Discussion:care for patients

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Discussion:care for patients




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This week, you will learn how to plan care for patients while considering their diverse cultural backgrounds. This is an APA paper, which requires a title page, double spacing, and set up as per the example papers in your APA book. Please select a culture different from the one you chose to research in week 2 Which is Islamic Culture.

Article:


Click here

to view The Giger and Davidhizar Transcultural Assessment Model (2002) article

Then, address the following:

  1. Describe the key components of conducting a comprehensive cultural assessment (rationales, interventions and evaluations may be found on the internet).
  2. Choose two of the components, reflect on your own culture and how it impacts your own attitude toward those aspects of providing culturally diverse care.
  3. Imagine that you are working in a physician’s office. A patient of a background different from your own comes in to be seen for a newly diagnosed problem. Create two nursing diagnoses that reflect cultural diversity (look at Appendix A for guidance ie., “Barrier to communication”); then give rationale for each diagnosis and describe how you would intervene and evaluate for success of your plan of care


References

Minimum of four (4) total references: two (2) references from required course materials and two (2) peer-reviewed references. All references must be no older than five years (unless making a specific point using a seminal piece of information)

Peer-reviewed references include references from professional data bases such as PubMed or CINHAL applicable to population and practice area, along with evidence based clinical practice guidelines. Examples of unacceptable references are Wikipedia, UpToDate, Epocrates, Medscape, WebMD, hospital organizations, insurance recommendations, & secondary clinical databases.


Style

Unless otherwise specified, all the written assignment must follow APA 6th edition formatting, citations and references.


Click here


to download the Microsoft Word APA 6th edition template. Make sure you cross-reference the APA 6th edition book as well before submitting the assignment.


Number of Pages/Words

Unless otherwise specified all papers should have a minimum of 600 words (approximately 2.5 pages) excluding the title and reference pages.


Textbooks:

Transcultural Concepts in Nursing Care, Joyceen S. Boyle & Margaret M. Andrews. (2015), 7th edition.

  • Chapters 3 – Cultural Competence in the Health History and Physical Examination
  • Chapters 10 – Transcultural Perspectives in Mental Health Nursing
  • Chapters 11 – Culture, Family, and Community
  • Chapters 13 – Religion, Culture, and Nursing

Article:

NRSE 4570 RUBRIC: M3 A6 WA: CULTURALLY APPROPRIATE CARE PLANNING (40 pts) Criteria Introduction Accomplished 7 to 7 Points  Clearly states the purpose of the paper.  Provides a comprehensive overview of topic or questions.

 Engages the reader.  Organized and has easy follow. Key Requirement 1 7 to 7 Points  Describe the key components of a comprehensive cultural assessment  Evidence of critical thinking Key Requirement 2 7 to 7 Points  Chooses two components of the cultural assessment, reflect on one’s own culture in terms of those components  Discusses how one’s own culture potentially affects how one provides nursing care 6 to 6 Points  Creates two nursing diagnoses that reflect cultural diversity.

 Gives rationale for each diagnosis and describes how you would intervene and evaluate for success of your plan of care. 7 to 7 Points  Summarizes paper and reflects on what the reader has learned from the paper.  Demonstrates persuasive thought and is well organized. Body Key Requirement 3 Conclusion Last updated: 06/07/2017 Levels of Achievement Needs Improvement 2 to 6 Points  Overview is provided, but key points/ideas are missing.

 Purpose statement is not clear.  Does not engage the reader.  Somewhat disorganized but still comprehensible 3 to 6 Points  One or two elements missing or are not fully described  Lacking some evidence of critical thinking. 3 to 6 Points  Chooses one component or is missing at least one area discussed in the instructions  Lacks critical thinking and depth. Not Acceptable 0 to 1 Points  Does not provide an overview of the paper or is absent.  No purpose statement. 0 to 2 Points  Missing half of the elements  Not enough depth to demonstrate understanding of the components of a comprehensive cultural assessment. 0 to 2 Points  Writer does not fully discuss two components or consider his or her own culture  Does not discuss how culture could affect care. 3 to 5 Points  Created two nursing diagnoses but did not give rational or intervention/evaluation of success. 0 to 2 Points  Only one nursing diagnosis, or did not fully answer the assignment questions. 2 to 6 Points  Merely summarizes the introduction or contains new ideas not present in the paper contents.  Somewhat disorganized but still comprehensible 0 to 1 Points  Simply restates the introduction or is absent.  Disorganized to the point of distraction. © 2017 School of Nursing – Ohio University Page 1 of 2 NRSE 4570 RUBRIC: M3 A6 WA: CULTURALLY APPROPRIATE CARE PLANNING (40 pts) Criteria Stylistics Accomplished 6 to 6 Points  APA Citations are appropriate.  Formatted correctly.

 Reference page is complete and correctly formatted.  At least 4 references provided: Two (2) references from required course materials and two (2) peer-reviewed references. *References not older than five years.  More than 600 words excluding title and reference pages. Levels of Achievement Needs Improvement 3 to 5 Points  APA Citations are appropriate and formatted correctly.  Reference page is formatted correctly.  References are not professional or is not formatted correctly.  Missing 1 professional reference.  At least 600 words or more excluding title and reference pages. Not Acceptable 0 to 2 Points  No citations are used or citations are made but not formatted correctly  Reference page is missing.  Less than 600 words excluding title and reference pages. Peer-reviewed references include professional journals (i.e. Nursing Education Perspectives, Journal of Professional Nursing, etc. –), professional organizations (NLN, CDC, AACN, ADA, etc.) applicable to population and practice area, along with clinical practice guidelines (CPGs – National Guideline Clearinghouse). References not acceptable (not inclusive) are UpToDate, Epocrates, Medscape, WebMD, hospital organizations, insurance recommendations, & secondary clinical databases.

*All references must be no older than five years (unless making a specific point using a seminal piece of information) Note: You will have three (3) attempts to submit a written assignment, only the final attempt will be graded. For each attempt you will receive a SafeAssign originality report. This will give you a chance to correct the assignment based on the SafeAssign score. Click here to view instructions on how to interpret SafeAssign originality report. Last updated: 06/07/2017 © 2017 School of Nursing – Ohio University Page 2 of 2 …


Purchase answer to see full attachment

1. Seek and Find Your Discussion should be 3-4 paragraphs in length- detailing your thoughts and position using 2-3 readings references for support. Also be sure to pose 1-2 well thought out question

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1. Seek and Find

Your Discussion should be 3-4 paragraphs in length, detailing your thoughts and position using 2-3 readings references for support.  Also be sure to pose 1-2 well thought out questions from which your colleagues can formulate a response or generate further discussion.

Choose and research four (4) infectious diseases. Try to achieve a variety in your own selections as well as diseases unique from what your classmates have already posted. For your research please use only well-known, reputable sources.

  1. In one discussion post that has four sections, create a brief description or summary of each of your four diseases. The word count for each disease should be approximately 100 words. The content of your summaries should include the etiology, mode of transmission, target host, or any other pertinent details about each disease that makes them unique. The summaries may be short, but they should be complete and include any essential or notable facts about the diseases.
  2. At the end of each summary include a question about the disease that would prompt your colleagues to visit your references and find the answer. They will have the opportunity to go into more detail about the topics in their discussion replies.

Resources to get you started

National Institute of Allergy and Infectious Diseaseshttps://www.niaid.nih.gov/

CDC MMWR Indexhttp://www.cdc.gov/mmwr/index2015.html

CDC Emerging Infectious Diseases Journalhttp://wwwnc.cdc.gov/eid/

Center for Infectious Disease Research and Policyhttp://www.cidrap.umn.edu/

Food Poisoning Related Diseases & Conditionshttp://www.medicinenet.com/food_poisoning/related-conditions/index.htm

2. Health Topic Q&A

In a 2-3 page paper, answer the following questions. In addition to the researched facts you present as your answer, you may provide opinions and real-world experiences where appropriate.

Scenario: You are a physician’s assistant at a local medical practice. You noticed that some of your patients could benefit from additional educational materials, especially to be given after their appointment or made available on your practice’s website. Your colleagues could benefit from reading this information and may also find it helpful to have on hand in case a patient poses similar questions to them in the future.

Choose a single pathogen or health topic related to infection and research medical facts about the condition and current medical recommendations. In planning your answer, select a relationship of the author with the audience. Examples include doctor to patient, nurse educator to other nurses, or counselor to family members of a patient.

Provide an informational brochure or blog post in the form of a Q&A or an expert advice column. Include five (5) or more original questions. The answers should be original, factual, and provide relevant information for the audience. Assume your target audience is not familiar with the material but would have a keen interest in learning more.

Your complete Q&A should include at least five individual questions with complete answers. Clearly identify the question and answer (e.g., “Q:” before the question) and go into detail in each answer. You may advise the reader to read more elsewhere, but first be sure each question in your submission has a thorough, informational answer.

Resources to get you started

Example: Does stopping a course of antibiotics early lead to antibiotic resistance?http://www.who.int/features/qa/stopping-antibiotic-treatment/en/

Example: Sexual health Q&Ahttp://www.nhs.uk/Livewell/women1839/Pages/sexualhealthquestions.aspx

Pulsed Radio Frequency Energy as Physical Therapy

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CHAPTER V DISCUSSION

Many adults with vascular disease and/or diabetes suffer with chronic leg or foot ulcers, leading to loss of functional ability, poor quality of life and long term ill-health. Studies on patients with chronic leg ulcers have reported the average duration of these ulcers is around 12-13 months, around 60-70% of patients have recurring ulcers, 24% of patients are hospitalized because of the ulcers and most people suffer from the condition for an average of 15 or more years. Care for chronic wounds is reported to cost 2-3% of total health care spending in developed countries and these costs are set to rise with ageing populations. Treatment in the U.S. costs over 3 billion $US and the loss of over 2 million workdays a year. Similarly, Harding quotes a cost of £400 million each year in the U.K. In Australia, wound dressings are the second most frequent procedure in General Practitioner practice and chronic wound care accounts for 22-50% of community nursing time in the UK and Australia

(Edwards et al.,


2013)

.

In addition to direct health care costs, chronic wounds are associated with hidden burdens on the community resulting from loss of mobility, decreased functional ability, social isolation and loss of participation in the workforce and society

(Price and Krasner, 2012)

.

The use of pulsed radio-frequency electromagnetic field (PEMF), also termed pulsed radiofrequency energy (PRFE) therapy has shown notable success in healing of chronic wounds. PEMF is a non-ionising energy at the shortwave radiofrequency band of the electromagnetic spectrum, commonly at a frequency of 27.12MHz. Since the introduction of PEMF    in the 1950s, clinical studies on healing of chronic wounds and surgical recovery, as well orthopaedic studies have documented PEMF as a successful clinical therapy. PEMF therapy is none invasive and is delivered through the wound dressing, and to date has shown no unwanted side effects. With positive reports in the literature documenting PEMF as an effective therapy, its wider adoption as an adjunct therapy seems warranted

(Rawe,


2012)

.

The measurement of wound dimension is an important component of successful wound management. Monitoring changes in wound area allows assessment of treatment efficacy and early detection of stasis or deterioration. The photographic method is an accurate alternative to digital planimetry system (Visitrak TM ) for measuring wound area. The photographic method is a more appropriate technique for clean and uncontaminated wounds, as contact with the wound bed is avoided

(Chang et al.,


2011)

.

This study investigated the efficacy of pulsed radio frequency energy as physical therapy modality in the treatment of chronic lower limb ulcers through reducing wound surface area (WSA) and wound volume.

The findings of this study indicated significant decrease in WSA after treatment in both groups A and B (P<0.0001) with bitter percentage of improvement in group A (62.78%) vs (16.48% in group B). Also, there was significant difference between Group A, and Group B post treatment values of WSA (p<0.0001) with favored results in group A.

Regarding the results of wound volume, both groups A and B showed significant decrease in wound volume after treatment (p<0.0001) with percentage of improvement 68.96%in group A and 31.09% in group B. Also, there was significant difference between Group A, and Group B post treatment values of wound volume (p=0.010) with favored results in group A.

Regarding the results of wound volume, there was significant increase in Ki-67% after treatment (p<0.0001) in groups A only with percentage of improvement 253.15%. Also, there was significant difference between Group A, and Group B post treatment values of wound volume (p<0.010) with favored results in group A.

Therefore the results of current study confirmed the therapeutic efficiency of pulsed radio frequency energy as therapeutic modality in reducing wound surface area and wound volume and treatment of chronic lower limb ulcers.


The results of our study consistent or supported by the works reported by Kao et al. (2013); Rawe and Vlahovic (2012); Conner-Kerr and


Isenberg


(2012);


Frykberg


et


al.


(2011);


Li


et


al.


(2011);


Maier


(2011);


Kloth et al. (1999); Bentall (1986).


Kao et al. (2013)

evaluated the effect of Pulsed radiofrequency energy diabetic wounded Db/db mice. Gross closure, cell proliferation, and morphometric analysis of CD31-stained wound cross-sections were assessed. The mRNA expression of profibrotic factors (transforming growth factor-β and platelet-derived growth factor-A), angiogenetic factors (vascular endothelial growth factor and basic fibroblast growth factor), and extracellular matrix components (collagen I and α-smooth muscle actin) were evaluated by quantitative reverse-transcriptase polymerase chain reaction. Collagen protein level of the wound was determined by Western blot analysis. Cell migration was  monitored  in  monolayer  dermal  fibroblast  cultures.  The  degree  of collagen alignment and gelation time was quantitatively assessed using image analysis techniques. Results show that pulsed radiofrequency energy-treated wounds were characterized by dermal cell proliferation and increased collagen synthesis.


Rawe and Vlahovic (2012)

evaluated the effect of a lightweight wearable form of a PFRE device on 3 diabetic foot ulcers and 1 venous stasis ulcer in a case report, the ulcers were present on the 4 patients for greater than 3 months and had failed to heal after conventional treatment. A lightweight battery powered, wearable form PRFE device was introduced as a treatment and used 6-8 hrs per day for a period of 6 weeks. All patients after 1 week of therapy showed improvement and wound size was seen to decrease. Patient 1 had a venous stasis ulcer, and reported significant pain relief after 2 weeks treatment. Patients 2 and 3 achieved complete healing after 3 weeks treatment, and patient 1 and patient 4 had a 95% and 88% reduction in wound size after the 6 week study period. Both these patients continued to complete healing using the PRFE device after the 6 week study period.


Conner-Kerr and Isenberg (2012)

evaluated the benefit of using PRFE therapy in the treatment of chronic pressure ulcers via Provant Therapy System in 89 patients show 51% median decrease in wound surface area after 4 weeks. Accelerate wound healing rate so that the median of wound healing course reaches 0.13 cm/d. the study concluded that PRFE therapy is a useful adjuvant treatment for healing of chronic pressure ulcers.


Frykberg


et


al.


(2011)

conducted a study to explore the effect of PRFE on the rate of wound healing results show mean percent reduction in wound area after 4 weeks was 49% ± 6% for pressure ulcer (PU) (P <0.0001), 38% ± 6% for diabetic foot ulcer (DFU) (P <0.0001), 44% ± 5% for venous leg ulcer (VLU) (P <0.0001), and 39% ± 9% for ulcers of various other etiologies (P = 0.0001). The median wound reduction rate was 0.08 cm (2)/day (range -4.14- 2.21). Results suggesting that a large proportion of these PRFE-treated ulcers wound have healed with ongoing therapy

.


Li


et


al.


(2011)

investigated the effect of pulsed radiofrequency energy on cutaneous ulcers to understand its mechanism. Full-thickness cutaneous ulcers were created in diabetic mice. The experimental group was subject to pulsed radiofrequency energy treatment two times per day, whereas the sham group was subjected to sham devices. The rate of wound closure was evaluated by digital analysis of surface area of the wound bed, zone of re- epithelialization, and rate of contraction. The results indicate that pulsed radiofrequency energy accelerates impaired wound healing mainly through wound contraction by means of stimulating cell proliferation, granulation tissue formation, and collagen deposition

.


Maier (2011)

evaluated the effect of PEMF on two patients with painful chronic cutaneous wounds in the lower limb. Adjunctive pulsed radio frequency energy was administered for 30 minutes twice daily through an applicator pad placed directly on the dressing over the wound area. Both patients reported immediate, marked pain reduction, allowing compression therapy. The ulcers healed completely within 3 weeks for patient 1 and 28 weeks for patient 2.


Kloth et al. (1999)

studied the effect of PRF treatment on healing of pressure ulcers in spinal cord injured patient. The study concluded that PRF treatment is a cost saving intervention that can stimulate the endogenous bioelectric tissue repair processes when wounds do not show evidence of healing with standard wound treatment. In addition, acceleration of tissue healing also reduces the pain and suffering experienced by individuals afflicted with chronic wounds. Also accelerated healing of chronic wounds with PRF enabled patients to return to functional activities sooner so undesirable complications do not develop.


Bentall


(1986)

evaluated the effect of pulsed radio-frequency energy in treatment of skin wounds. Results show that PEMF influenced the processes of acute secondary wound healing. The rate of healing was accelerated and the histological appearance of the actively treated wounds showed that the healed epidermis was more like normal skin than the scar tissue typical of secondary wound healing.

Finally, from the previous discussion of these results and according to reports of other investigators in similar studies, it can be explained that the beneficial effect of PRFE in treatment of lower limb ulcers is due to the following mechanisms:

Pulsed radio frequency energy found to make a significant improvement in the expression of genes involved in angiogenesis and wound remodeling. The expression of genes involved in angiogenesis and wound remodeling was assessed using microarray analysis of cultured human dermal fibroblasts (HDF) and human epidermal keratinocytes (HEK). Relative transcript levels of factors involved in these processes were determined at multiple time points following PRFE treatment using cDNA microarray analysis and confirmed by RT-PCR

(Moffett et al.,


2011)

.

Pulsed radio frequency energy found to promotes the healing of chronic wounds and facilitating the transition from a chronic inflammation cycle to that of a functional wound healing cycle, a process that in part may involve PRFE-mediated immunomodulation. The study concluded that PRFE field treatment of human dermal fibroblasts and epidermal keratinocytes resulted in robust increases in the levels of numerous transcripts encoding factors such as matrix metalloproteinases (MMPs) and their inhibitors (TIMPs), interleukin (IL)-related genes, interferon (INF)-related genes, and tumor necrosis factor (TNF)-related genes, that involved in the inflammatory phase of the wound healing process

(Moffett et al.,


2010)

.

Also, PEMF modulates the rate of calmodulin (CaM) activation when intracellular Ca2+ increases after insult or injury. This, in turn, modulates the activation of Ca/CaM-dependent constitutive nitric oxide synthase (cNOS) and, therefore, the dynamics of nitric oxide (NO) in the target cells/tissues. The Ca/CaM-dependent NO cascade is an important and early response to physical, chemical or thermal injury

(Pilla, 2012)

.

So it can be claimed that, there was greater improvement after application of PRFE and so enhancing the treatment of chronic lower limb ulcers by decreasing the WSA, wound volume and increase the cell proliferation rate of the wound area. Also PRFE cost effective, and finally patient can regain to work quickly.

Puerperal Sepsis: History- Causes and Interventions

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What is Puerperal Sepsis? Why is Puerperal Sepsis less prevalent now than 1900’s?


  • Lynda Williams



Abstract

The purpose of the report is to understand what puerperal sepsis is and to raise awareness of the condition to expectant mothers, women that have miscarried, families and physicians. To understand the risks that is linked with the condition and to be able to spot signs and symptoms, as well as how to prevent further cases through aseptic techniques and principles and hand hygiene.

The information that will be included is background information on the condition: what is it, how it came about, what treatment was used and what caused it. The report will include information on what are the symptoms, what causes it, who is at risk, how it can be diagnosed, how to treat it, what are the complications and how to prevent further cases from occurring.

The report will focus on national statistics for the UK. This will include statistics to show how the prevalence of puerperal sepsis within the UK has decreased from 1900’s to today through medical advances and research. The research used will be secondary: books, journals, and internet. Primary research will not be used as the report is based on facts and information that is already available through reports and medical advice.


Contents

Background/Historypage 4

Causespage 5

Symptomspage 5

Who is at Risk?Page 6

Diagnosispage 6

Treatmentpage 6

Complications page 7

Preventionpage 7

Analysis of Statisticspage 8

Conclusionpage 8

Recommendationpage 8

Referencespage 9

Bibliographypage 10-11

Glossarypage 12

Appendixespage 13


Background/History

Puerperal sepsis is a term giving to an infection that affect expectant mothers and those who have recently delivered. Infections within pregnancy can be severe as the genital tract has an increased surface area. (Knight, M. 2015). (Awori, N. et al. 1999). The infection can affect the cavity and walls of the uterus, which can lead to pelvic abscesses. The pus can spread high into the pelvis or into the lower abdomen. Infection tends to spreads after long labour or severe bleeding due to haemorrhaging which can cause peritonitis, septicaemia or death. (Awori, N. et al. 1999).

Puerperal Sepsis formerly known as childbed fever or puerperal fever was a mystery; it killed those at the cruellest of moments. It was understood that wherever physicians went the disease became more prevalent, especially within hospitals. During the 1700’s it was believed women were delivered from the peril of childbirth, not deliver a child into the world. Physicians believed sepsis occurred when there was a failure to urinate, it then became known as ‘milk metastasis’ as the internal organs of those that had died looked like they were covered in milk, it was later identified as pus. (Burch, D. 2009).

It was believed that puerperal fever was caused by various environmental factors: sewage, poor ventilation, cold, mists, vague ‘putrid tendencies,’ not bacterium and infection control. During the late 1700’s, Alexander Gordon leading obstetrician studied childbed fever and came to the conclusion that the disease was spread by physicians, it was related to skin infections and the only treatment was bloodletting. Bloodletting was widely accepted as a cure, however physicians understood more needed to be done to stop the spread of sepsis. (Burch, D. 2009).


Causes

Puerperal sepsis is caused by bacterium being introduced into the genital tract and women that are in labour or giving birth are more susceptible due to large genital tract surface area. The genital and urinary tracts have warm, moist environments that bacteria need to multiple. The bacterium can enter the body through pelvic exams, trauma during labour or prolonged labour. During pelvic exams the bacterium is introduced into the genital tract by unclean hands during examinations or through the use of non-sterile instruments. (Nall, R. 2014). Bacteria that are known to cause a puerperal sepsis include:

  • Chlamydia
  • Clostridium tetani
  • Clostridium welchii
  • Escherichia coli (E.coli)
  • Gonococci
  • Staphylococci
  • Streptococci

(Nall, R. 2014).

Other causes of puerperal sepsis are mastitis, pyelonephritis, ruptured membranes, respiratory complication, first birth, poor socioeconomic status, caesarean delivery and superficial or deep-vein thrombosis. (Baring, N. 2013).


Symptoms

Symptoms for puerperal sepsis normally appear between 24 hours to 10 days after infection begins. If one or more symptoms are present, action should be taken and treat as appropriate. Women should be monitored closely for any of the following symptoms:

  • Fever – higher that 38⁰C or 100.4⁰F
  • Shivering and chills
  • Uterus does not return to normal size
  • Pain and discomfort in lower abdomen
  • Tenderness and pain in the uterus
  • Malaise
  • Discharge from the vagina – foul-smelling and containing pus
  • Pale and discoloured skin
  • Short of breath
  • Fatigued, difficult to rouse
  • Altered mental state
  • Edema
  • Flu like symptoms

(Nall, R. 2014) (Sepsis Alliance 2015).


Who is at Risk?

Any woman that is pregnant, has miscarried, aborted or delivered are at risk of sepsis but certain factors increase that risk. Women that are more susceptible are those that have liver disease, lupus a condition of the immune system, diabetes, congestive heart failure, are obese, first pregnancy, women that are under 25 or women that are over 40. Women over 40 are at risk of sepsis from infections due to placenta praevia and placenta abruption. Women that are underwent invasive procedures to become pregnant or invasive tests during pregnancy are more prone to infections that can lead to sepsis. (Sepsis Alliance 2015)


Diagnosis

Abnormal changes in the patient temperature, heart and breathing rate can indicate infection. The vagina and uterus will be checked for swelling and tenderness by abdominal and internal exams. Broad-spectrum antibiotics will be prescribed if sepsis is suspected to prevent the infection from spreading, long term damage to the body and death. Further tests will be carried out to determine the type of infection, where it is located and if bodily functions have been affected. These tests can include:

  • Blood and urine test
  • Wound swabs
  • Blood pressure checks
  • Ultrasound scan, X-rays or computerised tomography (CT) scan
  • Organ function tests – liver, kidney, heart
  • Lumbar puncture
  • Stool samples

(NHS Choices. 2014) (Nall, R. 2014)


Treatment

If sepsis is suspected broad-spectrum antibiotics will be given orally or intravenously to prevent infection spreading. When results from further testing have been received then a focused antibiotic is used to kill the bacterium. Anti-fever medication and cold compresses may be used to keep the fever under control. Oxygen may be given as levels in the blood can become low due to the body demand for oxygen. Intravenous fluids may be given to prevent dehydration and kidney failure, normally given within the first 48 hours after hospital admission. Sepsis can cause the blood pressure to drop; medication called vasopressors will be given to increase blood pressure allowing the patient condition to improve. Infection sites need to be keep clean and dry; pus to be drained away allowing infected tissue to repair and to prevent bacteria from entering. (Nall, R. 2014) (NHS Choices. 2014)


Complications

Sepsis can lead to serious complications and the damage can be irreversible. Complications for the women include:

  • Septicaemia
  • Septic shock
  • Peritonitis
  • Haemorrhaging
  • Pyelonephritis
  • Mastitis
  • Pulmonary embolism
  • Disseminated intravascular coagulation
  • Abscesses
  • Death
  • Compromise fertility

The foetus can be affected causing depressed Apgar scores, neonatal septicaemia, pneumonia and death. (Dharmaraj, D. Patriquin, G. 2012)

Willacy (2012) wrote that severe sepsis can cause acute organ dysfunction and has a mortality rate of 20-40%. If septic shock develops the mortality rate rises to around 60%.


Prevention

Following aseptic techniques and principles is very important. Correct cleaning practice of hospital and home environments need to be followed and use of sterile packs and equipment must be used to prevent contamination; these must only be used once then deposed of. (Johnson, R. Taylor, W. 2011. p. 80). Physicians must exercise the correct hand hygiene techniques (appendixes A) and use antiseptic soap, washes, alcohol-based rubs and sterile gloves. By doing this it reduces the risk of introducing bacterium into a sterile environment. (Johnson, R. Taylor, W. 2011. pp. 73-77). Protective clothing: aprons, shoes covers must be worn to prevent spread of infection and contamination from one situation to another, these to be deposed of after one use. Use of non-touch technique is important by ensuring sterile equipment does not touch with anything unsterile to prevent contamination and potential for infection. The use of an assistant to open packs and equipment can reduced the risk of cross contamination as it prevents touching anything non-sterile with sterile gloved hands. (Johnson, R. Taylor, W. 2011. pp. 80-82).


Analysis of Statistics

During the early 1900’s, just under 1.5% in 1000 births within the UK died from sepsis, greatly decreased on early years. Advances in medicine meant physicians were discovering asepsis was paramount in infection control. The introduction of carbolic spray in operating room, hand washing and rubber gloves were used to minimise contamination. Then in 1920, face masks were introduced into obstetrics to prevent contamination through body fluids. (Chamberlain, G. 2006).

In the last hundred years there has been a significant drop in puerperal sepsis. In 2003-5 0.85% of maternal deaths per 100,000 births were a direct cause of sepsis, which means asepsis was tackling infection. However in 2006-8 there was a rise to 1.13%, through lack of knowledge, not seeking advice when unwell and through infection control. Sepsis is now the leading cause of maternal death within UK above hypertension, thromboembolic disease and haemorrhage, where there has been a reduction in these. It has been noted that over recent years that it has been hard to achieve a reduction in the number of deaths within the UK due to bacterial infections, more needs to be done in order to prevent maternal deaths and these statistics rising further. (Sriskandan, S. 2011).


Conclusion

Puerperal sepsis is now the leading cause of maternal death, which means more medical research need to be undertaken in order to reduce the number of cases. Sepsis through pelvic exams, trauma during labour or prolonged labour needs to be evaluated and assessed on how using aseptic techniques and principles can reduce the risk of cross contamination and introducing bacterium into the genital tracts.

Over the last hundred years puerperal sepsis has declined significantly, however over recent years it has increased from lack of knowledge and infection control. The UK is a developed country and should have infection control and aseptic techniques and principles at the forefront of medical practice.


Recommendations

After miscarriages, during last trimester and during delivery broad-spectrum antibiotic should be given orally or intravenously to expectant mothers to provide the body with a barrier towards infections, this could reduce the number of cases sepsis.

More training and awareness of sepsis and aseptic principles should be provided to physicians, to ensure understanding and they are being diligent in regards to infection control.

Expectant mother and families should receive education through antenatal classes to learn the signs and symptoms of sepsis and what to do if they suspect it. Symptoms can be confused with flu like symptoms and education should be given to seek help and advice off midwives, health visitors and other physicians.


References

Awori, N. Bayley, A. Beasley, A. Boland, J. Crawford, M. Driessen, F. Foster, A. Graham, W. Hancock, B. Hancock, B. Hankins, G. Harrison, N. Kennedy, I. Kyambi, J. Nundy, S. Sheperd, J. Stewart, J. Warren, G. Wood, M. (1999) ‘Puerperal Sepsis,’

Primary Surgery,

1 [Online]. Available at:

http://www.meb.uni-bonn.de/dtc/primsurg/docbook/html/x1831.html

(Accessed: 20/04/2015).

Baring, N. (2013)

OBSTETRICS – Puerperal Infection.

Available at:

(Accessed: 23/04/2015).

Burch, D. (2009)

When Childbirth Was Natural, and Deadly

. Available at:

http://www.livescience.com/3210-childbirth-natural-deadly.html

(Accessed: 23/04/2015).

Chamberlain, G. (2006) ‘British maternal mortality in the 19

th

and early 20

th

centuries’ Journal

of the Royal Society of Medicine.

99(11). 559-563. [Online]. Available at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1633559/

(Accessed: 20/04/2015).

Dharmaraj, D. Patriquin, G. (2012)

Puerperal Infection.

Available at:

http://www.sharinginhealth.ca/conditions_and_diseases/puerperal_infection.html

(Accessed: 25/04/2015).

Johnson, R. Taylor, W. (2011)

Skills for Midwifery Practice.

3

rd

edn. London: Churchill Livingstone Elsevier.

Knight, M. (2015)

What is a life threatening

complication in pregnancy and childbirth? Available at:

http://ww.healthtalk.org/peoples-experiences/pregnancy-children/conditions-threaten-womens-lives-childbirth-pregnancy/what-life-threatening-complication-pregnancy-and-childbirth

(Accessed: 12/04/2015).

Nall, R. (2014)

Puerperal Infection.

Available at:

http://www.healthline.com/health/puerperal-infection

(Accessed: 23/04/2015)

.

NHS Choices (2014)

Sepsis – Diagnosis.

Available at:

http://www.nhs.uk/Conditions/Blood-poisoning/Pages/Diagnosis.aspx

(Accessed: 25/04/2015).

Sepsis Alliance (2015)

Sepsis

. Available at:

http://www.sepsisalliance.org/sepsis/symptoms/

(Accessed: 24/04/2015).

Sriskandan, S. (2011) ‘Severe peripartum sepsis’

Royal College of Physicians of Edinburgh,

41 339–46. [Online]. Available at:

www.rcpe.ac

.uk/sites/default/files/sriskandan.pdf (Accessed: 26/04/2015)

Willacy, H. (2012)

Puerperal Pyrexia.

Available at:

http://www.patient.co.uk/doctor/Puerperal-Pyrexia.htm

(Accessed: 25/04/2015).

World Health Organizations (2015)

Clean Care is Safer Care.

Available at:

http://www.who.int/gpsc/clean_hands_protection/en/

(Accessed: 26/04/2015).


Bibliography

Awori, N. Bayley, A. Beasley, A. Boland, J. Crawford, M. Driessen, F. Foster, A. Graham, W. Hancock, B. Hancock, B. Hankins, G. Harrison, N. Kennedy, I. Kyambi, J. Nundy, S. Sheperd, J. Stewart, J. Warren, G. Wood, M. (1999) ‘Puerperal Sepsis,’

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When Childbirth Was Natural, and Deadly

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Puerperal Infection.

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Knight, M. (2015)

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complication in pregnancy and childbirth? Available at:

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.

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Sepsis – Diagnosis.

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O’Connell, K. (2012)

What is septicaemia?

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Sepsis following Pregnancy, Bacterial.

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Sepsis Alliance (2015)

Sepsis

. Available at:

http://www.sepsisalliance.org/sepsis/symptoms/

(Accessed: 24/04/2015).

Sriskandan, S. (2011) ‘Severe peripartum sepsis’

Royal College of Physicians of Edinburgh,

41 339–46. [Online]. Available at:

www.rcpe.ac

.uk/sites/default/files/sriskandan.pdf (Accessed: 26/04/2015)

Willacy, H. (2012)

Puerperal Pyrexia.

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(Accessed: 25/04/2015).

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Glossary


Apgar scores

– designed to quickly evaluate a newborn’s physical condition.


Asepsis

– the absence of sepsis or infection.


Disseminated intravascular coagulation (DIC)

– is a serious disorder in which the proteins that control blood clotting becomeover active.


Malaise

– is a feeling of general discomfort or uneasiness; normally first indication of infection of other disease.


Mastitis

– is the inflammation of breast tissue.


Peritonitis

– is the inflammation of the thin layer of tissue that lines the inside of the abdomen called the peritoneum.


Placenta abruption

– part of the placenta comes away from the uterus wall),


Placenta praevia

– all or part of the placenta covers the cervix.


Pulmonary embolism

– is a blockage in the artery that transports blood to the lungs.


Pyelonephritis

– inflammation of the substance of the kidney as a result of bacterial infection.


Septicemia

– is known as bacteremia or blood poisoning. Septicemia occurs when a bacterial infection enters the bloodstream.


Appendixes

Appendixes A – Hand washing techniques (WHO. 2015)

http://www.who.int/entity/gpsc/media/how_to_handwash_lge.gif


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“MEDICAL CARE AND NURSING ROLES IN LONG-TERM CARE”

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“MEDICAL CARE AND NURSING ROLES IN LONG-TERM CARE”
Medical Care and Nursing Roles in Long-Term Care” Please respond to the following: Per the text, when patients cannot receive needed medical care, nursing services, or rehabilitation therapies in a community-based setting, they are typically admitted to a long-term care facility, where medical care is traditionally delivered by physicians and / or practitioners with advanced qualifications. All nursing services in long-term care facilities are delivered by a nursing staff which is headed by a Director of Nursing (DON). Compare and contrast the roles of the medical director and the DON. Select the role which has the overall greater impact on patient care. Provide a rationale for your response. Imagine that you are responsible for staffing a long-term care facility with sixty (60) full-time residents. Propose your strategy of selecting the key staff members, and specify their main roles and responsibilities. Support your selections.

Decrease Ventilator Associated Pneumonia

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Patients on ventilator support are very prone to respiratory infections. These patients have no means or control over what enters their lungs or what does not. One prevalent infectious process that can occur in these patients is ventilator associated pneumonia (VAP), and affects many patients every year who require ventilator support. Ventilator associated pneumonia is a form of pneumonia, a lung infection, which occurs in mechanically ventilated patients. It develops at least 48 hours or more after the ventilator is utilized (Powers, 2006). Ventilator associated pneumonia is caused by bacterial organisms entering the patient’s lower respiratory tract usually by aspiration of oral pharyngeal secretions. The bacteria colonize within the lungs causing immune response or infection to occur (Powers, 2006). The development of this infection can lead to a decline in the patient’s outcome and increased healthcare cost to the patient as well as the health care facility (Mori, 2006). With all these problems VAP can produce it is important to the patient as well as healthcare providers to be able to find ways to reduce the development of VAP cases in patients. The purpose of this paper is to determine if routine oral care can decrease the incidence of ventilator associated pneumonia in mechanically ventilated patients. The picot question guiding this paper is what effect does routine oral care have on the incidence of ventilator associated pneumonia rates in mechanically ventilated patients.

Background and Significance

Ventilator associated pneumonia is a serious infection affecting both the patient, healthcare facility, and staff. It is the second most common healthcare-acquired infection (Koening, 2006). Incidence of VAP is estimated as high as 65% and it occurs in up to 28% of patients who have been on the ventilator 48 hours or longer (Powers, 2006). The mortality rate associated with VAP ranges from 12-50% (Sona et al, 2009). Studies on the mortality rates of VAP also show that patients who develop VAP have a 2.2 to 4.3 times higher risk of death compared to other mechanically ventilated patients who do not have pneumonia (Powers, 2006).

A couple affects that VAP has upon the patient and healthcare facility are time of hospitalization and healthcare costs. Ventilator associated pneumonia causes the length of a hospital stay to increase significantly. It can increase the hospitalization time anywhere from four to nineteen days longer (Powers, 2006). This extra hospitalization can cause additional stress for the patient and their health. As the incidence of VAP causes longer hospitalizations to occur, patient and health care facility costs climb also. It is estimated that the average increase in hospital costs is around $57,000 per VAP occurrence (Powers, 2006). There are also increases to the hospital that occur due to increases in supplies used, staff that is utilized, and more medications used.

Since VAP has such a negative impact upon patients and healthcare facilities many interventions have been tried to prevent the incidence of VAP. One intervention utilized is keeping the head of the patient’s bed raised to at least thirty degrees to prevent aspiration of bacteria in secretions. Another is “sedation vacations” which consists of interrupting the patient’s sedation medication until patient shows signs of alertness, to assess if patients can be weaned off the ventilator more quickly. Other notable interventions that have been utilized in the past and some in today’s practice as well include: suctioning secretions, good aseptic techniques such as hand washing, and oral care (Pruitt & Jacobs, 2006).

Patients are continually developing VAP and having complications from the infection. If it is found that routine oral care, defined as teeth brushing with the use of an oral antimicrobial within this paper, can reduce the incidence of VAP in mechanically ventilated patients it could decrease length of hospital stay, keep costs due to incidence of VAP down for both patient and healthcare institution, as well as decrease mortality rates in these patients.

Clinical Question

Ventilator associated pneumonia occurs way too often in the hospital setting. It causes significant stress on the patient’s already problematic health status. The writer of this paper has observed many nurses who are vigilant in providing oral care to ventilated patients, but has also observed other nurses who forego oral care as if it not important and has no affects upon the patient’s health. This made the writer question what the actual effectiveness of oral care has upon reducing the incidence of ventilator associated pneumonia in mechanically ventilated patients. This issue is very relevant to nursing because the ultimate goal of a nurse is to help the patient have the best possible outcome. Trying to achieve the best possible outcome for the patient makes infection control is a very high priority for nurses. Patients who have infections are more prone to get other infections and require more nursing care and more time to recover from their illnesses. Although VAP will continue to occur in patients, and oral care is not a cure for ventilator associated pneumonia, there is valuable information included in research studies included within this paper that shows the incidence of VAP can be reduced in mechanically ventilated patients by implementing routine oral care.

Empirical Review 1

The purpose of the first study, conducted by Sona et al, 2005 was to determine the effect of a routine oral care protocol upon incidence of ventilator-associated pneumonia. The research design was a quantitative, experiment, quasi-experimental study which utilized a non-equivalent control group before and after the design. The study had no conceptual framework stated by the researchers. Within the study, the variables of significance to the clinical question being looked at were the routine oral care protocol and the ventilator-associated pneumonia rates. The independent variable of new oral care protocol was defined as the mechanical cleansing of the teeth or gums to remove plaque with a tooth brush and the application of an oral antimicrobial. The study went on to further discuss the protocol as brushing the teeth for one to two minutes with a regular toothbrush and then applying .12% chlorahexidine to all oral surfaces every twelve hours. The dependent variable was the ventilator associated pneumonia rates. It was defined as a common hospital acquired infection and is the leading cause of death in ICU patients who are ventilator dependent. Ventilator associated pneumonia rates were measured using the National Nosocomial Infections Surveillance System (NNIS) criteria.The reliability nor the validity of this instrument was addressed within the study. Another variable that was studied was length of stay. This was just measured by the number of days that the patient spent within the ICU after a ventilator associated pneumonia infection occurred (Sona et al., 2009).

This study took place at Barnes Jewish Hospital on a 24 bed intensive care unit (Sona et al., 2009). The study focused particularly on patients that were admitted to the surgical intensive care unit (SICU) whom required mechanical ventilation. The subjects consisted of all patients who had mechanical ventilation between June 1, 2003 and May 31, 2005. Subjects were chosen using non-probability convenience sampling. The pre-intervention was implemented for patients that were admitted between June 1, 2003 and May 31, 2005. The size of this sample was 777 patients. The pre-intervention phase consisted of standard care the nurse provided to the patients, no changes were provided during this time; only observation took place. One month before the end of the pre-intervention phase all nursing staff working on the SICU were debriefed and educated on the aims of the study as well as the new routine oral care protocol by two clinical nurse specialists and a nurse educator. This was to help prevent discrepancies in the intervention. During the post intervention phase of the study which took place between June 2004 until May 2005 the sample size consisted of 871 patients who were all nil per os (NPO) (Sona et al., 2009)

On June 1, 2004 the new routine oral care protocol was implemented (Sona et al., 2009). The intervention/protocol consisted of the nurse brushing the teeth of the patient for one to two minutes with a regular toothbrush, rinsing the mouth with water and suctioning it out, and then using 15 mL of .12% chlorahexidine to cleanse the mouth. The intervention was repeated every 12 hours by the registered nursing staff. Compliance of the protocol was estimated to be around 90% and the implementation was carried out for 12 months before results were analyzed(Sona et al., 2009).

For this study the level of significance was expressed using p-values. A p value of less than .05 was considered significant (Sona et al., 2009). For the data analysis, two statistical tests were used: The Mantel-Haesnel Chi Squared . After the analysis of data, it was determined that p=.04 showing that the routine oral care protocol did cause a significant reduction in the ventilator-associated pneumonia rates within the subjects studied. The pre-intervention rate for VAP was 5.2 infection per 1000 ventilator days while post-intervention rate for VAP showed 2.4 infections per 1000 ventilator days (Sona et al., 2009). Other statistics for the study showed the patient’s number of days the patient was on ventilator was decreased(Sona et al., 2009).

From the statistical analysis within the study, the researchers derived certain findings and conclusions (Sona et al., 2009). One of the findings was that the post intervention group had trends toward shorter time on the ventilator, as well as length of hospital stay. The main finding within the study found that when the routine oral care protocol was being utilized, the rates of ventilator-associated pneumonia were significantly decreased. The researcher makes it a point to state that although the finding suggests that the implementation of the protocol reduces rate of VAP this cannot be proven (Sona et al., 2009).

This study is a nonrandomized controlled trial. The quality of this evidence was convincing and significant. It was a consistent study and it is considered to be of Level II quality. Certain extraneous variables that could have had an effect upon the outcome of the study, as identified by the student, could have been the condition the patient was in before the ICU admission, any pre-existing conditions that could alter health and increase the risk of infection, and the nurses attitude toward performing oral care.

Although the study was a strong and consistent one, it did have both strengths and weaknesses. There were no strengths identified by the researchers. However, the student did identify some strengths within this study. One of the first strengths was the education that was given to the nursing staff prior to the implementation of the protocol. This helped the study to be more valid by increasing the continuity of the care and way the nurses performed the protocol. The other strength of the study was the design being a quasi-experimental. This is because quasi-experimental studies usually can be generalized to the population that is being studied. Weaknesses that were addressed within the study by the researchers was that the researchers themselves did not evaluate the teeth brushing portion of the intervention to make sure that the nurses were being consistent in the way they did it, and if the nurses performed it for the correct amount of time (Sona et al., 2009). This resulted in the lack of control over nursing techniques. Another weakness of the study recognized by the researcher was the study did not take into account the change in the patient population over the duration of the study (Sona et al., 2009). Some weaknesses the student identified within this study was that the study was very susceptible to bias because no blinding or masking was used within this study. Everyone knew what was occurring and this could have had the researchers looking as if the intervention helped more than it actually did.

Within the study the researcher did not address if the study could be generalized. However, the writer of the paper believes that this study can be generalized. The intervention is a very simple one. Most cultures have no problems with utilizing oral care. Also, most hospitals have intensive care units and/or ventilator dependent patients which were the population within the study. This intervention within the study does not have a lot of risks. The only risks mentioned were possible tooth staining from the antimicrobial and poor taste (Sona et al., 2009). Also, this intervention is very feasible. To implement oral care there is no special training needed, although education should be provided. The oral care routine is a relatively quick intervention that takes no more than 5 minutes to implement, which would allow nurses with busy schedules to still be able to perform the intervention. Also, this intervention is very low cost compared to the cost of ventilator associated pneumonia cases. Therefore, the cost-benefit ratio would be a great benefit to health-care facilities.

This study suggests that oral care can be very effective in decreasing the incidence of ventilator-associated pneumonia rates. Although a very valid study, one study is not enough evidence to implement a new protocol into a nurse’s practice. One must look for more studies and literature to support the finding in order to attempt to implement it into practice. The next study that was appraised by the writer of this paper seems to support the findings that were found in this study.

Empirical Review 2

The next study examined by the writer of this paper was a research study conducted by Mori et al.,2005. The purpose of the study was to determine if oral care of mechanically ventilated patients contributed to the prevention and reduction of the incidence of ventilator associated pneumonia (Mori et al., 2005). The research design utilized for this study was a quantitative, experimental, quasi-experimental which used a non-equivalent before and after approach. Within the study the researcher did not state any theoretical framework to guide the study. The study was not randomized, and used a non-probability convenience sample method (Mori et al., 2005).

The research study took place on a medical/surgical intensive care unit in an urban university hospital which was not named by the researcher (Mori et al., 2005). The population of interest was ventilator dependent patients with tracheal intubation. Since subjects were chosen by convenience sampling, they were chosen as they became available on the unit. Inclusion criteria for subjects were that they must have been receiving mechanical ventilation and have tracheal intubation. Exclusion criteria for the study were patient’s whose conditions contraindicated oral care, patients with severe bleeding tendencies, or patients with iodine allergies. The sample for the oral care group was patients admitted to the intensive care unit between January 1997 and December 2002, and consisted of 1,248 patients. The sample for the non-oral care group, or the control, was patients admitted during January of 1995 until December of 1996; this sample size was 414 subjects (Mori et al., 2005)

For this study, the independent variable was the oral care being delivered (Mori et al., 2005). This variable was defined as cleansing of the oral cavity three times a day by nursing employees following the specified new protocol. The protocol was that the nurse would check the patient’s vital signs and then do oral suctioning, followed by positioning the patient’s head to the side to prevent asphyxiation and determine the condition of the oral mucosa. After this the nurse would clean the mouth with a 20-fold diluted solution of providone-iodine gargle (antimicrobial). Then the use of a standard toothbrush was used to brush the teeth; the patient’s mouth was rinsed with water. Directly following the brushing and rinsing, the providone-iodine was utilized again by swabbing the mouth and teeth. Finally, oral suctioning was done one final time. The dependent variable in the study was the incidence of ventilator associated pneumonia. This variable was defined as a hospital-acquired pneumonia that becomes present after 48 hours of the patient being mechanically ventilated. Ventilator associated pneumonia was suspected if patch infiltrates were present upon the patient’s chest x-ray and two of the following were present: a temperature of 100.4 degrees Fahrenheit, white blood cell count of 10,000 m3 or higher, or purulent respiratory secretions were observed. A definite diagnosis of ventilator associated pneumonia, which was used for evidence of the incidence in this study, was determined by trancheobronchial secretion cultures showing a result of 1+ or more. Other variables were duration of hospitalization defined as length of stay measured by the number of days and the causative agent of the pneumonia identified by bacterial cultures (Mori et al., 2005). Reliability and Validity of the cultures and radiography used to measure if ventilator associated pneumonia was present and causative agent were not addressed within the study by the researcher, so the validity is unknown.

Examine the current stage in the specialty’s evolution.

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Examine the current stage in the specialty’s evolution.

 

For this question, select a specialty (nurse educator, nurse informaticist, nurse administrator, nurse executive, nurse manager, and clinical nurse leader) that you think is in some stage of evolution toward advanced practice or has the potential to evolve. Conduct an Internet search (including the online library as well as specialty organizations) and address the following:
Examine the current stage in the specialty’s evolution.
Describe the reasons why the specialty has the potential to evolve.
Compare and contrast the advantages and disadvantages for the specialty as it is evolving to the advanced practice level.

URLs to assist you in answering this question:
AACN for Nurse Informatics
AACN for Clinical Nurse Leader
ANCC for Nurse Managers
AONE for Nurse Administrators/Executives
NLN for Nurse Educators

Epidemiology of the Influenza Virus

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  • Hector Lucca

  • Instructor: Leslie Greenberg

The influenza virus, colloquially referred to as the flu, is a standout amongst the most well-known infectious processes in individuals of all ages and demographics. The central focus of this paper is to investigate the methodology of disease transmission for the influenza virus. To altogether comprehend the organism there are a few features to be examined. This includes identifying the virus itself through the distinguishing signs or symptoms, mode of transmission, complications and available means of treatment. The demographics affected will likewise be inspected through current information of mortality and morbidity, pervasiveness and rate of infection. An intensive examination will be made of the social determinants of health and how those components factor into the ailment along with the epidemiologic triangle in relation to the flu infection and the chain of contamination. Lastly the roles of the community health nurse and public aid as they relate to the treatment and response to the viral impact will be reviewed.

The flu arrives in various outbreaks episodes of variable range yearly. To accurately describe Influenza we must incorporate details on what causes the infection. The flu is an intense respiratory disease brought about by influenza A or B infections, most often occurring during the span of the winter months. (CDC, 2015) The infection lives in the respiratory discharges of an infected individual and is spread through droplets caused by talking, hacking or wheezing. (CDC, 2015) These respiratory droplets then land in the mucous membranes of individuals close-by or are spread through a non-tainted individual touching a surface or article of clothing with the organism on it and after that touching their own eyes, nose, or mouth. (CDC, 2015) The virus can continue to shed for 5-10 days. (Dolin, 2015) The incubation period, from the time one is infected to displaying symptoms of infection is 2 days. (WHO, 2014) Signs and symptoms of influenza are a fever or feeling hot, coughing, sore throat, runny nose, headaches, weariness, emesis, and loose bowels. (CDC, 2015) Complications of this season’s flu virus can include bacterial pneumonia, ear contaminations, sinus diseases, and dehydration. (CDC,2015) pneumonia is the most widely recognized complication and is more regular in those with debilitated and susceptible systems. (CDC, 2015) Prevention with inoculation is an effective way to fight infection and the complications that come with it. Treatment choices for most incorporates treating the symptoms; by resting, increasing intake of liquids, taking acetaminophen, and cough remedies. (CDC, 2015) Antiviral medicines, such as Tamiflu, can diminish the seriousness and length of time of symptoms by a day and this prescription is ordered in the off chance that you have had influenza symptoms for more than 48 hours and you have complications related to contracting the flu.

The demographic of interest is juveniles and the elderly. Although death tolls related to Influenza contraction is “usually disproportionately higher among elderly individuals and infants during influenza epidemics, a shift in the age distribution are seen during pandemics.” (Dolin 2015) Nurses are at risk for infection as well. The World Health organization states that “vaccination is especially important for people at higher risk of serious influenza complications, and for people who live with or care for high risk individuals. High risk individuals are pregnant females, the young 6 months to 5 years, the elderly over 65 years of age, individuals with chronic conditions, for example, diabetes, and healthcare workers. (WHO 2014)

As indicated by the Healthy People 2020 the social determinants of health are: Economic Stability

Education

Social and Community Context

Health and Health Care

Neighborhood and Built Environment.

These determinants of wellbeing have an effect on the infection rate of flu. There has been broad research on how social and financial circumstance assumes a significant part in the general health status of an individual, family and the community at large. As indicated by the WHO there is a relationship between habitations in devastated or overcrowded neighborhoods and increased risk of poor health status results and transferrable illnesses. (WHO, 2014). Absence of access, or restricted access, to health resources enormously affects the individual’s wellbeing. Case in point, when people don’t have health insurance, they are less inclined to take an interest in preventive care and are more prone to defer therapeutic treatment. The time of year or season is one of the greatest natural elements for influenza transmission in the United States. Regular occurrence of influenza happens predominately in the winter months from October to March. Individuals have a tendency to invest more energy inside and are exposed to a higher amassing of airborne viruses. Dry climate can dry out nasal passages which results in making them more vulnerable to airborne infections. Individual observation of infection precautions assumes a large part in community health management of infections. Case in point, if a man gets this season’s flu virus immunization his or her danger of getting the flu infection is significantly reduced. An individual has some control over how to decrease danger of this season’s flu virus by honing hand washing skills, covering the mouth when coughing and getting the prescribed measure of rest and reduction of every day stressors.

The epidemiological triangle model for understanding and visualizing a transmittable illness depicts the communication of the agent, host and environment giving a visual guide in controlling and keeping the transmission at bay by disturbing the equalization of this triangle. The Influenza virus (A, B and C) is the causative agent. Human beings are the primary host of the flu infection. Viruses have a genetic core, yet no real way to replicate itself. The virus attacks a host cell and assumes control over the cells capacity to reproduce. Influenza viruses are very versatile and resilient. Low temperature and low humidity support drop transmission. This clarifies the rationale for the seasonal nature of the virus. In tropical climates flu infection rates are connected with increased precipitation. Individuals invest more energy inside during harsh weather and cool climate expanding human to human interactions, in turn increasing exposure to the beads which convey the influenza infection. The extremely immunocompromised can be contagious for a considerable length of time. The epidemiologic triangle is utilized to break the chain of the flu disease. Immunization makes the host less susceptible against the influenza infection, observing good hygiene breaks the chain of transmission from reservoir or tainted individual to the next host. (CDC 2014).

The Institute of Medicine characterizes general wellbeing as what the general public does, by and large to guarantee the conditions in which individual can be healthy. (IOM n.d.). The Public Health Nurse is the foundation of the public health system’s framework. A nurse can use the epidemiologic triangle alongside the nursing procedure to lessen the effects and quantities of flu cases in their communities. The assessment phase is utilized to gather and dissect information about the flu infection and to distinguish community needs and accessible assets. Through the gathering and interpretation of information on the flu infection in the community the nurse has the capacity take part in flu case findings and serves to monitor trends. The diagnostic phase is the used to translate data and is the premise for execution of care and interventional planning. The nurse via home visits has the capacity identify and plan for strategies to overcome hindrances to vaccination such as cost and accessibility of service. Primary prevention would incorporate instruction on cleanliness, how the viral infection is transmitted, and inoculation. Secondary prevention incorporates distinguishing those in the community who are infected and conceivably the of caring for the individuals who are at most serious risk for getting an secondary infection by administration of antiviral medication.

There are various associations which advance flu awareness and prevention, an example of such an association would be the CDC. The CDC formed a program called The Influenza Division International Program, which works collectively with other international entities like The World Health Organization and others to develop the capacity to react to pandemic and seasonal flu outbreaks. The Influenza Division International’s plan is to decrease the risk factors of individuals contracting the flu by giving individuals and the overall population including health care professionals about transmission precautions, populaces at risk and the significance of seasonal influenza immunizations. The CDC reduces the dangers of a pandemic, restrains the spread of pandemic and seasonal influenza through week after week observation and evaluation of data. Through the utilization of the epidemiologic triangle the CDC has the capacity to: distinguish new strains of the flu, focus variables influencing individual to individual transmission, the directions of infection as it spreads at the worldwide and neighborhood levels, and team up with organization on general wellbeing measures to breaking the chain of transmission.

The CDC can advance the treatment of patients by perceiving variables connected with pathogenesis and clinical seriousness. An impact can be made on the general wellbeing of the population on a local or global scale. History has demonstrated the potential the influenza virus has to be incredibly destructive and its ability to evolve keeps public health organizations in close observation, advancement of new immunizations, and training on all levels from healthcare workers, communities and the citizen. By using the epidemiologic triangle to map the influenza virus in order to give a more all encompassing picture of communicable disease, both the individual health care professional and the public health organization can help stem the tide against a potent viral agent.

REFERENCES

Center for Disease Control. (2015, April). RetrievedJune 20, 2015, from

http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/flu.pdf

Dolin, R. (2015). UpToDate: Epidemiology of influenza, Retrieved June 20, 2015 from

http://cursoenarm.net/UPTODATE/contents/mobipreview.htm?26/30/27119?source=see_link

Public Health – Institute of Medicine. Retrieved from

http://www.iom.edu/Global/Topics/Public-Health.aspx

Social Determinants of Health. (n.d.). Retrieved June 21, 2015, from


http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health

World Health Organization. (2014). WHO | The Determinants of Health. Retrieved from

http://www.who.int/hia/evidence/doh/en/

Project 4 Finance for Managers

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Project 4: Finance for Managers

Start Here

As a senior analyst at Maryland Creative Solutions (MCS), you have continued to prove your value after helping Choice Hotels make strategic decisions by analyzing their financial reports. Frank Marinara and Elisa Izuki, continually happy with your work, have decided to transfer you to the finance team. You’re excited to continue working for MCS and you strongly believe you are capable of someday making senior partner.


Dialogue with Frank Marinara

You meet with Frank so he can orient you to the upcoming task. “The finance operations have a slightly different focus than the accounting operations,” he says. “The financial analysis part of our business is more involved with analyzing financing and investment decisions, making corporate asset valuations, evaluating corporate financial performance, and providing corporate valuations. You will be working to complete a project for our Maryland-based client McCormick & Company.”

Given your position as a senior analyst, you are anticipating that Frank will have several separate requests. Frank explains that McCormick & Company is considering expanding their operations by building another factory to increase the production volumes of their spice products. The client has asked MCS to help them determine if this financial investment is worthwhile.

Frank continues by delineating your responsibilities for the project: “To get started, we will need to look at the variables involved in this purchase and the questions McCormick & Company has provided. Ultimately, MCS will help them determine their corporate valuation, responsibly raise capital, and make the right financing and investing decisions. This information will help you determine which financing and investing options would provide McCormick & Company with the best potential outcomes for sustainability and growth.

“You will also need to participate in a meeting with the other finance analysts to discuss risk and returns,” Frank says. This discussion will help the client decide if they should invest in the new factory.

“The client also mentioned they would like MCS to provide them with guidance on retirement plan options and other employee benefits,” Frank elaborates. “Finally, I will need you to complete the project by preparing an executive summary that highlights your recommendations.”

Frank needs all of these tasks done within two weeks and suggests you begin right away. Click Step 1 to get started!

When you submit your project, your work will be evaluated using the competencies listed below. You can use the list below to self-check your work before submission.

  • 1.3:      Provide sufficient, correctly cited support that substantiates the      writer’s ideas.
  • 1.6:      Follow conventions of Standard Written English.
  • 3.1:      Identify numerical or mathematical information that is relevant in a      problem or situation.
  • 3.2:      Employ mathematical or statistical operations and data analysis techniques      to arrive at a correct or optimal solution.
  • 3.3:      Analyze mathematical or statistical information, or the results of      quantitative inquiry and manipulation of data.
  • 3.4:      Employ software applications and analytic tools to analyze, visualize, and      present data to inform decision-making.
  • 8.1:      Evaluate major business/organizational systems and processes and make      recommendations for improvement.
  • 10.3:      Determine optimal financial decisions in pursuit of an organization’s      goals.
  • 10.4: Make      strategic managerial decisions for obtaining capital required for      achieving organizational goals.
  • 12.1:      Assess market risk and opportunity.

Project 4: Finance for Managers

Step 1: Analyze Financing and Investing Activities

INBOX (1 NEW EMAIL)


From:

Frank Marinara, Director of Finance


To:

You and Finance Team

I hope you are ready to move forward with the project at hand. I want to give you the background on the McCormick & Company case and instructions for this project.

McCormick & Company approached MCS because they would like to increase the production of their spice products and are considering the construction of a new factory in Largo, Maryland. The new factory would allow the company to increase its overall production capacity. As McCormick decides whether to build the factory, they are asking our finance team to evaluate options to finance this construction. McCormick has provided MCS with the purchase price, expected cash flow, and two new product lines projects they expect to run in the newly built factory.

To understand which financing option would be best for the client, you must first understand

time value of money

,

present value

,

future value

, and

loan amortization

. These topics will help you make recommendations about the relative benefits and drawbacks of each option.

Working in the attached Excel Workbook, complete the Financing and Investing worksheet. The Financing and Investing worksheet contains information about present value, revenue, expenses, and cash flows, as well as questions that will help Frank guide the client in selecting the best financing option.

When you have completed the Financing and Investing worksheet, submit it to the submission folder located in the final step of this project. You should aim to complete this step during Week 7. Then, proceed to Step 3, where you will examine the factors affecting McCormick’s corporate valuation.

Looking forward to seeing your work,

Frank

ATTACHMENTS


McCormick & Company Workbook.xlsx

Project 4: Finance for Managers

Step 2: Determine Corporate Valuation

McCormick & Company is also interested in gaining further insight on the

corporate valuation

of the company, as they need to know how much capital they’ll need to raise to construct the factory. To understand valuation, you must review

dividends

,

options

,

warrants

,

derivatives

,

discount rate

, and

yield

.

Dialogue with Frank Marinara

Frank tasks you with recommending a method for raising sufficient capital. “McCormick & Company has been paying dividends to its shareholders for several years now,” he says. “The company has given us some data and would like us to recommend ways they can further leverage their financing activities. The company is interested in potentially issuing more stock or purchasing bonds to raise additional capital for the construction of the new factory. I will need you to answer a few questions about the company’s stock prices and minimum acceptable rate of return. Your answers will help me make a recommendation to McCormick.”

Working with the same Project 4 Excel Workbook you worked with in Step 1, complete the Valuation of Performance worksheet. This worksheet contains information on McCormick’s dividends,

stocks

, and

risk premiums

, as well as questions that will guide the client’s decisions.

When you have completed the Valuation of Performance worksheet, submit the Project 4 Excel Workbook to the folder located in the final step of this project. Next, proceed to Step 3, in which you will advise the client on selecting a retirement plan for its employees.

Project 4: Finance for Managers

Step 3: Evaluate Annuities

As McCormick & Company reviews its capital in preparation for constructing the factory, it has asked MCS to help with the process of selecting the best retirement options for their employees. To help McCormick make the best decision based on our recommendations, you will need to understand several concepts:

You will also apply what you learned about present value and future value.

Working with the same

Project 4 Excel Workbook

you will use in Steps 1 and 2, complete the Annuities worksheet. The worksheet poses questions about the retirement annuities, US treasury bond rates for the employees’ portfolios managed by a retirement fund company, and annuities for employee’s personal investments. This information will clarify the best choice of retirement plan for McCormick employees.

When you have answered the questions provided, submit the Project 4 Excel Workbook to the submission folder in the final step of this project. Then continue to Step 4, where you will discuss risk and returns with your colleagues.

Project 4: Finance for Managers

Step 4: Discuss Risk and Returns


Dialogue with Frank Marinara

As McCormick decides whether they will invest in an additional factory to keep up with demand, the company remains uncertain if the investment will yield worthwhile

returns

. “That is where they need us to provide them with a risk and return evaluation,” Frank says. “

Risk

is the financial liability a company takes in a given investment in consideration of a potential return on the investment.”


Meet and Discuss

Frank has asked you to meet with your colleagues and discuss how risk and returns will influence McCormick’s investment decision. Complete the following tasks:

· Discuss whether McCormick & Company should invest in building a new factory in Largo, Maryland. Give credit to any sources you use to support your statements.

· Discuss how understanding risk and returns will impact this decision. Give credit to any sources you use to support your statements.

· Later in the week, after you are back in your office, you have a follow-up discussion with your MCS colleagues in an effort to summarize the key lessons from your discussion on risk and returns at the meeting. Respond to your colleagues’ original discussion posts and give credit to any sources you use to support your statements.

During Week 8, submit one original posting of at least 250 words in the Risk and Returns Discussion by Saturday and post two responses of at least 50 words each to other discussion participants by Tuesday. Consult the

MBA discussion guidelines

for assistance.

When you have finished Step 4, proceed to Step 5, where you will review your recent findings in a report to management.

Project 4: Finance for Managers

Step 5: Submit Executive Summary

Team Report

At the conclusion of your project, Frank requests an executive summary based on your analysis and recommendations in the previous steps. He is planning on using this executive summary to provide the client, McCormick & Company, with guidance on the potential construction of an additional factory. This executive summary should include facts and figures to support your recommendations. The report should highlight your analysis and recommendations based on the work you completed in the Project 4 Excel Workbook. Be creative and use charts, graphs, or any other tools you feel would be useful to convey your analysis and recommendations. Post your executive summary to management in the submission folder located in the final step of this project.

When you have completed Step 5, proceed to Step 6, where you will submit all work for Project 4.

Attachments

Instructions

Instructions

To complete this workbook, answer the questions on each worksheet.

Financing and Investing

1
2
3 Price Percent Down Amount Financed
4 Loan N I/Y PV PMT
Loan A
Loan B
Loan C
5 Loan N I/Y PV PMT Total Paid
Loan A
Loan B
Loan C
6

McCormick & Company is considering building a new factory in Largo, Maryland. James Francis, a landowner, is selling a 4.35-acre parcel of industrial zoned land with a listed sale price of $3,000,000.00 for the land. McCormick & Company is interested in the land and so is another manufacturing company. The competing manufacturing company has made an offer of $2,300,000.00 in cash and $300,000 each year for 15 years for the land. McCormick & Company knows it can make an offer to outbid the competitor to obtain the land. So, McCormick & Company decided to offer $4,242,000.00 in cash.

Now, the land owner, James Francis, must make a decision between the two competing offers. To make this decision, James should first identify the Present Value (PV) of each offer. James’s bank is offering a 12 percent (12%) interest rate when invested through the bank-managed growth stock portfolios. Let’s help James make his decision by answering the following questions using the template to the right.

1. Without any calculation involving TVM, what offer would James accept ?

2. Using PV and/or FV, which offer should James accept? Does it change your perspective? Elaborate and explain.

McCormick & Company has decided in order for the company to have a minimal impact on current cash flows, the company will need to borrow seventy percent (70%) Loan to Value (LTV) of the $4,242,000.00 offer in the form of a commercial acquisition and development loan to purchase the land. This means McCormick & Company will need to make a thirty percent (30%) down payment to secure the commercial acquisition and development loan. McCormick & Company is considering three different loan options:

Loan A: 20-year loan with a fixed annual interest rate of 6 percent
Loan B: 10-year loan with a fixed annual interest rate of 4.5 percent
Loan C: 15-year loan with a fixed annual interest rate of 5 percent

3. How much of the total $4,242,000.00 offer will be financed?

4. Which loan will have the lowest monthly payment?

5. Which loan will have the lowest total payback amount?

6. Would you recommend McCormick & Company select the loan with lowest monthly payment or lowest total payment and why?

Corporate Valuation

Capital Asset Pricing Model
1
0
Dividend Valuation Model
2
0.00

Now that McCormick & Company has secured the land for the new factory through a loan, now it is time to construct the new factory. Instead of using operating cash flow to fund the construction of the new factory, McCormick & Company has decided to raise capital. To raise additional capital the company is considering issuing additional shares of stock. For McCormick & Company to determine how much it will cost the company to issue stock, the company must determine the required return on the stock in relation to the systematic risk. We can help McCormick & Company with this by answering the following questions using the provided information below:

McCormick & Company uses the 10-Year Treasury Constant Maturity Rate as the risk-free rate. As of 7/1/2019, this was 2.03 according to the U.S. Treasury.
McCormick & Company has disclosed the company’s levered Beta is 0.60 (MarketWatch, 7/1/2019).
McCormick & Company has disclosed the company’s expected return on the market is 8.03%

To answer the following questions, please use the template to the right.

1. What is McCormick & Company’s required return on the issuance of stock using CAPM?

In the CAPM, we examined the expected return on the market as a whole. In an effort to estimate the required return of McCormick & Company’s stock, we will assume market equilibrium and use the Dividend Valuation Model (DVM), which is the expected return of McCormick’ & Company stock. To find the cost of equity using DVM, we take the original equation
and rearrange it solving for Rs:

→

McCormick & Company’s expected dividend per share next year is $2.28
McCormick & Company’s expected dividend per share constant growth rate is 8.70% (as of May 2019)
McCormick & Company’s stock price per share was $155.70 on 7/1/2019

2. Using the DVM what is the cost of equity?

Annuity

Answer Questions 1 and 2 here. Show your calculations.
1 PV
PMT
1b PMT
2 PMT
Monthly

Questions

1. Marie, an employee at McCormick, has determined that she will need $5500 per month in retirement over a 30-year period. She has forecasted that her money will earn 7.2% compounded monthly. Marie will spend 25-years working toward this goal investing monthly at an annual rate of 7.2%. How much should Marie’s monthly payments be during her working years in order to satisfy her retirement needs?  Hint: Find how much Marie must have at retirement, then find the monthly payments to reach that goal.
What maximum amount could Marie withdraw each month so that her balance never decreases (nearest dollar)?

2. Kathy plans to move to Maryland and take a job at McCormick as the Assistant Director of HR. She and her husband Stan plan to buy a house in Garrison, MD and their budget is $500,000. They have $100,000 for the down payment and McCormick will pay for closing costs. They are considering either a 30 year mortgage at 4.5% annual rate or a 15 year mortgage at 4%. Calculate the monthly payment for each. Property taxes and insurance will add $1,000 per month to which ever mortgage they choose. What should Kathy and Stan do?

Hr managers who pass certification exams in human resource management

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aQuestion 1 5 / 5 points

HR managers who pass certification exams in human resource management are knowledgeable in all of the following aspects except __________.

Question options:

strategic management

information technology

employee and labor relations

occupational health and safety

Question 2 5 / 5 points

No manager wants to __________.

Question options:

have his or her employees not performing at peak capacity

hire the wrong person for the job

find employees not doing their best

all of the above

Question 3 5 / 5 points

A(n) __________ examines current organizational practices for potential action violations.

Question options:

EEO representative

training specialist

job analyst

compensation manager

Question 4 5 / 5 points

A __________ is a system that enables employees to manage their own benefits and update their personal information.

Question options:

company portal

cybernetic portal

formulation system

software-based system

Question 5 5 / 5 points

Strategic human resource management refers to __________.

Question options:

formulating and executing human resource policies and practices that produce the employee competencies and behaviors the company needs to its achieve strategic aims

planning the balance of internal strengths and weaknesses with external opportunities and threats to maintain competitive advantage

emphasizing the knowledge, education, training, skills, and expertise of a firm’s workers

extending a firm’s sales, ownership, and manufacturing to new markets

Question 6 5 / 5 points

The __________ HR group focuses on being HR business partners to specific departments.

Question options:

embedded

corporate

centers of expertise

transactional

Question 7 5 / 5 points

Which term refers to letting vendors abroad provide services for a firm?

Question options:

external work systems

application service providers

offshoring

data warehousing

Question 8 5 / 5 points

Which of the following is an issue that HR managers have to deal with today?

Question options:

managing ethics

managing employee engagement

adding value

all of the above

Question 9 5 / 5 points

Of the 10 most serious ethical issues, how many were HR related?

Question options:

six

10

seven

four

Question 10 5 / 5 points

__________ maintain contact within the community and publicize openings.

Question options:

Job analysts

EEO representatives

Recruiters

Compensation managers

Question 11 5 / 5 points

In today’s business environment, __________ are often the firm’s main source of competitive advantage.

Question options:

machines

highly trained and committed employees

superior organizations

superior ad campaigns

Question 12 5 / 5 points

Which of the following demographic issues represents a challenge for human resource managers?

Question options:

an increasingly diverse workforce

an aging workforce

an increasing use of contingent workers

both A and B

Question 13 5 / 5 points

Which organization provides professional certification for human resource managers?

Question options:

Academy of Management

Society for Human Resource Management

Academy of HR Partners

Association of Business Administration

Question 14 5 / 5 points

Which of the following is an example of HR management’s changing role?

Question options:

HR managers must measurably improve organizational performance.

HR managers must represent the organization even when they are off the clock.

HR managers must be individually centered so as to ensure that there will be no favoritism.

None of the above.

Question 15 5 / 5 points

All of the following are new HRM skills except __________.

Question options:

improving off-shoring skills

supplying transactional services while serving more strategic, internal consulting activities

improving internal consulting skills

all of the above

Question 16 5 / 5 points

Over the next few years, employers may face a severe labor shortage because __________.

Question options:

there are fewer people entering the job market than there are retiring baby boomers

one-third of single mothers are not in the labor force

people are living longer

all of the above

Question 17 5 / 5 points

Which of the following job titles indicates a position in human resources?

Question options:

recruiter

training specialist

EEO coordinator

all of the above

Question 18 5 / 5 points

The __________ HR group may provide specialized support for organizational change.

Question options:

transactional

corporate

embedded

centers of expertise

Question 19 5 / 5 points

Which strategic management tool provides a departmental performance overview indicating how the department helps achieve the firm’s strategic plan?

Question options:

an HR score card

a strategy map

a department performance report

a digital dashboard

Question 20 5 / 5 points

The ________ HR group works with the top management team to develop long range plans for the company.

Question options:

transactional

embedded

centers of expertise

corporate