Performance Management and Training

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Write a 7-10 page research paper on the topic of performance management and training for an organization of your choice.

Introduction

It is essential for members of management to understand the important of conducting performance reviews. An effective performance management system is a big component of improving employee performance, which ultimately adds to the bottom line of the organization. Failure to communicate performance expectations and achievements to employees could cause them to be unaware of the expectations or how they can improve. Additionally, formal performance management and training is imperative to help protect an organization against legal claims.

Preparation

Research the topic of performance management and training for an organization of your choice. Performance management includes the supervision of employees and ongoing goal setting, training, and measurement to meet individual and organizational objectives. A minimum of five resources are required to support your work.

Scenario

Choose an organization to use for this assessment. It can be where you are currently employed or a company with which you are familiar. It

must

be an organization that is researchable, as you will need to gather and analyze information to complete the assessment. You may use the same organization for the other assessments in this course.

If you choose the organization where you are currently employed, please keep in mind that the analyses you make must be based on facts that can be documented rather than your personal opinion as an employee.

Contact your faculty if you have questions.

Instructions

Write a research paper based on your research into the performance management system, which includes training, of the chosen organization. In your paper:

  • Describe the performance management system currently in place.
  • Explain how the performance management system is explained and communicated to employees.
  • Analyze how the current performance management system is effective for the organization or why it needs to be changed. If the system needs to be changed, discuss how current trends of performance management could be incorporated into the current system.
  • Explain the differences between formal and informal performance feedback processes.
  • Analyze best practices to improve employee performance.
  • Analyze the importance of training to meet organizational needs and performance goals.

    • What should be considered in designing an effective training program?
  • Explain how training and performance management protect an organization from possible litigation.

    • What types of litigation might arise?


Note

: You must address all the required elements of this assessment. If details for any of the bulleted points are unavailable, research the topic and present recommendations you believe would be best for the organization, along with your supporting rationale.

Additional Requirements

Your assessment should also meet the following requirements:


  • Length:

    7-10 typed, double-spaced pages, in addition to a title page and reference page.

  • Written communication:

    Communicate in a manner that is scholarly and professional. Your writing should be:

    • Concise and logically organized.
    • Free of errors in grammar and mechanics.

  • Validation and support:

    Use a minimum of five relevant and credible scholarly or professional resources such as the

    Wall Street Journal

    to support your work. These resources should not include the resources found in the course.

  • APA format:

    Format all citations and references in accordance with current APA guidelines. Refer to the


    Evidence and APA


    Campus page for guidance.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

  • Competency 1: Apply human resource strategies to business needs.

    • Explain how training and performance management protect an organization from possible litigation.
    • Analyze how the current performance management system is effective for the organization or why it needs to be changed.
  • Competency 2: Analyze core functions of human resource management.

    • Describe the performance management system currently in place and how the performance management system is explained and communicated to employees.
    • Explain the differences in formal and informal performance feedback processes.
  • Competency 3: Analyze the strategic value of human resource management within a competitive global business environment.

    • Analyze best practices to improve employee performance.
    • Analyze the importance of training to meet organizational needs and performance goals.
  • Competency 4: Communicate effectively in a scholarly and professional manner.

    • Apply APA formatting to in-text citations and references.
    • Convey purpose in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly writing standards.

Linda and her 12-year-old daughter molly had moved to glasgow

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Linda and her 12-year-old daughter Molly had moved to Glasgow, UK in August 2020. Since mother and daughter both loved eating out, they explored the many restaurants and eateries that the city had to offer.

law

Description

1) Linda and her 12-year-old daughter Molly had moved to Glasgow, UK in August 2020. Since mother and daughter both loved eating out, they explored the many restaurants and eateries that the city had to offer. On Sunday, October 4th, they ate at Nico’s, having heard about the “world’s best hamburgers” being served at there. Nico’s was known to serve hamburgers custom cooked to varying degrees of doneness – medium rare to well done – based on the customer’s request. On busy weekend evenings, Nico’s usually serves around 50-60 hamburgers every hour. On that Saturday, Linda and Molly ordered medium rare hamburgers and fries, enjoying their experience. Molly found the meat in her hamburger to be rare, at best, but she did not complain and ate the burger anyway.On Monday, October 5th, Molly became violently sick. She ran a fever and was vomiting uncontrollably. She was rushed to the hospital and, by the afternoon, Linda developed a fever and felt nauseous. Molly’s condition progressively worsened over the next two days and, despite the best efforts of the doctors, she died on Thursday. Linda got better and was sure that Molly’s illness had something to do with the hamburger at Nico’s. On her suggestion, Donna made some inquiries and found out that Nico’s used hamburger patties processed and sold by Argus International, a transnational meat processing giant. The next day, her fears were confirmed: Molly’s reports showed that she had died from a deadly strain of e coli bacteria, 0157:H7 (commonly referred to only as H7). H7 is usually found in ground meat and when consumed undercooked, it can lead to serious complications including kidney failure and death. https://essaypandit.com/you-may-choose-to-discuss-the-metabolism-often-focusing-on-electron-donors-and/ On the very same day that Molly died, the Glasgow Herald carried a news item about the death of a middle-aged gentleman, Mr. Kelvin Lithgoe. His estate had issued a statement pointing out that Lithgoe’s death had occurred after consuming a pack of processed meat manufactured by Argus International. Lithgoe’s medical reports revealed that he had been infected by H7. The estate further alleged that the pack had been sold by Besco’s Supermarket. Following the report, Besco’s recalled all processed meat items that had been supplied to the retail chain by Argus International. Argus International, on the other hand, defended its processing units. It further stressed that all its ground meat packages displayed an advisory that the contents should be cooked to at least “medium-doneness” before consumption.

Please advise all parties on possible causes of action under Law of Torts, including    potential defences.

2) Alice and Bharath are neighbors. Alice took issue with Bharath and his wife, Clara, moving next door three months ago and has repeatedly made comments to other neighbors about the “Indian trash littering her pristine British streets”. Alice, without instigation, decides to dump her garbage all over the front doorstep of Bharath and Clara’s flat. She leaves a note stating that they should join the rest of the trash and be shipped back to India.  When Bharath ignored the note and cleaned up the mess, Alice became even angrier.  Alice spread a rumor that she saw Bharath kissing another Indian man near the shops and entered his house. The rumors eventually found their way to Clara, as several women, including Alice, took delight in telling Clara about her husband’s supposed indiscretions and how you cannot expect “savages to be faithful or straight”.  Later that night, she experienced severe episodes of uncontrollable shaking and vomiting. Clara, who is otherwise fit and healthy, suffered from these physical effects for two weeks until a psychiatrist proscribed some medication.  One month after the incident with Alice, Bharath is denied a job at a local IT firm with his friend, who works there, alleging that upper management were not comfortable with a gay man working at their company.    https://theeliteessaywriters.com/2021/06/16/assignment-descriptionenvironmental-deaths-include-drowning-lightning-hypothe/

As the lawyer of Bharath and Clara, please explain the potential tort claims that the couple can pursue against Alice.

3)  Sandy, a third grade teacher, is the head coach of the fifth-grade girls’ basketball team at Queen’s Elementary and her team is currently 0-16 in the season. Roman, the part-time assistant coach and teaching aide, blames Sandy for the team’s poor performance and devises a plan to get her fired. Roman decides to accuse Sandy of stealing money from the team fund in front of the parents and student-players after a game. Sandy, outraged, yells at Roman and calls him a liar before throwing a basketball at the man.  The basketball missed Roman but struck Tanav, a parent, in the face. Sandy then went up to Roman and told him, “You’d better watch your back, you coward.” Roman also posted on his social media profile that “The head coach is a thief! Lock her up!”. Delighting in her outburst and striking of a parent, he continues to spread the accusations across social media and through the parents and students. Sandy was fired not only from her position as head coach, but also from her teaching position.  The school board stated clearly that this was based on Roman’s accusation that Sandy had stolen money from the team and her subsequent striking of a parent.  Roman’s accusations were never substantiated; however, he was promoted to fill Sandy’s old teaching position as well as her coaching position. After six months, Sandy is still unable to find a teaching or coaching position in the community.

Summary & response (3 attachments uploaded )

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Read the article I uploaded. 1. ARTICLE2. YELLOW SHEET INSTRUCTION3. BLUE SHEET INSTRUCTION(If the dog ate your homework, by Jaime O’Neill)Then write a Summary of it (follow the instructions on the blue sheet pls, 6 sentense max)After Summary write a response which means your own ideas and how do you think about writer’s ideas.(follow the instructions on the blue sheet pls, 8 sentenses required.) DONT FORGET TO Use the specific sentenses which on the yellow paperex, should(n’t) have + V3 / During…during / due to …………..

Infected Surgical Wound Of Total Knee Replacement Nursing Essay

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Wound care with all its aspects is the very most important step in nursing care for patients with surgical wounds, it has given nurses a very comprehensive approach to stimulate the healing process and get the maximum benefit out of the treatment (Cook. 2011). But when this care fails it has a lot of consequences, and the most abundant one that accounts for 14% of the complications is surgical site infections. Surgical site infections (SSI) occur due to lack of care (Wilson, Burman-Roy & Leaper. 2009). One of the most commonly infected surgical wounds are those of total knee replacement (TKR) as some studies showed that 9% of total knee replacement surgeries got infected (Venkataramanan & Sinha. 2002). In another studies TKR infections are most common in the orthopedic with a percentage of 0.3% – 0.25% (Wójkowska-Mach, et al. 2008). TKR is performed for patients with rheumatoid arthritis RA to allow patients’ to gain full function, RA patients are three times more virulent to acquiring post-op infection than any other patients (Carl, Gelse, & Swoboda. 2011& Chesney, Sales, Elton, & Brenkel. 2008). This essay will critically analyze a scenario addressing infected TKR surgery; explain the plan of care done by the nurse that includes assessment, goals, interventions with mentioning which is the best one and discharge planning and education.

Discussion

1.Assessment:

The assessment is the first step in any nursing care plan, in this step the nurse gathers all important information that would help in establishing a diagnosis and selecting an appropriate intervention to accelerate the healing process (Myers. 2008) and perform wound bed preparation using wound bed preparation tools (Granick, & Gamelli. 2012). When doing the first step of assessment the nurse should gather all information from patient himself and other sources. The nurse would ask about the patient demographical information that are age, sex, education and language as this would affect the processes of some diseases and would help in building the patient education based on the patient level of understanding (Granick & Gamell. 2012). Also about patient life style that includes information about patient living status what do the patient do for a living. Referring to the scenario the patient is a retired 72 years old male that lives alone with three cats. Other information to gather is patient history of all past medical conditions and why the patient is seeking medical help, in this case patient history is artrial fibrillation, chronic case of RA and cholecystectomy 20 years ago that got complicated with deep vein thrombosis (DVT). He came to the hospital with infected surgical wound after right knee replacement surgery on the same leg with DVT and RA after noticing that his wound became hot to touch, red, painful and swollen (signs of inflammation) (Casey. 2012).

When gathering information regarding medical conditions the nurse would also ask about any allergies and mention all the medications taken by the patient to ensure proper medication administration know if it may affect wound healing and prevent any interactions. The patient is on wafarin daily, prednisone 5mg (steroids), Diclofenac 50mg and Cefazolin IV 1gram.

Wound bed preparation tool (TIME) is the acronym for four assessment areas, T for the tissue type, I for inflammation and infection, M for moisture, E for edges. In the scenario the patient wound is acute surgical, unhealthy granulated with unexpected acute inflammation and all signs of infection like Edema, pain , redness, purulent exudates thus delayed healing (Cook. 2011). The use of wound assessment tools would fall under the physical examination of the patient that would also include checking vital signs (BP:152/87(hypertension) – P:89 -RR:18-T:37.9-CBR- BMI 34), the patient is also experiencing pain in his right knee in the place of surgery that is relieved with elevation. Taking pulses from site of the wound as the patient has DVT which will cause weak pulses in the limb and poor healing outcome using Doppler ultrasound for accuracy (Carl, Gelse & Swoboda. 2011) and perform CBC count to show WBC count to confirm the infection.

2.Pathophysiology:

To understand the Pathophysiology related to the patient in the scenario with infected surgical wound; understanding the healthy surgical wound healing path is essential. The healing process contains three stages which are separate yet correlate; these are: Inflammation, proliferation and remodeling. In the first stage (inflammation) the first response is vasodilatation which increases blood flow to the area and cause an increase in the flow of white blood cells, (cytokines, interleukin, Histamine, growth factors, coagulating factors) that are inflammatory mediators which produce all signs of inflammation. Second stage includes the proliferation of the damaged tissue to regain full thickness and healthy tissue and finally the remodeling stage includes the reorganization of new tissue to much stronger one that can withstand stress (Li, Chen & Kirsner. 2007).

Unfortunately any disruption due to external or internal causes would lead to delayed wound healing. Generally, these factors lead to either prolonged inflammation at wound site, or decreased oxygen and nutrients delivery. Infection can be addressed as the most common cause for delayed healing (Casey. 2012). Infected surgical wounds of TKR surgery occur due to certain risk factors that are entirely found in the patient from the scenario.

In the scenario the patient has a lot of risk factors that were proven by research to increase risk for infection after TKR surgery, the highlight of the risk factors found in the patient are RA and its’ medication (Prednisone), age, obesity DVT with medication (Warfarin).

RA is a disease that causes poor bone strength and density due to increased osteoclasts activity. Also RA affects the surrounding soft tissue and increase antibodies count that attack all self and foreign antigens (Carl, Gelse & Swoboda. 2011 & Schrama, et al. 2010), it also makes the skin very vulnerable which increases the ability of microorganism to enter the site. Thus, increase the ability of the foreign body implanted in the knee to cause the infection as there are more antibodies to reject the implanted prosthesis and cause a prolonged inflammatory reaction which in return cause infection (Schrama, et al. 2010).

Another effect of RA is increased risk for infection is the medication given for the patient that is mainly corticosteroids and Diclofenac. In the scenario the corticosteroid given to the patient is prednisone 5mg, this medication main action of corticosteroids is immunosuppressant, which inhibit both prostacyclin synthesis and recruitment of leukocytes (Vince, Chivas & Droll. 2007). These mediators are important in the inflammatory stage in wound healing.

In a study done by Garvin, K., & Konigsberg, B. (2011). It was found that patients with average age of 62.8 and obese had higher risk for infection after the surgery like TKR. In the scenario the patient is 72 years old with body mass index of 34.

The third risk factor is the DVT. In this disease there is an abnormality in the production of coagulants and ability of platelets to protect vessel walls but instead it forms an embolism in the blood vessels. An aggregation of platelets and other clotting factors to the specific vein causes decrease in the blood flow to the site. This in return causes low antibodies, fibroblasts, nutrients and WBC to initiate the healing processes and aid in the proliferation stage as it causes ischemic tissue injury (Motto. 2011). In addition, this pathogenesis makes the patient more prone to acquiring infection than other people with no DVT (Battinelli, Murphy & Connors. 2012).

For the DVT treatment the patients are put on anticoagulants to decrease the coagulation and prevent tissue from becoming necrotic, but in TKR it was found that patients put on anticoagulants like warfarin which is given to the patient in the scenario made patients twice as likely to acquire infection as it reduces the ability of the body to normally fight infection (Vince, Chivas & Droll. 2007 & Yurube, et al. 2010). Therefore the patient in the scenario is in much higher risk to developing the infection.

3.Goals:

In the goals part of the plan of care includes basically covering how to achieve the objectives of the interventions, which should be specific measurable and time framed (Myers. 2008). In this scenario the goals include: minimize pain, swelling, exudation and any other clinical signs and symptoms of infection. Promote healing by applying therapy and directly observing its’ effects. Verbalize to the patient and make him repeat the personal care to be performed by the patient (Casey. 2012). Watch and minimize for any factors that could cause complications. The patient will be able to ambulate effectively without pain (Vince, Chivas & Droll. 2007). Finally, providing a safe environment for the patient promotes healing (Wilson, Burman-Roy & Leaper. 2009).

4. Interventions:

After assessing the patient and understanding the patients’ risk factors it is important to intervene to be able to achieve the goals put by the nurse (Schrama, et al. 2010). In the scenario case the nursing interventions should not be the regular TKR postoperative interventions, but rather focus on curing infection and promote healing (Casey. 2012).

There are a lot of nursing interventions to do in case of infection these interventions include: Continuous monitoring of vital signs to ensure stability and decrease of infection, the patient at admission showed high vital signs including high BP, RR and temperature which indicates infection, so as the proper treatment is taking place it is vital to keep record of how the patients’ vital signs are improving to assure that the treatment is working and infection is being healed. Always reassess wound appearance and characters using the TIME tool and other measurement tools, this will be recorded in patient chart and a comparison between different measurements taken at different times will address the wound improvement and that infection is subsiding (Schrama, et al. 2010).

Asses patients’ pain level on a scale from 1 to 10 and apply measures to relief it like massage, analgesia and teaching patient breath exercises. This will increase patient comfort and compliance to his treatment and own care (Allnurses, 2009).

Administer antibiotic prescribed (Cefazolin) IV precisely and monitor for side effects and any abnormalities, this is the main pharmacological treatment and the fastest intervention to relief infection it works on interfering with the synthesis of bacteria cell wall and makes cell membranes very rigid and protective (Jones & Bartlett, 2011). As the patient is in complete bed rest it is important to position him Q 2 hours to prevent any complications like pressure ulcers and decrease of blood flow to the surgery, it is of high importance for this patient due to the DVT. DVT as mentioned before increases the risk for ischemic injury and necrosis of the limb that ultimately may lead to limb amputation (Brunner & Suddrath, 2008). Of course because the patient is on complete bed rest the nurse should assure that the patients’ environment is safe and that the patient has all his needs near him in a way that will not endanger him, so the nurse should have the bed side rails up at all times, calling bell placed at the patients sides and that the bed is not high.

check the tubular bandage and remove it every 20 minutes to check pulses and skin temperature so it wouldn’t cause any complications and compromise tissue perfusion (Allnurses, 2009), make sure that the urinary catheter is placed correctly to assure normal and safe voiding and make sure to provide regular assistant in hygienic procedures (Brunner & Suddrath, 2008).

The main intervention to perform for this wound is the correct wound dressing (Brunner & Suddrath, 2008). Because the patient in the scenario has an infected surgical wound, it is required to use dressing with very specific characteristics. The most appropriate dressing to use is calcium alginate dressing its’ benefits come from the ability to form gels when in contact with wound exudates. The high absorption occurs due to the gel formation which limits secretions, minimizes bacterial contamination and maintains the healing temperature. In addition it has been proven by research like (Oateng, Matthews, Stevens & Eccleston, 2008) that calcium alginate dressings have the ability to actively enhance wound healing either by increasing macrophages, improve inflammation or by forming hematoma.

5. Discharge plan and teaching:

At the end of the hospitalization period the nurse will initiate the discharge plan (Brunner & Suddrath, 2008). In this scenario the nurse will advice the patient about daily exercising program to maintain the normal function of the joint and strengthening it with emphasizing on the fact that it will take time to regain full strength (about 3 months). So, it is important to take things slowly and perform certain activities in a certain way. Use of assistive devices and show the patient how. Also the nurse will need to tell the patient about the prescribed medications and how to take them and what side effects it may cause with telling the patient about what complications should he visit the GP for.

As the patient lives alone the nurse need to make home visits to assess for problems and to monitor wound progression. Assess home environment for physical barriers that may delay the patient’s progress. Assist the patient in acquiring devices, such as reachers or toilet seat extenders (Brunner & Suddrath, 2008).

6. Conclusion:

In conclusion, wound TKR surgeries are very effective in improving patient quality of life (Carr, 2012 & Clement, Breusch, & Biant. 2012), but it has a lot of risks including the risk for infection (Kotelnicki, & Mitts. 2009) this scenario is one of those cases that got infected and this essay mentioned all the parts of the nursing plan of care starting with assessment, that covered all subjective and objective data, explained all the physiological factors associated with the patient risk factors that increased his risk of acquiring the infection (DVT, RA, age and obesity). What are the goals of the nurses’ plan was alo addressed and the interventions to meet these goals and facilitate patient treatment (dressing, monitoring vital signs and pain management) and finally the discharge plan and patient education including teaching patient about medications, complication how to take care of himself.

Electronic Health Records

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Summarize electronic health records and its impact on the medical industry. 

Identify the strengths and weaknesses of implementing electronic health records in EHR in an adult facility and children’s hospital. 

Formulate at least one question to prompt a discussion around an area of weakness you would like your classmate to address.

For this assignment- use the provided template to conduct a SWOT (strengths- weaknesses- opportunities- and threats) analysis of your current (or former) emergency medical service (EMS) organization

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For this assignment, use the provided template to conduct a SWOT (strengths, weaknesses, opportunities, and threats) analysis of your current (or former) emergency medical service (EMS) organization. If you have not worked for an EMS organization, conduct a SWOT analysis on your local organization. There should be a minimum of four assessments for each category. First, provide a brief overview of your organization. Then, using your SWOT analysis, determine the top two priorities that should be included in a strategic planning report to the personnel responsible for the leadership of the EMS organization. Also, provide a brief summary of your findings and recommendations for strategic planning based on your findings .

This SWOT analysis and report should be a minimum of three pages in length, not counting the title page. Since this is about your organization, there is no requirement for any references, but they may be used if needed. If you choose to include references, you must cite and reference them according to APA guidelines.

Review Henderson’s definition of nursing and the current ANA definition of nursing. Explain how and why the definition has developed over time.

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Review Henderson’s definition of nursing and the current ANA definition of nursing. Explain how and why the definition has developed over time.

 

Review Henderson’s definition of nursing and the current ANA definition of nursing. Explain how and why the definition has developed over time. If the definition would be updated again, what do you feel needs to be added? Be specific and provide reasons.
Case Study
In anticipation of the home health nurse visit scheduled for later in the morning, Mrs. Anderson reflected on her current living situation: The grandchildren were late for school again! What would their mother say? Ever since Mrs. Anderson had moved in with her daughter-in-law, it seemed that she just couldn’t do things the way her daughter wanted her too. She wondered if she would ever get it right. She had volunteered to make breakfast for the children and see them off to school in the mornings, since both her son and daughter-in-law left for work before the children left for school. She felt she had to help out somehow to repay her family. They had been helping her since before she fell and then had to have surgery. Her hip was healing nicely after the surgery and the doctor said she might be able to stop using the walker soon, but it seemed to be taking too long to her. The medicines were so difficult to take. The calcium pills were so big! Sometimes she just wanted to be back in her little apartment and be taking care of herself by herself. She just didn’t understand why everyone thought she would forget to eat or take care of herself. She was doing just fine!! She did very well when she was helping her late husband Fred. She helped with the bathing and turning and getting him out of bed when he couldn’t walk anymore. The home health nurses always told her what a good job she was doing with her husband. It just didn’t seem like 9 months since he had passed away.

What factors should be considered when the nurse assesses the self-care agency of Mrs. Anderson in order to determine Mrs. Anderson’s nursing care needs?
What self-care deficits can be identified for Mrs. Anderson?
Using Orem’s Theory of Self-Care Deficits, develop a plan of care for Mrs. Anderson. Develop 1 nursing diagnosis with nursing interventions.
What additional nursing theory (from the ones we had discussed) would you incorporate into Mrs. Anderson’s care to provide additional support? Explain how you would apply the theory to this case and how the theory would change the plan of care.
Power Point should include at least 3 outside references and the textbook. It should include title and reference slides and be 14-20 slides.

How should I reply to this person on the discussion board?

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 How should I reply to this person on the discussion board?

How should I reply to this person on the discussion board? Tyranny of should is believing that others should think the same as you do. Working in the healthcare field I always thought that everyone that was in this profession would be compassionate for the sick patients that were in our care; because I am a caring and compassionate person I just thought that it’s a given for a nurse, nurses aid and especially a physician to have the same kind of compassion as I do for sick patients. I was wrong when I was faced with being bluntly told that my loved one was dying and there was nothing that could be done for her. I thought that the physician giving the news to family should have been more caring have more empathy as I would have been if I was in his position of breaking bad news. I understand that he had to be honest, but it was his delivery I just thought his delivery was very cold. I still think that professionals in the health care setting should always have empathy.

Myth of causation the belief that one person’s emotions are the direct result of another person’s actions. My sister has a habit of getting angry with other people because of what she thinks the other person is doing or has done to her negatively. If she thinks that the person has treated her certain way she automatically gets angry with the person. She will stay angry with the person that she thinks has wronged her instead of just telling them how their actions towards her made her feel.

Patient Case Study: Chronic Diastolic Heart Failure and Chronic Respiratory Failure

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Chief Complaint:

Ms. B is a 47-year-old morbidly obese female who was admitted to the hospital via the ED on 6/22/19 with a chief complaint of shortness of breath (SOB) and congestive heart failure (CHF).


Diagnosis:

Chronic diastolic heart failure and chronic respiratory failure


History of Present Illness:

Ms. B has had repeated admission for heart failure. She is now presenting with decompensated diastolic heart failure and acute hypoxic respiratory failure requiring BIPAP when her pulse ox desaturates to the 60-70s.  Ms. B has had SOB for 2 weeks which has gotten worse over the last two days associated with dyspnea, paroxysmal nocturnal dyspnea, and BLE swelling. In the ED, she was found to be hypoxic and required 6L of O

2

by NC and an ICU consult was obtained. They recommended no need to admit to ICU at that time. She’s currently on a 2g NA diet and was placed on a 1,000 mL fluid restriction.


Past Medical History:

The patient’s past medical history includes:

  1. Congestive heart failure
  2. Diabetes mellitus
  3. Hypertension
  4. Systemic lupus erythematosus (SLE)
  5. Mixed connective tissue disease (MCTD)
  6. Interstitial lung disease (ILD)
  7. Pulmonary hypertension
  8. Obesity hypoventilation syndrome
  9. Chronic coronary artery disease
  10. Upper respiratory tract infection
  11. Anemia
  12. Acute kidney injury (AKI)
  13. Chronic kidney disease stage III


Past Surgical History:

The patient’s past surgical history includes:

1.Cholecytectomy

2. Partial lung removal


Medications:


Acetaminophen (Tylenol)

650 mg Oral Q6H (mild pain)


Albuterol

2.5 mg Inhalation route Q4H as needed (wheezes, shortness of breath)


Aspirin

81 mg Oral Daily (prevent and manage heart disease and stroke)


Azithromycin

500 mg IV Q24H (antibiotic, to treat bacterial infections due to CAP)


Bumetanide

2 mg Oral BID (diuretic, to treat hypertension)


Carvedilol

25 mg Oral Q12H  (Beta blocker, to treat hypertension)


Ceftriaxone

1 g 100mL/hr IV Q24H (Antibiotic, to treat bacterial infections due to CAP)


Dextrose

10% bolus 125mL 937.5mL/hr  IV (as needed per glucommander – low blood glucose less than 70mg/dL)


Glucagon

1mg injection IM (as needed per glucommander – low blood glucose less than 70mg/dL)


Heparin

5,000 units SubQ Q12H (anticoagulant, to treat or prevent clots)


Hydroxychloroquine

200 mg Oral BID (to treat lupus)


Metolazone

5 mg Oral BID (diuretic, to treat hypertension )


Mycophenolate

1,000 mg Oral Q12H (to treat lupus)


Ondansetron

4mginjection IV Q6H PRN (for nausea and vomiting)


Allergies:

Ms. B is allergic to atenolol (causes facial swelling)


Smoking and Alcohol (and any other substance abuse):

Ms. B reports she has never smoked previously or used chewing tobacco, she also reports no alcohol or drug use.


Family/Social/Work History:

Ms. B has a family history of diabetes, heart disease, heart attack, and hypertension from her mother’s side. Her father is deceased. She used to work as a pharmacy tech and lives with her mother and sister. She is not married and has one son. She identifies herself as a Christian and her hobbies include drawing and listening to music.


Pathophysiology:

Diastolic heart failure occurs when the left ventricle is not properly filled with blood during the filling phase. Consequently, the heart has less blood to pump out to the body. This is caused by thickening of the ventricular walls, which leads to slower relaxation of the ventricle. The heart then increases pressure inside the ventricle to make up for the thickened walls. This manifests as fatigue and exertional dyspnea. Increased pressure inside the ventricle can lead to buildup of blood in the atrium and even into the lungs which can lead to fluid congestion and shortness of breath, edema, fatigue, weakness, and rapid irregular heart beats. The ejection fraction represents the amount of blood that is ejected from the heart after each contraction. A normal ejection fraction is more than 50%. Diastolic heart failure is defined as having symptoms of clinical heart failure with a normal left ventricular ejection fraction. Ms. B’s ejection fraction was recorded as 60-65%.


Side note:

Systolic heart failure is when the heart doesn’t contract properly (indicating a pumping problem). While diastolic heart failure is when the heart fails to relax or fill fully how it should (indicating a filling problem).

The function of the respiratory system is to facilitate the exchange of oxygen and carbon dioxide between the blood and the atmosphere. Gas exchange takes place in the alveoli of the lungs. Oxygen molecules in the alveoli cross the alveolar membrane and enter the bloodstream while carbon dioxide from the blood travels out into the alveoli. Respiratory failure occurs when there is no longer that exchange in the body between blood and air. This can be due to fluid filling the alveolar spaces, alveolar space collapse, pulmonary embolism, emphysema, and thickening of the alveolar membranes. Chronic respiratory failure can be divided into two types: hypercapnic respiratory failure and hypoxemic respiratory failure. Hypercapnic respiratory failure occurs when carbon dioxide is not exchanged out and accumulates in the blood (increased carbon dioxide in the blood). Hypoxemic respiratory failure occurs when there are low oxygen levels in the arterial blood.


Physical Assessment:


  • Vital signs

    BP 115/69, HR 76, Temp 96.9 °F (Oral), Resp 18, Ht 5′ 8″, Wt 154.2 kg (340 lb), SpO2 89%, BMI 51.70 kg/m²

  • Level of Consciousness:

    Awake, interactive, alert and oriented x4. Patient speaks freely and in full sentences.


HEENT:

Head is normocephalic, no gross motor or sensory deficits. Pupils are equal, round, reactive to light, and accommodate. Ears are intact; mucous membranes are moist and pink. No nasal discharge or other apparent abnormalities to the head, nose, or throat.


  • Respiratory:

    On continuous BIPAP, 60% O

    2

    , uses nonrebreather when not on BIPAP. Normal respiratory rate, no retractions or increased work of breathing. Symmetrical chest expansion. Clear to auscultation and percussion bilaterally. Crackles heard bilaterally in lung bases, but no wheezes, rhonchi or rales.

  • Cardiovascular:

    Normal S1 S2, normal sinus rhythm, no murmurs, gallops, or palpable thrills. No JVD.

  • GI:



    Soft, non-distended, non-tender, no rebound or guarding. Normoactive bowel sounds heard on all quadrants.


GU:

Voiding pattern is frequent due to diuretics, urine is clear yellow/straw and there is no foul smell present. Urine output of 1450 mL/kg in the past 12 hours. Patient uses bedside commode.


Skin:

Appropriate for ethnicity. Skin is warm and dry. No pallor, capillary refill less than 3 seconds. Has a peripheral IV (left anticubital)


  • Extremities:

    Bilateral +1 LE edema; diminished pulses 2+ symmetric and intact. ROM and motor strength grossly normal, high fall risk.


Lab Results:


Lab Test
Patient’s Results
Normal Range
Pathophysiology
WBC 6/22:

5.60

3.5 – 10.8 mcL Normal
HBG 8.3 13 – 17 g/dL Most likely due to history of anemia
HCT 29.5 42 – 54% Possibly due to 1,000 mL fluid restriction and CHF.
PLT 227 140 – 400 mcL Normal
RBC 4.32 4.7 – 6.0 mcL Normal
Glucose 102 70 – 100 mg/dL Hyperglycemia. Pt. has diabetes mellitus.
BUN 47 9.0 – 28.0 mg/dL BUN is typically elevated due to CHF, acute kidney injury, and chronic kidney disease
CREAT 2.2 0.7 – 1.3 mg/dL Creatinine is typically elevated due to CHF, acute kidney injury, and chronic kidney disease
Sodium 137 136 – 145 mEq/L Normal
Potassium 4.0 3.5 -5.1 mEq/L Normal
Chloride 92 100 – 111 mEq/L Hypochloremia- Most likely due to CHF, chronic kidney disease, and diuretics.
CO2 34 22 – 29 mEq/L Elevated most likely due to chronic respiratory failure.
Calcium 8.9 8.5 – 10.5 mg/dL Normal
Magnesium 2.0 1.6 – 2.6 mg/dL Normal
AST 10 5 – 34 U/L Normal
ALT 13 0 – 55 U/L Normal
Alkaline Phosphatase 58 38 – 106 U/L Normal
Albumin 3.1 3.5 – 5.0 g/dL Hypoalbuminemia – Most likely due to CHF, acute kidney injury, chronic kidney disease.
`Protein, Total : 7.5 6.0 – 8.3 g/dL Normal
Globulin 3.8 2.0 – 3.6 g/dL Elevated most likely due to chronic kidney disease and acute kidney injury.
Bilirubin, Total 0.9 0.2 – 1.2 mg/dL Normal
pH, arterial 7.36 7.35 – 7.45 On 11/01 pt was in compensated respiratory acidosis

On 11/02 pt was in

Partially compensated respiratory acidosis. Pt. uses BIPAP.

pCO2, arterial 47.1 35 – 45 mmhg Same as above
pO2, arterial 60.6 80 – 90 mmhg Same as above
HCO3, arterial 26.7 23 – 29 mmhg Same as above
02 sat, arterial 89.1 95 – 100 % On 11/01 pt oxygen sat is low, most likely due to chronic respiratory failure.


  • XR Chest AP portable was done on Oct. 29

    th

    . Findings showed patchy nodular regions of airspace disease predominantly in in the mid and lower lung zones; pulmonary edema. Findings also showed moderate cardiomegaly and no pneumothorax present.
  • Chest CT without contrast was done on Oct. 30

    th

    . Findings showed cardiomegaly, a small amount of pericardial fluid, and nonspecific hepatosplenomegaly

Nursing Diagnosis
Individualized Nursing Interventions
Rationale
Actual:

  • Excess fluid volume RT congestive heart failure  AEB bilateral lower extremity swelling, dyspnea, hepatomegaly, crackles, and pulmonary edema.
  1. Maintain strict fluid intake and output measurements.
  2. Assess for leg swelling/edema and report if abnormal.
  3. Monitor daily weights.
  4. Administer diuretics per MD order.
  5. Maintain patient on strict fluid restrictions as prescribed.
  6. Maintain sodium diet intake as prescribed.
  1. Diuretic therapy can cause a sudden loss of fluid.
  2. Edema occurs when there is excess buildup of fluid in the extravascular spaces.
  3. Sudden weight gain may indicate fluid retention.
  4. Diuretics aids in the excretion of excess fluids in the body.
  5. Excess fluid can result in pulmonary edema and excess fluid volume.
  6. Restriction of sodium aids in decreasing fluid retention.
Actual:

  • Impaired gas exchange RT acute on chronic respiratory failure and pulmonary edema AEB dysnpnea, aroxysmal nocturnal dyspnea, respiratory acidosis, and

low Sp02

  1. Complete a full respiratory assessment (ex. lung sounds, breathing pattern, and depth of breaths ect.)
  2. Monitor respiratory rates, and oxygen saturations every 30 minutes.
  3. Teach and encourage the patient to practice breathing techniques.
  4. Elevate head of the bed so patient is in optimal position to decrease work of breathing.
  5. Provide supplemental oxygen support to facilitate gas exchange when needed (ex. BIPAP, non-rebreather).
  1. To detect changes or further decompensation.
  2. To determine whether the patient is hypoxic. Respiration rates should be 12-20 breaths per minute and oxygen saturation should be 90-100%.
  3. So patient can utilize breathing techniques during dyspneic episodes.
  4. To enable appropriate lung expansion and allow for adequate inspiration and expiration, facilitating better gas exchange.
  5. To assist the delivery of higher concentrations of oxygen.
Educational:

  • Knowledge deficit regarding condition RT chronic diastolic heart failure AEB questioning, lack of understanding.
  1. Assess patient’s knowledge base of chronic diastolic heart failure.
  2. Provide teachable moments to encourage health promotion and understanding about chronic diastolic heart failure.
  3. Provide patient with appropriate resources and information about complications of disease and support.
  1. To determine how much or little the patient knows about her diagnosis.
  2. To allow patient to better understand the disease process and potential complications of chronic diastolic heart failure.
  3. In order for patient to initiate necessary lifestyle changes and encourange patient to participate in treatment regimen.
Potential:

  • Risk for impaired skin integrity RT edema, fluid retention, and obesity.
  1. Encourage frequent position changes (patient is able to reposition self).
  2. Assess skin condition throughout every shift for color, edema, or breakdown.
  3. Increase mobility as tolerated by assisting patient with active and passive ROM exercises.
  4. Educate on the importance of keeping the skin clean and dry.
  1. To prevent skin breakdown.
  2. Redness, pain, and swelling may indicate inflammation to localized tissue trauma.
  3. To improve circulation throughout the body.
  4. Moisture softens the skin and its integrity can be compromised.

References


  • Ackley, B. J., Ladwig, G. B., & Makic, M. B. (2017).

    Nursing diagnosis handbook: an evidence-based guide to planning care

    (11th ed.). St. Louis: Elsevier.
  • Lewis, S. M., Bucher, L., Heitkemper, M. M., Bucher, L., & Harding, M. M. (2017).

    Medical-surgical nursing: assessment and management of clinical problems

    (9th ed.). St. Louis, MO: Elsevier, Inc.


Homework: Epidemiology in Public and Global Health

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Homework: Epidemiology in Public and Global Health

Homework: Epidemiology in Public and Global Health

Assignment: Epidemiology in Public and Global Health Note: This Assignment is not due until Day 7 of Week 3. Epidemiologic surveillance is used in public and global health. For this Assignment, begin by locating a recent article about an outbreak of an infectious or communicable disease. The article can come from a newspaper or other source but must be supported with scholarly literature. For this Assignment, review the following: AWE Checklist (Level 4000) Walden paper template (no abstract or running head required) The Week 3 Assignment Rubric for additional instruction and guidance By Day 7 of Week 3 Write a 3- to 4-page paper that includes the following: A summary of the article, including the title and author The relationship among causal agents, susceptible persons, and environmental factors (epidemiological triangle) The role of the nurse in addressing the outbreak Possible health promotion/health protection strategies that could have been implemented by nurses to mitigate the outbreak




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You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.


Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.


Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.


The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.