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Nursing

cat summary essay

You review the electronic health record (EHR) with Dr. Nayar and consider which aspects of the past medical history you will want to obtain from Christina.
Chief Concern: 19-year-old female presenting with right ankle pain.
Problem List:
Otitis Media (age 2)
Mononucleosis (age 14)
Left radial head fracture (age 15)
You refer to the CDC Immunization schedule to identify if Christina is overdue for any immunizations. After reviewing her immunization record, you conclude that she is up to date on all recommended shots.
TEACHING POINT
Past Medical History
All portions of the past medical history including medical problems, surgeries, food and medicine allergies, and social history are important.
Often, the immunization history is overlooked when patients don’t come in expressly for a prevention visit. But, the immunization history is significant, even in an acute visit, as another opportunity to update immunizations may not present itself for a while.
You go to the exam room and introduce yourself to the patient, Christina, and her mother, Mrs. Martinez. You then begin to interview Christina about the mechanism and timing of her ankle injury.
“Can you tell me more about how you hurt your ankle?”
Tearfully, she elaborates, “I was playing soccer last night and was trying to pass the ball to a teammate. Somehow I slipped and fell.”
“Do you know which way you fell on your ankle?”
Christina says, “My ankle really hurts along the outside. I am having a lot of problems walking and it’s a little stiff. It was swollen yesterday.” Mrs. Martinez adds, “I saw her ankle twist inward as she fell to the ground. The coach immediately iced the area and she was able to leave the field under her own power.”
“Have you ever had other difficulties with your ankle?”
“No, this is the first time anything like this has ever happened.”
“Do you have other health concerns you would like to address today?”
“Actually, I have been having problems when I pee, but I want to talk about my ankle first.”
Given this information, you suspect Christina’s injury is probably moderate. You refocus and plan to follow up by asking questions to eliminate concern about a limb-threatening injury.
TEACHING POINT
Significance of Historical Features of Ankle Injury
A patient who seeks help immediately, and is non-weight bearing, is more likely to have a severe injury than one who presents a few days after an incident and is fully weight-bearing (the ability to take four steps independently).
A history of previous ankle sprain is a common risk factor for an ankle injury.
While hearing a snap or tear is diagnostically significant in an acute knee injury, it is not in an acute ankle injury.
Differential of Acute Ankle Pain Following Inversion Injury
Acute ankle injury is one of the most common musculoskeletal injuries in athletes and sedentary persons, accounting for an estimated 2 million injuries per year and 20% of all sports injuries in the United States.
There are many potential reasons for ankle pain.
Achilles tendon rupture
A common sports injury classically associated with an audible “pop.” Incidence increases with age. Patients are unable to plantarflex.
Fibular fracture
Usually due to a fall, an athletic injury, or a high-velocity injury such as a motor vehicle accident. Patient may have severe pain, swelling, inability to ambulate, and deformity. The Ottawa ankle rules help to distinguish patients who need an x-ray to rule out such a fracture.
Lateral ankle sprains
Generally present acutely (after trauma) with pain, warmth, and some swelling. Ankle sprains do not create a deformity. If there is a large amount of swelling present, however, it may appear to be a deformity.
Medial ankle sprain
Somewhat rare and suggests that forced eversion has occurred. There is typically injury to the deltoid ligament.
Osteoarthritis of the ankle
Less common than in some other joints. It is a chronic process, more commonly seen in older people. The tibiotalar joint is generally involved and the condition may occur as a result of prior injury, obesity, or history of rheumatoid disease. Symptoms may include stiffness, swelling, deformity, and a feeling of instability.
Peroneal tendon tear
Typically due to an inversion injury and may occur in conjunction with a lateral ankle sprain. Patient may complain of persistent pain posterior to the lateral malleolus. Swelling may or may not be present. Repetitive trauma may cause injury to the peroneal tendons.
Syndesmotic sprain
Generally involves the interosseous membrane and the anterior inferior tibiofibular ligament. Pain and disability are often out of proportion to the injury. One would expect a positive ankle squeeze test.
Mechanism of Injury and Anatomy of Ankle Sprains
Plantar flexion and inversion
The most common mechanism of injury in ankle sprains is a combination of plantarflexion and inversion. The lateral stabilizing ligaments, which include the anterior talofibular, calcaneofibular, and posterior talofibular ligaments, are most often damaged.
The anterior talofibular ligament is the most easily injured. Concomitant injury to this ligament and the calcaneofibular ligament can result in appreciable instability. The posterior talofibular ligament is the strongest of the lateral complex and is rarely injured in an inversion sprain.
The anterior drawer test can be used to assess the integrity of the anterior talofibular ligament, and the inversion stress test can be used to assess the integrity of the calcaneofibular ligament.
Excessive eversion and dorsiflexion
In medial ankle sprains, the mechanism of injury is excessive eversion and dorsiflexion. Medial ankle stability is provided by the strong deltoid ligament, the anterior tibiofibular ligament, and the bony mortise. Because of the bony articulation between the medial malleolus and the talus, medial ankle sprains are less common than lateral sprains.
Question
What are the signs/symptoms that are included in determining the grade of an ankle sprain?
Select all that apply.
The best options are indicated below. Your selections are indicated by the shaded boxes.
A. Ecchymosis
B. Ligament tear
C. Loss of functional ability
D. Pain
E. Swelling
SUBMIT
Answer Comment
The correct answers are A, B, C, D, E.
All of these elements—in addition to whether the patient can bear weight—are used to grade an ankle sprain. See Teaching Point below.
TEACHING POINT
Grading Ankle Sprains
Grading of ankle sprains takes into consideration:
The presence/absence of a ligament tear
Loss of functional ability
Severity of pain
Presence and/or severity of swelling
Presence of ecchymosis
Difficulty bearing weight: the ability to take four steps independently
Grade I sprain involves stretching and/or a small tear of a ligament. There is mild tenderness and swelling, slight to no functional loss, and no mechanical instability. No excessive stretching or opening of the joint with stress.
Grade II sprain is characterized as an incomplete tear and moderate functional impairment. Symptoms include tenderness over the involved structures, mild to moderate pain, swelling, and ecchymosis. In this grade, there is some loss of motor function and mild to moderate instability. Stretching of the joint with stress, but with a definite stopping point.
Grade III sprain is characterized as a complete tear and loss of integrity of the ligament. Severe swelling (greater than 4 cm about the fibula) and ecchymosis may be present, along with an inability to bear weight and mechanical instability. Significant stretching of the joint with stress, without a definite stopping endpoint.
Please note that clinical grading of lateral ankle sprains may be limited based on a number of factors including patient pain level, interexaminer reliability, and the subjective nature of using visual inspection findings to establish an accurate diagnosis. Initial management amongst each grade of lateral ankle sprains will likely depend more on other factors individualized to a given patient and their symptoms.
The next step you would like to take to work up Christina’s symptoms is to see if you can elicit any costovertebral angle (CVA) tenderness and examine her abdomen. You tap on Christina’s back below the ribs on both sides and elicit no expression of tenderness. She does not have suprapubic tenderness, rebound, or guarding.
Mrs. Martinez wants to know, “What do you think is going on?”
Dr. Nayar asks you,
“So what grade of ankle sprain do you think Christina has?”
You reply, “I am not sure. Christina has some loss of functional ability and pain. She had swelling on the first day, but none now. There isn’t any bruising on exam, but she does not want to weight bear. I’m having trouble deciding between Grades I and II. In the end, I would say Grade I because Christina has persistent pain, previous swelling that has resolved, tenderness, and mild to moderate inability to function.”
He agrees and adds,
“Do you think we should get an x-ray to rule out a fracture?”
“I’m pretty sure she just has a sprain. But Mrs. Martinez was very firm in wanting Christina to have an x-ray. I’m not really sure what the best thing to do is.”
TEACHING POINT
Deciding When Foot/Ankle Radiography Is Indicated – Ottawa Ankle Rules
Ankle injuries are the most common presentation to the emergency department, yet less than 15% of these injuries turn out to be clinically significant fractures.
The Ottawa rules are evidence-based tools developed to help physicians decide when radiography is indicated.

QUICK QUOTE

Approximately 250 words

Categories
Nursing

Florence Nightingale

Finda scholarly article about Nightingale’s life and efforts to make a difference in the lives of others.
Instructors preferences:
-Do not use direct quotation, just paraphrasing
-No running header
-No abstract
-400 words not including title or reference pages
-APA 7th edition
Attached:
-rubric
-one article I found
Lloyd, J. (2020, April-June). Florence Nightingale: a reflection on a nurse ahead of her time: The World Health Organization (WHO) has declared 2020 the Year of the Nurse and Midwife–a recognition of the vital role we play in global health. Australian Nursing & Midwifery Journal, 26(10), 26. https://link.gale.com/apps/doc/A623924121/PPNU?u=lirn99776&sid=bookmark-PPNU&xid=392d42a3

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Approximately 250 words

Categories
Nursing

Discussion post

Jasmine Clark: Cont. HR 68, RR 22, BP 116/86, Temp 98.9, O2 sat-100%
History of Chief Complaint:
Jasmine reports she needs help because she overthinks everything and thinks she has a mental illness. Intrusive, obsessive thoughts started when she was 14 years old. She reports watching a television show about sex offenders and began to think that she would engage in behaviors she saw on the TV show. She reports thoughts that she might hurt or kill her parents and she is very frightened by these thoughts. She started having suicidal thoughts so that she wouldn’t hurt other people and feels the need to punish herself for those thoughts. She tries to distract herself with other thoughts in order to avoid the homicidal and suicidal thoughts. She denies history of self-injurious behaviors or eating disorders.
The pediatrician recommends that Jasmine go to the nearest emergency department for referral to an inpatient adolescent unit. The recommendation is Voluntary Commitment.
Her parents voice concern regarding their daughters willingness to actually go to a hospital.
This is an unfolding case study which we will be utilizing for this discussion
Questions:
Based on what you know so far, what are your concerns and what will be your interventions. (Elaborate on at least 3)
How will you explain Mental Health Hospitalizations to Jasmine’s parents? (Elaborate on at least 3 important points)
Jasmine is worried about how she will be treated at the hospital. She has seen many movies and does not want to be tied down and medicated. How will you educate Jasmine?
Is it ever ok to alert others to Jasmine’s condition? Why or why not?
As the parents predicted Jasmine now states emphatically “I do not want to go to the hospital.” How do you anticipate Jasmine’s care will change?
Add a question: After you have analyzed the content from the discussion board, please add a question to the end of your initial post regarding the reading material for the week.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer-reviewed journal evidence to support the student’s position.

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Approximately 250 words

Categories
Nursing

Lymphatic, Chest, & Heart

This Discussion post has 3 parts:
1-Lymphatic: Define lymphedema.
What is elephantiasis?
Provide the differential diagnosis of mumps versus cervical adenitis.
2- Thorax and Lungs: Define and provide an example of a disease/situation where this sign/symptom might be present:
Dyspnea, Orthopnea, Apnea, Paroxysmal nocturnal dyspnea, Tachypnea, Bradypnea, Hyperpnea, Kussmaul breathing, Periodic breathing (Cheyne-Stokes).
Support your answer with a previous experience you have encountered in your career. (Med surg NUrse)
3-Cardiovascular System: Name and write the location of the five traditionally designated auscultatory areas and explain why it is heard there.
A pregnant patient (32 weeks’ gestation) is having difficulty with dependent edema and painful varicosities. What can you suggest to help this patient’s problem and explain rationale?
Instruccions:
post should be at least 500 words, formatted and cited in proper current APA 7 style with support from at least 3 academic sources.
Quotes “…” cannot be used at a higher learning level for your assignments, so sentences need to be paraphrased and referenced.
Acceptable references include scholarly journal articles or primary legal sources (statutes, court opinions), journal articles, and books published in the last five years— no websites or videos.
Read:
Jarvis, C. (2019). Physical examination and health assessment (8th ed.). Elsevier.
Chapters 19, 20, & 21

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Approximately 250 words

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Nursing

collaborative healthcare week 1

Reflection Question
Based on the results you obtained from the Foundation of Nursing Leadership self-assessment in Week 1 Lesson, reflect on the questions below and share in a post.
What is your current leadership style?
How does your leadership style impact your decision making in nursing care?
How will you further develop your leadership skills?
please add 1 reference

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Approximately 250 words

Categories
Nursing

440 Discussion 1 # 1

Module 1 Overview
Done: View
Introduction
The first module discusses the role of the case manager in a wide variety of settings. Case management is not only a large part of the acute care setting but, is becoming more and more accessible in the outpatient setting. With current changes in CMS guidelines Case Managers must critically think and evaluate patient and family dynamics quickly to assess for needs outside of the acute care setting. In week one we will review the differences in roles of the case manager.
Learning Outcomes
After completing this module, you will be able to:
Identify the differing roles of the nursing case manager
Discuss the difference between acute and outpatient case management
Apply case study activities to holistic patient care planning
Reading & Resources
Read Chapter 1 in Fundamentals of Case Management Practice
Review Case Management Society of America
Hodgkinson, I., Vince, C., Aylott, C., Pamphilon, J., Chandler, J., & Chumbley, K. (2018). P-243 End of life care education within the nursing and residential home setting. BMJ Supportive & Palliative Care, 8http://dx.doi.org/10.1136/bmjspcare-2018-hospiceabs.268.
Review the National Committee for Quality Assurance certification criteria
Learning Activities
Introductions: Introduce yourself in the Introductions Forum.
Discussion: Participate in Discussion 1. Discussion 1 Question 1
To do: Make forum posts: 3
You have been hired as a consultant by a hospital that is going to begin using case managers in the acute, home care, and primary care settings. You meet with the vice president (VP) of patient services. She tells you that the hospital tried to use case managers 3 years ago, and the project failed. She believes one of the major reasons it failed is because there was no clear position description or role description that was understood by the staff. She would like you to help develop an effective nurse case manager position description.
1. Identify the skills needed for a nurse to enter the case manager role.
2. Describe the role of the nurse case manager in acute, home care, and primary care settings.
3. Explains the approaches case managers use to promote the highest quality of care.
You must use at least 2 scholarly references to support your answer.
See the Nursing Syllabus Standards & Policies Document for Discussion Participation Guidelines & Grading Criteria.

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Approximately 250 words

Categories
Nursing

five models of evidence-based practice

• Context: Total knee arthroplasty (TKA) carries with it a risk of potential hypothermia and significant pain subsequent to the operation. The potential link between heightened postoperative pain and this associated risk of hypothermia requires further research.
• Objective: To determine whether the use of warming gowns during the TKA procedure has a positive effect on a patient’s postoperative pain. For further reference, locate the following article on the internet:
° Benson, E., McMillan, D., & Ong, B. (2012). The effects of active warming on patient temperature and pain after total knee arthroplasty. American Journal of Nursing, 112(5), 26-33.
Step 2 Review the five models.
Review the five models of evidence-based practice:
• PICOT Model for Writing Questions,
• The lowa Model of Evidence-Based Practice to Promote Quality Care
• Multidisciplinary Evidence-Based Practice Model
• Care Bundles
• Stetler Model of Research Utilization
1 in
Step 3 Write a two-page (500-word) paper using APA 7.0 format style..
Write a paper briefly illustrating how each of the five models might be used in nursing practice. Use the article provided as the research problem in question. Address the following questions in your paper:
Briefly summarize the five models of evidence-based practice.
• How might each of these models be implemented in practice to the research problen describec-in the article?
• Which model(s) would you recommend for implementation to this research problem?
Why?
• Conclude your paper with your recommendation of which of the model(s) would best be applied to the research problem and why?
• Be sure to cite all resources used to complete the assignment and include a reference list in APA 7.0 format style.
Step 4 Save and submit your assignment.
When you have completed your assignment, save a copy for yourself in an easily accessible place and submit a copy to your instructor using the dropbox.

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Approximately 250 words

Categories
Nursing

Topic DQ 2

Health teaching is one of the population-based interventions that can be implemented by public health nurses. Could you implement this intervention for your chosen population? What would be the positive and negative aspects of utilizing this intervention?

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Approximately 250 words

Categories
Nursing

Topic DQ 1

Describe two or three population-based interventions that are evidence-based. Explain why it is important to evaluate different interventions addressing a community health need?

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Approximately 250 words

Categories
Nursing

Musculoskeletal System Problems

Identify and analyze the causes and risk factors that precipitate diseases of the musculoskeletal system.
Arthritis: osteo, rheumatoid, gout
Upper extremity: shoulder, elbow, wrist, hand
Low back pain
Lower extremity: hip, knee, ankle, foot
Create and formalize 5 questions related to the topic of the class. (musculoskeletal)

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Approximately 250 words