Sarah Smith is a 28 y/o African American female who presents to the office with c/o wound to her left foot for the past few days. States she had tripped and fell while barefoot scraping the top of her foot on the pavement. She denies any other injury from the incident. Over the past 24 hours the wound has had “smelly” drainage. Has been experiencing generalized achiness, but denies fever and chills. Did not seek medical attention at the time of injury. Has been using hydrogen peroxide to clean her wound. Is unclear of her last tetanus vaccination. Patient PMHx significant for DM II. States that she takes her medications when she remembers, and does not always check her blood sugar.
Asthma: no hospitalizations for exacerbation.
Former tobacco user: ceased smoking 2 years ago. Had smoked 1ppd x 5 years
Illicit drugs: denies
Significant for paternal DM, otherwise unremarkable
Metformin: 500mg BID po – did not take the last few days
Albuterol MDI: 2 puffs every 6 hours prn – last use just PTA
Singulair: 10mg po daily
Trinessa: 1 tab po daily – last taken this am
LNMP: 2 weeks ago.
General: denies any weight changes, fatigue or fever; body aches
Skin: denies any rashes; wound to left foot
HEENT: denies headache, head injury, dizziness, lightheadedness;
Denies any vision changes
Denies any hearing changes, tinnitus, vertigo, earache
Denies any nasal congestion, discharge, nose bleeds or sinus tenderness
Denies any sore throat, difficulty swallowing
Neck: denies any swollen glands, pain
Breasts: denies any pain, discharge
Respiratory: denies any dyspnea; positive cough and wheezing
CV: denies any chest pain, edema
GI: denies any nausea/vomiting/diarrhea/constipation; denies bloody stools
PV: denies claudication, swelling to LE
GU: denies frequency, urgency, burning;
Denies vaginal discharge, itching, sores
Denies penile discharge, itching or sores
MS: positive pain to left foot
Psych: denies nervousness, depression
Neuro: denies Headache, dizziness, vertigo, syncope, weakness; numbness to right LE
Heme: denies any easy bruising
Vital signs: 100.5 (tympanic), 162/88, 118, 22, O2 sat 95% on RA
Height: 5’5” Weight: 250 lbs.
Blood glucose: 230 (Fasting; states has not eaten yet today)
patient awake, alert, oriented x 4 in NAD
Skin: warm, dry, color WNL. 4 cm lesion noted to anterior left foot with crusting and purulent drng; surrounding erythema extending up 7 cm proximally
HEENT: head nontraumatic, normocephalic
Pupils PERRLA, EOMs intact; disc margins sharp, without hemorrhages, exudates; no AV nicking noted
Ears: bilateral TM with good cone of light and intact
Nose: mucosa pink, septum midline; no sinus tenderness appreciated
Mouth: mucosa pink, moist; tongue midline; tonsils 1 without exudate
Neck: supple; trachea midline; no LAD
Resp: regular and unlabored; lungs with end expiratory wheezing throughout
CV: RRR, S1 and S2 noted; no s3, s4 or murmur appreciated
Abdomen: soft, non-distended; Bs x 4; no tenderness with palpation; no CVA tenderness with percussion
Extremities: warm and without edema; calves supple, non-tender
PV: no LE edema
MS: swelling to left foot; tenderness of 2-4th left metatarsals; left pedal pulse; CMS intact; Cap refill < 2 sec.
Neuro: alert, cooperative; thought coherent; oriented x 4; cranial nerves II-XII intact
List your differentials for her current problems. Remember you should have at least three different differentials for each problem. Include rationale for each differential.
At this time what medical diagnoses are you most concerned about? Do they impact other diagnoses? If so, how?
What diagnostic images would you order? Provide your rationale. What are you trying to rule in or out?
What laboratory work would you order? What would you anticipate to be abnormal? Provide your rationale for each.
What is your comprehensive plan of care? Include your rationales.
APA 7th Edition
Discussion Overview: This week you will identify your project goal and at-least one short-term and one long-term project outcome.Discussion Overview: This week you will identify your project goal and at-least one short-term and one long-term project outcome. You will also discuss your target population, stakeholders, and your project’s potential impact on healthcare quality.
PROJECT GOAL: EDUCATION ON NURSE BURNOUT INCLUDING IN THE POST-ANESTHESIA UNIT (PACU)
Outcomes are what you hope to meet or achieve when you accomplish your project’s goal. Therefore, before you can determine your project outcomes, you need to identify your project’s goal. Think about goals in terms of your change component. Goals are what you intend to do as your part of your project’s implementation process.
IMPLIMENT NEW EDUCATION FOR RECOGNIZING NURSING BURNOUT TO ULTIMATELY REDUCE OR PREVENT NURSE BURNOUT THROUGHOUT THE HOSPITAL (HCA)INCULDING IN THE PACU DEPT
HERE ARE SOME EXAMPLES
Example 1: For my capstone project, my goal is to implement an educational inservice on evidence-based hand hygiene for isolation patients to my unit’s nursing and ancillary staff.
Example 2: For my capstone project, my goal is to draft a revision to our unit’s current nursing orientation policy to include the role of ICU nurse mentors. Nurse mentors will be assigned to any nurse, after unit orientation, without previous critical care experience for one year. I will present the draft revision proposal to leadership for approval and evaluation.
Outcomes refer to what you want your target population to do in response to your change component. Outcomes are both short-term (what will happen before the end of the Capstone course) and long-term (before the end of the first year of the project) in nature.
BEFORE THE END OF CAPSTONE; EDUCATION MATERIAL CAN BE HANDED OUT TO PACU FOR NURSES TO RECOGNIZE FEELING BURNED OUT AND HOW TO PRIORITIZE PHYSICAL AND MENTAL HEALTH. ALSO FOR NURSING LEADERS TO RECOGNIZE THE LEVEL OF STAFF STRESS
REDUCTION IN NURSE TURNOVER RATES, NURSE RETENTION, AND HAPPIER NURSING STAFF.
Example 1: My desired short-term outcome for my education inservice is that my target population (nursing and ancillary staff on my unit) state an increased knowledge about evidence-based hand hygiene of isolation patients. My desired long-term outcomes are that I am hopeful my target population will use the skills and knowledge learned from my education inservice to improve healthcare quality, and our unit will see a decrease in healthcare-associated infections (HAIs).
Example 2: My desired short-term outcome is for leadership to approve of my revision to the current nursing orientation policy after the presentation of my draft. My long-term outcomes are that the creation of the ICU nurse mentor role for nurses with no previous critical care experience will improve patient outcomes and decrease staff turnover rates in our unit.
Discussion Prompt: Re-state your small-scale change project, and then answer the prompt:
Who is your project’s target population? NURSE LEADERS AND NURSING STAFF IN PACU TO START AND THEN THROUGHOUT THE HOSPITAL
Compare and contrast your stakeholders from your target population.
Share one or two examples of how you are planning for stakeholder buy-in of your project.
What is your project short-term goal?
Based on your short-term goal, what is your desired short-term and long-term outcome?
How will your project help improve healthcare quality?
Provide supportive rationale for how your project help improve healthcare quality from a scholarly source using an APA in-text citation and full reference.
Nursing QuestionNursing Assignment Help Instructions
To prepare, before viewing this video, create a table with 2 columns like this one here.
Fill in the table while viewing the video, “Just A Routine Operation” by Laedal Medical Human Factors in Patient Safety by viewing link#1 (Links to an external site.) or link#2. (Links to an external site.) In a later TeamSTEPPs training, you may be asked to refer to this table. However, you don’t need to submit the table for this assignment.Just a Routine Operation (Links to an external site.)
For this assignment, you will complete the assigned readings below about patient safety and then write a short essay citing both resources.
Culture of Safety (Links to an external site.)
Nursing and Patient Safety (Links to an external site.)
In your short essay, clearly identify (at least) one safety issue that was ignored in this case scenario. After researching the issue(s), explain from a nurse’s perspective how the outcome could have been altered, and what safety measurescould have helped to protect this patient. Submit this assignment as one file that will include (in the following order) a:
1-page cover page,
1-reference page (1 page)
this grading rubricActions.
This essay is written using APA format and submitted on Canvas as a Word (doc or docx) file or Adobe PDF. Use the APA manual and SMU’s writing services to guide you. No abstract is necessary for this essay. Five points will be deducted if the essay exceeds two pages in length. Please note additional pages will not be read. TurnItIn is enabled on this assignment. Submit/turn in your assignment via Canvas before the deadline.
**PLEASE NOTE: The video depicts a re-enactment of medical errors occurring in an operating room, which results in a patient death. If you feel this video may be too triggering for you, please contact me by 8am on Tuesday, 1/4 to discuss alternatives prn.
Topic: Helping and Healing RelationshipsConsider the various steps of the nursing process in order to address the following critical thinking questions.
As a healthcare provider, discuss ways in which you will establish a helping hand and healing relationship with your patient and their families.
How will you develop professional partnerships with health care team members in your clinical practice?
What personal behaviors, biases, and attitudes would you have to change to develop these professional relationships?
APA 7th Editon
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