulitis by exercising and avoiding smoking.
References
Burch, J., & Tort, S. (2018). For people with diverticulitis, how does mesalamine (5-ASA) compare with placebo for the prevention of recurrence? Cochrane Clinical Answers, 2(7), 6-14. Web.
Thompson, A. (2016). Diverticulosis and diverticulitis. JAMA, 316(10), 11-24. Web.
It is important to note that the project is designed to prevent or minimize the effect of nosocomial infections, which can also be described as hospital-acquired infections. In order to implement the proposed plan, teams will need to consist of different categories of healthcare professionals. In other words, these groups will be primarily multidisciplinary by nature because diverse expertise is necessary to ensure that patients do not acquire new infections after they are admitted to a hospital. It should be noted that nosocomial infections constitute the largest form of hospital-acquired conditions, which is almost 6% (Ellison & Cohen, 2018). Therefore, the Continuous Quality Improvement or CQI team will be comprised of a physician, an information specialist, a health care epidemiologist, an infection control specialist, a clinical microbiologist, and nurses. Nursing staff and physicians are needed to provide healthcare services in a traditional sense, but other specialists are critical due to the infectious nature of nosocomial issues.
Representation of Process/Activity
The detailed checklist for the process is shown in Table 1 below. The key checklist points revolve around the most common vulnerability points. Nursing staff must be provided with protective gear, which needs to be checked. The further steps will focus on the most vulnerable patients, which are at risk of nosocomial infections. The high-risk points requiring caution include physical injuries or surgical wounds, ventilator-associated pneumonia, and bloodstream infections. In addition, there are urinary tract infections as well as surgical wound infections (U.S. Centers for Medicare and Medicaid Services, 2022). Each patient type needs to be identified by using electronic health records and other sources of information. An additional level of caution needs to be taken by doubling the safety procedures, including protective gear use. The identified patients need also be constantly monitored from the moment of their admission until they fully recover from their primary health problem and leave the hospital. Lastly, the nature of nosocomial infections should be checked, such as bacterial, viral, or fungal origins. The latter statement is critical because it will determine the course of action if the infection is identified.
Table 1. Checklist
#
Measures
Check
1
Protective gear
2
Patients with physical injuries or surgical wounds: identification, caution, and monitoring
3
Patients at risk of ventilator-associated pneumonia: identification, caution, and monitoring
4
Patients at risk of bloodstream infections: identification, caution, and monitoring
5
Patients at risk of urinary tract infections: identification, caution, and monitoring
6
Patients at risk of surgical wound infections: identification, caution, and monitoring
7
Nature of infection: bacterial, viral, or fungal check
Benchmark Table
The detailed benchmark table to display a comparison of national quality standards against current standards at the healthcare organization for the CQI proposal is shown in Table 2 below. The table depicts the most relevant standards for the nosocomial infection case, where communication plays a critical role in ensuring that patients are safe from hospital-acquired infections. The problematic area can be seen in the close to benchmark section, which will be addressed with the leadership style and flexibility increase.
Table 2. Benchmark Table
Benchmark Table
Far away from benchmark
Close to benchmark
Achieved benchmark or better
National Quality Standards
Adult hospital patients who strongly disagree or disagree that staff took their preferences and those of their family and caregiver into account when deciding what the patients discharge health care would be (Agency for Healthcare Research and Quality, 2022).
Adult hospital patients who sometimes or never had good communication about medications they received in the hospital Agency for Healthcare Research and Quality, 2022 .
Deaths per 1,000 adult hospital admissions with pneumonia Agency for Healthcare Research and Quality, 2022 .
National Benchmark
Benchmark = 3.2
Benchmark = 7.8
Benchmark = 21.6
Current Standards
Benchmark = 4.9
Benchmark = 7.5
Benchmark = 22
Leadership
In order to successfully implement the project and achieve the desired objective of reducing or eliminating the rate of nosocomial infections, it is critical to apply a proper leadership framework. A study suggests that strong clinical leadership is required to improve the quality of care & compassionate leadership is paramount in healthcare (Graham & Woodhead, 2021). Since the CQI plan revolves around two main elements, which are protective gear and high-risk patient groups, there is a need for compassionate leadership with strong clinical management. In the case of personal protective gear or PPE, the emphasis needs to be put on balancing standardization procedures and staff flexibility. A study suggests that the highest level of error reduction is found in circumstances in which employees are granted a high degree of discretion, standardization rigidity is intermediate, and, as a result, adherence to standardization is high (Nissinboim & Naveh, 2018, p. 43). Medical experts need to be given room for autonomy and choice-making to introduce flexibility. In other words, standardization is effective to a certain extent in order to make the procedures and processes more consistent.
Subsequently, a leader at the organization should focus on compassionate transformational leadership to harness trust and support among the team members. The organization already has a rigid standardized structure of processes and procedures, which is why the emphasis needs to be put on flexibility factors. In addition, there are at least five high-risk groups, which include physical injuries or surgical wounds, ventilator-associated pneumonia, bloodstream infections, urinary tract infections as well as surgical wound infections. The standardization might become ineffective in addressing all of these vulnerable patients. The latter statement is further substantiated by the fact that nosocomial infections can be of three different origins. Therefore, the proper approach is to focus on healthcare staff development, flexibility, and support, which will allow them to be more responsive to diverse instances of infections.
Graham, R. N. J., & Woodhead, T. (2021). Leadership for continuous improvement in healthcare during the time of COVID-19. Clinical Radiology, 76(1), 67-72.
Nissinboim, N., & Naveh, E. (2018). Process standardization and error reduction: A revisit from a choice approach. Safety Science, 103, 4350.
U.S. Centers for Medicare and Medicaid Services. (2022). Glossary. Web.
Anemia is one of the diseases that come in a variety of forms. It may be linked to chronic iron deficiency or vitamin deficiency, be the result of a chronic disease, etc. Still, whatever its nature might be, it is one of the most common health issues in the elderly (Macedo, Dias, Camara, & Antunes, 2017). However, even though anemia is often viewed as part and parcel of aging, it does not necessarily develop in all seniors. Seeing that in older people, anemia often leads to the development of more serious conditions, one must explore the avenues for addressing the issue in a manner as efficient as possible to sustain the patients condition at a satisfying level.
Difference Between an Elderly Patient and Other Age Groups
Although there is no primary difference in which the disease manifests itself in elderly patients and young ones, senior members of the population with anemia are much more prone to developing comorbid health problems than the young ones (Macedo et al., 2017). For senior citizens, anemia is nearly inevitable, whereas, in adolescents and young adults, the problem is rather rare. It is also noteworthy that the reasons for the disease to develop are different in older and younger population in most cases. For instance, in children and infants, anemia is typically caused by iron deficiency, whereas in the elderly, the problem is triggered by the lack of Vitamin B12, although iron deficiency may also be a possible cause (Macedo et al., 2017).
Pathology of Anemia in the Elderly
After erythroid precursors are developed in the bone marrow, they gradually mature to the stage where they turn into erythrocytes. Without the nucleus, erythrocytes do not have a Krebs cycle and, therefore, cannot generate as a result of respiration. Therefore, the generation process depends heavily on the glycolysis processes, especially on the Embden-Meyerhof type, which is the most common one. Seeing that the production of enzymes that are necessary for the proper function of glycolytic pathways is slackened down significantly with age, elderly patients are predisposed to the development of anemia to a greater degree than young ones. One must admit, though, that, due to the slow development of the problem, the patients body may produce a response that will help manage anemia successfully (Oberoi & Pratap, 2015).
Comorbidities
Among the comorbid issues that elderly patients with anemia may have, one should mention hypotension first. The reason for the identified comorbidity to occur in patients is rather simple. Seeing that anemia implies that the production of red blood cells is hampered, the blood tension drops immediately as soon as anemia is developed. Therefore, hypotension must be addressed accordingly when managing the needs of anemia patients.
Furthermore, the levels of antidiuretic hormone (ADH) secretion are increased significantly. As a result, anemic patients are under the threat of having the syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH manifests itself in numerous symptoms, including muscle pain, tremor, ataxia, and the related symptoms (Raje, Biradar, Reddy, Kabra, & Panicker, 2015).
Conclusion
Seeing that in the elderly, anemia is not only much more frequent than it is in young people but also fraught with much more serious outcomes and comorbidities, it is imperative to introduce the tools that would allow identifying the problem at the earliest stages of its development and designing the approach for managing it efficiently. Particularly, the means of keeping the patients health rate at the required high level and preventing the disease from triggering more serious concerns should be suggested. As long as a nurse has control over the progress of anemia, improving patients outcomes remains a possibility.
References
Macedo, B. J., Dias, P. P. I., Camara, H., & Antunes, C. M. F. (2017). Anemia in the elderly: Neuropsychiatric repercussions. Advances in Aging Research, 6(1), 11-16.
Oberoi, T., & Pratap, A. (2015). Prevalence of anemia in pediatric age group patients and its co-relation with socio-demographic factors in patients presenting at department of pediatrics at Rohilkhand Medical College and Hospital, Bareillly, U. P. Journal of Evolution of Medical and Dental Sciences, 4(34), 5877-5882. doi:10.14260/jemds/2015/860.
Raje, V., Biradar, S., Reddy, M., Kabra, M., & Panicker, S. (2015). Neuroendocrine Disturbances Following Head Injuries. Journal of Evolution of Medical and Dental Sciences, 4(43), 7567-7575, doi:10.14260/jemds/2015/1099.