The public health system focuses on prevention through population-based health promotion-those public services and interventions which protect entire populations from illness- disease- and injury-and

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The public health system focuses on prevention through population-based health promotion-those public services and interventions which protect entire populations from illness, disease, and injury-and protection. Social media is increasingly used for public health and health promotion as well. The use of graphic videos is controversial. Some are offended, others upset, children may be especially so. The biggest question is-do they work?

Watch this video: CDC Tips from Former Smokers

Determine the effectiveness of public education initiatives.

Include the following aspects in the journal:

Ø  Identify healthful initiatives in your area

Ø  Do you feel that they are beneficial? Please explain why.

Ø  Describe a social media site that promotes a specific health activity?

Ø  Reflect on your feelings about graphic public health warnings

Q1: what differences and similarities would be present in user

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In approximately 300 words, answer the question below.

Use of proper APA formatting and 5 citations are required

.

If supporting evidence from outside resources is used proper citation is required.

Your submission should largely consist of your own thoughts and ideas but may be supported by citations and references.

Question 2:  In your own words, explain how threat modeling a system can help with development of realistic and meaningful security requirements.

200 words, APA format with 4 citation

Different Subject: Legal, Regulations, Compliance and Investigations

Question 3:

Write a paper that describes a unique, non-tech risk. You cannot repeat what anyone else has used.

In your Initial Post also describe how your firm, or another one, would best mitigate, remove, or pass along the risk to another entity. You must be descriptive. For example, you cannot simply say that “The best way to avoid the risk of hurricanes is to buy insurance.”

Systematic Review Of Barcode Medication Administration Nursing Essay

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One of the most important and potentially life altering tasks that a nurse must perform is that of medication administration. While the entire process may involve many disciplines, the bedside nurse remains the final stop in a line of checks that occur prior to any medication reaching a patient. The goal of medication administration is to deliver prescribed medications in an effective and safe manner. Often times, barriers are present that prevent the safe administration of medication which include, but are not limited to, errors in the translation of physician orders, inappropriate judgment and lack of attentiveness (Ulanimo, O’Leary-Kelley, & Connolly, 2007). The incorrect administration of medications may be devastating to the patient as well as the healthcare provider. The adverse effects from inappropriate administration could ultimately include death. Research has shown that many adverse outcomes in the hospital and in patient care are due to medication errors (Poon, Keohane, Bane, Featherstone, & Hays, 2008). It is estimated by the Institute of Medicine that, “on average, a hospitalized patient is subject to one medication administration error per day” (Koppel, Wetterneck, Telles, & Karsh, 2008, p. 408). Medication errors are costly to an organization as well. It is estimated by the Institute of Medicine as well, that a single adverse event could cost a hospital upwards of near 4,600 dollars for each occurrence (Ross, 2008). Adverse events alone have the potential to cost an organization up to 1.22 million dollars annually (Ross, 2008).

Healthcare organizations and officials have initiated standards to help with safe patient care, one of which pertains directly to medication administration. The Five Rights of Medication Administration is the initiative that has been guiding the way that nurses and bedside providers administer medications to patients. These rights ensure that the right patient receives the right medication, to include dose and route, and that it is given at the right time (Fowler, Sohler, & Zarillo, 2009). No matter what measures are used to focus on this issue, there will always be human error. Leaders in technology have implemented a system that helps to reduce errors, therefore increasing patient safety, when it comes to medication administration. They have done so by using a barcode medication administration system. This system helps by putting hard stops on different aspects of medication administration in hopes to decrease the amount of errors that occur, with patient safety being the ultimate focus.

Barcode medication administration embodies the values of the five rights of medication administration by using a systematic and consistent process for each and every patient. It does so by prompting the nurse to scan the patient’s armband to ensure patient identification. It then pulls that patient up and allows the nurse to access the medication profile (Ross, 2008). The nurse then scans the barcode that is on the medication package verifying they have the right medication, right dose and right route. If the medication matches the ordered dose and route, no further documentation is needed in most cases. However, it is when there is a discrepancy between these that nurses are made aware of the situation by an alert message that they must act upon in order to continue (Dasgupta, Jacob, & Dwibedi, 2011). They must also scan their own name badge in order to confirm or document the provider that is administering the medication (Koppel et al., 2008). As with any change, some barriers exist in the initiation of the system. These may include implementation issues that include staff acceptance as well as potential for continued error due to staff finding workarounds to different aspects of the administration. There are also proven benefits with the system such as a decrease in errors and improved efficiency by staff. The alert messages and required action makes it harder for the nurse or provider to overlook warnings that may prevent possible adverse events.

Literature Review

An initial computerized literature search of “barcode medication administration” using CINAHL and ProQuest resulted in numerous articles. To broaden the research also used were the terms “informatics” and “medication errors”. The information obtained from these searches included qualitative and quantitative research studies, literature reviews, and descriptive analysis of the medication administration system. The research resulted in numerous viewpoints of barcode medication administration to include the perspectives of multidisciplinary teams, administration as well as barriers and issues with initial implementation and nursing satisfaction. In all of the different articles that were discovered, there were some key points that repeated throughout. Those key points discovered were tactics used to make the systems successful as well as barriers that were encountered, as outlined below.

Implementation. The implementation of a new system or process always has its challenges. A significant amount of the research founded dealt with the initial implementation barriers and how they were worked through. In an article by Ross, the entire implementation process was defined and reviewed retrospectively. The nursing administrators and bedside nurses as well as Information Technology (IT) and Pharmacy all worked together to build a common vision and work in collaboration to make the transition accepted and enable it to succeed, this group was called the collaborative design team (Ross, 2008). The article outlined the process of the vendor selection in which conscious decisions were made based upon the different needs of the hospital. Staff participation was encouraged in order to make the implementation a success. Staff insight was taken into consideration and weighted heavily when it came to choosing the right system. The decision was made and the design was completed over the course of six months. The viewpoint of the nursing staff was taken in the highest consideration and they were involved in the implementation process. Policies were changed and re-written and introduced to staff prior to training so that they were aware of the change. “The biggest concerns among the staff were that the system slowed them down, took them away from patient care, and that the standard hospital dosing times and ‘real time’ administration would cause conflict” (Ross, 2008, p 4). The hospital administrators took this into consideration making process maps and rewriting policies again to make the transition as smooth as possible.

Wireless technology had to be upgraded so that the systems that were in patient rooms were able to operate and function well. IT left logs for staff to report errors. Prior to the roll out, each staff member was required to take a four hour course for education on the new system. To also make the transition smoother, super users were placed on the unit for two weeks to help with staff issues and questions. Weekly meetings were held after implementation as well to continually work on issues that were occurring with the system. Staff was kept up to date on these by a ‘Barcode Bulletin Board’ that was present in each unit (Ross, 2008). The implementation of the new system was a success due to the collaboration that occurred between all of the disciplines. “We found that collaboration was critical to our success. Our barcode implementation has improved not only patient safety but also how our outsourced IT utilizes its resources and time” (Ross, 2008, p. 7).

In another article by Wakefield, Ward, Loes and O’Brien, discussed was the implementation of the barcode medication administration in critical access hospitals. The barcode medication administration system that was implemented here helped to maintain accuracy in all of the associated critical access hospitals while reshuffling the medication inventory process (Wakefield, Ward, Loes, & O’Brien, 2010). The barcode system also helped maintain accuracy in billing. Often times, prior to the implementation, medications were dispensed and not charted, therefore creating it impossible to bill the patient or insurance for services rendered. All of the critical access hospitals that were discussed in this article have been able to maintain their target of a 90 percent scanning rate (Wakefield et al., 2010). Nursing staff also remains happy with the change. “All interviewees indicated that the use of the BCMA devices and change in workflow have been generally well-received by the nurses, and have prevented medication administration errors” (Wakefield et al., 2010, p. 585).

Acceptance. It is well known that in order to make a system function to its full capacity and potential, buy in from staff must be obtained. Several articles were found in research speaking to nursing and staff satisfaction when it came to barcode medication administration. In a time motion study completed by Poon, et.al, nursing satisfaction and workflow was observed within the system. Concern was discussed that with the nursing shortage, the barcode system would slow nursing staff down, which would hinder them from fully caring for their patients in the capacity that they deserved (Poon et al., 2008). The study was set in a 735 bed hospital over a nine month period to explore nursing workflow within the barcode administration system. Baseline observations were taken before the roll-out as well as after. In these situations, an observer, after allowed consent by the patient, followed the nurse into the room and observed her action when administering medication. It was found after the completion of the study that time spent on medication administration did not change significantly among the nursing units from before to after (Poon et al., 2008). The amount of time spent with management of physician order decreased by 11 minutes over an eight hour shift, actually saving the staff more time than before. This study completely helped to alleviate nursing staffs’ fears about increasing their workflow and helped to create acceptance surrounding the implementation.

Fowler, Sohler and Zarillo also outline several aspects that deal with nursing satisfaction when it comes to barcode medication administration. This study used a comparative, descriptive design to answer several questions about nursing satisfaction and the system. Staff was surveyed prior to implementation as well as three and six months after. The research completed showed mixed feelings. The staff was dissatisfied prior to implementation and continued to be after the study. They did however rate that they were highly satisfied with the safety that the barcode system brought into medication administration and they expressed that it made it easier for them to practice the five rights of medication administration (Fowler et al., 2009). The authors recommend continued surveys be completed to see if time helped to increase satisfaction or new employees helped to increase the overall satisfaction.

Reduction in Error. Errors in medication administration can be devastating to a patient as well as to the nurse. It has been investigated as to why medication errors occur. These discoveries are discussed in the article by Ulanimo, O’Leary-Kelley and Connolly. It has been found that most medication errors are due to, “lack of attentiveness, inappropriate judgment and missed or mistaken physicians orders” (Ulanimo et al., 2007, p. 29). The authors used a descriptive style study to answer the research questions that they had posed. The sample consisted of 61 registered nurses at a Veterans Affairs hospital in California. The nurses were asked to return a survey as to what they thought were the largest cause for medication errors. The number one and number two reasons were failure to check patient identity and they occurred when nurses were tired and exhausted (Ulanimo et al., 2007). All of the nurses surveyed agreed that the number of administration errors has decreased since the hospital implemented the barcode administration system. This study shows that while errors still occur, the nursing staff believes that their current practice of barcode administration truly does prevent or decrease errors.

In a short article written by AHRQ, pharmacy workload is examined after implementation of barcode medication administration. Often times, pharmacists are interrupted by emergent phone calls, patients or by physicians. It is easy to see with this that the potential errors from pharmacy distribution can be real and extremely costly. One hospital mentioned in the article decreases their dispensing errors by 63 percent after the implementation of a barcode system. This is so because by the nurse verifying the route and dose at the bedside, medications are not mistakenly given to patients if they are the wrong item (“Studies Examine,” 2008). In the same study, the largest benefit was a decrease in the adverse drug events that saved the hospital 2.2 million dollars annually (“Studies Examine,” 2008).

In the research completed by Wild, Szczepura and Nelson a study was completed over several years’ time in the United Kingdom regarding the implementation of barcode medication administration in a long term care facility and the reduction in adverse drug events that were seen. The staff was given a questionnaire and asked to assess their knowledge of medication errors. This was completed prior to, as well as after implementation (Wild, Szczepura, & Nelson, 2011). It was found through the surveys that nursing staff felt less stress and pressure with the system. This was so because barcode medication administration was helping to prevent medication errors that may have been previously overlooked due to the system alerting when one of the rights was violated or incorrect.

Potential for Continued Error. At times, users deviate from the written standards when it comes to new or unfamiliar systems. This may be called a “work around” and is often seen when a staff member is not able to navigate through the system efficiently. This may be due to lack of knowledge or due to build flaws in the system. In the study completed by Koppel, et.al, several methods were used to evaluate work around in the healthcare setting; observation, interviews and participation in staff meetings and education (Koppel et al., 2008). Fifteen different workarounds were noted in the study that were placed into three different categories. These categories were, omitted steps in the process, those that performed steps out of sequence and those that were unauthorized steps completed in the process (Koppel et al., 2008). At times, the reasoning was due to missing medication, medications that were not bar-coded or possibly home medications that were brought in to take. Other times, however, staff was lazy and did not go into the room to scan wristbands and instead scanned a sticker they kept on their person for convenience. It is suggested in the article to continue with observations and monitor compliance to ensure that standards are being met.

Discussion

The review of literature shows much promise for the reduction of medication errors as evidence by multiple studies. There are areas in which the system would work extremely well such as inpatient medical/surgical floors and in long term care facilities. Nursing homes often have hand written Medication Administration Records (MAR) and the transcription of handwritten instructions leaves much room for error. Often times, in the way of the old systems, nursing staff did not even know that errors had been made due to lack of awareness. Now with the barcode medication administration, it leaves smaller room for error. With some systems in the long term care facilities, pictures of the resident come on the screen to give another assurance of accuracy since, at times, residents may suffer from memory problems and may be unable to identify themselves.

An area where the system may not work as efficiently and could potentially cause delays in care would be in an emergency department or in an intensive care unit. In these areas, lifesaving medications may need to be given quickly and on the premise of verbal orders when time does not allow for the entry of the order or verification by the pharmacy. In these situations, there is often times a pharmacist in the department that is able to be a resource for medication administration. “In the emergency department, the timing of actions is extremely important and circumstances are occasionally such that there is no time to register prescriptions before the medications are administered” (Lenderink & Egberts, 2004, p. 186). In these situations, staff should still verify the order and that the five rights are being met by a conversation with the physician to ensure safety is being met.

An initial computerized literature search of “family witnessed resuscitation” using CINAHL and PubMed resulted in numerous articles. Using this search we were able to obtain numerous studies regarding outcomes of family witnessed resuscitation. To broaden our research we also used the terms “cardiopulmonary resuscitation” and “family presence”. The information we obtained from these searches included qualitative and quantitative research studies, literature reviews, and a concept analysis review. The research resulted in numerous viewpoints of family witnessed resuscitation to include the perspectives of both family members as well as healthcare professionals.

Barcode medication administration, as proven by the research, shows great promise in the world of medication administration. It is a new and exciting advancement in technology that hospitals should implement in order to decrease adverse drug events and poor outcomes associated with medication administration and the error that is associated with this. As technology advances, it is expected that more research will be completed in order to fully see the impact of the system.

Conclusion

It is likely that by adopting barcoded medication administration into our practice, it will decrease the number of adverse drug events that are seen in the hospital setting. It is evident by the research that has been completed that barcode medication administration has true benefit in the safe administration of medications and helps to decrease the errors that could potentially be made along with this. Many systems are new still and it would hold benefit to continue to survey areas months and years after implementation. As with any system change, there will always be resistance but what it comes down to is what is best for the patient and what increases the overall good. In this situation, barcoded medication administration is most certainly in the best interest of the patient and this will be proven as research continues.

Care Pathways and Strategies for Diabetes and Coronary Heart Disease Patients

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Discuss how the practitioner and agencies involved in the care pathways for one of the chosen physiological disorders


Diabetes:

A professional that will help with individuals who have diabetes is their optometrists as they are trained to be able to examine the eye and see defects in individuals vision, and are able to identify problems with their general health, for example, high blood pressure and diabetes, if an individual with diabetic retinopathy.However, if they require surgery they will then go see ophthalmologists are a surgical medical specialist who is able to perform surgeries on the eye. They went to medical school whereas optometrist when to optometry school. Ophthalmologist is able to examine the eye thoroughly and are able to diagnose many diseases and infection for example cataracts, glaucoma, macular degeneration and diabetic retinopathy’s use many different tools in order to examine the eye for example medical history indicates if there is any in the family who has diabetes or is they have been any recent changes in vision. A slit-lamp microscope it I device which shines light into the eyes and can examine the inside of the eyelid and the inner eye and the front surface if the eye.

Another professional that is a podiatrist they are health care professional who has been trained to diagnose and treat an abnormal condition of the feet and lower limbs. They can prevent and correct deformities and help to keep people on their fee and moving, they also help people relieve pains and treat their infections. Day to day foot problems such as ingrown toenail, fungal nail, calluses, blister and verrucae. the orthotics are a tailor-made insoles, padding which supports your arch and relives and heel pain., its placed in your show and takes the pressure off vulnerable places in your feet.

Furthermore, professionals that help with someone who suffers from diabetes can be a nurse. Diabetes management is an essential part of keeping healthy with the support of nursing staff it can be managed and prevent future complication DNS (diabetes specialist nurses) they are a crucial part patient care and promoting self-care management. DNS provides training for other health care professional for example school nurses and public health nurses. Practice nurses play a particular role when it comes to managing diabetes as they are often the one who maintain screening and support people with diabetes. For example, they do this by monitoring the blood glucose, identify and treat hyperglycaemia and hypoglycaemia and also assessing and meeting their nutritional needs.


Coronary heart disease:

A cardiologist is a healthcare professional in which an individual who suffers from coronary heart disease would see regularly. They work in order to prevent the disease from progressing further. They used cutting edge technology and therapy; emergency treatment is frequently required to treat individuals with CHD. They also do palliative care, at the end of someone’s life due to their heart disease. There are many different sub-specialities for cardiologist, and one is adult congenital heart disease as CHD falls under this sub-speciality. As women who suffer from heart attacks their symptoms tend to be different from the men’s they some places have women’s heart program which specialises in the care need to prevent and treat the heart disease’s a symptom is a heart attack.

Another professional in which plays a role in cardiovascular care is a dentist. It may seem they play a minor role however when they treat patients, they are able to see warning signs for a range of diseases including those of the heart. they must make to be more vigilant so that as they are the first in line to detect any potential problems during their oral health treatment. If an emergency is detected they must refer the patients to the general practitioner or the or hospital department. As there is a link between periodontitis and coronary heart disease as it is commonly known as gum disease. As our oral health is commonly spread through the spread of bacteria and other germs to various parts of your body through the bloodstreams. When they reach the heart, the bacteria will then attach themselves to damage the area of the heart and this will then cause inflammation. This can result in illness such as endocarditis etc. This is how periodontal; disease will release toxins into bloodstreams which will then help to form fatty plaques within the arteries. This can lead to serious issues such as blood this will block the blood flow to the heart which can lead to someone dying.

Lastly, another professional which can be involved in the care pathway for individuals with coronary heart disease is a nutritional therapist are qualified professionals who provide services which help to improve prevent any problems with individual care. It is a complementary therapy which works to helps chronic conditions such as coronary heart disease. As nutritional therapy will identify where a nutritional status is and use this information, so they are able to produce resources to help better the individuals diet. There are several factors which can be associated with the of the fatty tissues within the coronary heart, for example, most commonly linked to a diet and lifestyle. Obesity is one as those who are overweight will tend to have a diet which is high in saturated fats Cholesterol levels, as will produce cholesterol in our liver after we have eaten food. LDL which is lipoprotein cholesterol can lead to plaque forming in the arteries. Saturated and unsaturated fats can increase LDL cholesterol in the blood. (Betterhealth.vic.gov.au.2019)


Discuss the care strategy that can be used to support individuals with each physiological disorder




Diabetes

A care strategy which can help someone who suffers from diabetes is an aid for living. This is a useful service as it provides individuals with help in their everyday life when there is no one there to support them. An induvial with diabetes can go onto to suffer many problems with their health, for example, they can develop foot problems know as ‘diabetic foot’, also they can start to lose their eyesight and malnourishment. Aid for living will help them manage these condition with their diabetes so they are able to live at home as being mobile is hard if someone is not able to see and has not learned how to do everyday task also if their feet were hurting and they unable to stand no long enough to make some food this could lead to why they could become malnourished. It is possible for this to be a short-term care plan for the individuals as it helps them to stay at home, for an elderly, this can be preferred rather than moving to a care home. A reason in which aid for a living may not benefit an individual with diabetes is that it is not a permanent solution for especially an elderly who suffers from diabetes their health may start to decline and it is possible they would need 24-hour help, therefore, aid for a living may not be the best solution.

Nutritional therapy is a complementary therapy which helps people who suffer from conditions such as diabetes. It helps induvial with diabetes as they as the nutritional therapist will identify the status in which this person is at and will then go onto creating a meal plan for them to follow, it has everything that they need in their body. They use commercial dietary supplement (not approved by the NHS) such as mega disease of vitamins and minerals in order to help the induvial. As they believe that our body has a nutritional and biochemical imbalance which leads to poor health (Bda.uk.com. (2019). This is a long-term care plan as this will help them increase their nutritional health as they have identified which area needs improvement and this will help them in the future as they are healthier which means they will become less tired and weak. (Bda.uk.com. 2019) Nutritional therapy may not be good for someone who is suffering from diabetes, for example, they are using alternative medicine and are non-regulated by law such as dietician, they do not work alongside other health care professionals therefore for each induvial it is a risk as the treatment they offer may not be the best as they do not have a degree.

A podiatrist is a health care professional who helps with foot problems. They help individuals to manage foot pain by providing individuals with orthotics this is a tailored made insole which helps to relieve heel pain for individuals. Also, they advise patients on footwear to help with feet pain. This is a short-term care plan as their recommendation and all they try to do help may be exhausted and not for some people. It may not be best to use this care strategy for those who suffer from diabetes is that if you are classified as low-risk patient as your mobility is yet affected then the NHS won’t cover for individuals to see a podiatrist meaning that individuals may have to go see them privately which can vary from up to 25 to 40 pound per session and regular sessions monthly can be very expensive, also this can deter people as they may not have the financial capability of paying for this treatment leading them to have server problems with their feet.

Lastly managing the disorder is an important part of someone’s health when they suffer from a chronic condition such as diabetes. It provides patients with the confidence, skills and knowledge to be able to love with this disorder. It will help take of themselves, for example, teaching individuals how to administer their own insulin, check the levels of their blood glucose and learn the way to help reduce or increase it. This is a long-term care strategy as it will help individuals for the rest of their lives being able to take care of oneself. It may not be wise to when the induvial is diagnosed between the ages 9-14 with type one diabetes at that age they may find it difficult to remember to take their medication also find it overwhelming to administer their own insulin so managing the disorder is better for individuals later on in their life rather than when they are first diagnosed.




Coronary heart disease

Mobility aid is a care strategy which can help to support individuals, who are suffering from coronary heart disease. This is because individuals who suffer from CHD also suffer from a stroke which can cause them mobility issues. This can come either as a helping hand by career or methods placed around the individuals home. For example, they may need the use if a wheelchair placing ramps around the house so that it is easy for them to move around. This can be a short-term solution to help an induvial life to be much easier. However having a wheelchair and making the necessary adjustments to their environment can be very costly and therefore not all individuals are able to us access this service which can cause restriction as they are then confined to one space which can cause problems for their mental health as they are not going out and seeing others, therefore the may start to withdraw. Also, the lack of independence can make them feel uncapable of looking after oneself.

Moreover, another care strategy which can help to support individuals who are suffering from coronary heart disease can be a lifestyle change. This can be very useful as many professionals can provide the necessary resources which the individuals will need to lead a better and healthier lifestyle. As cholesterol plays a role I the build-up incapable is important that individuals are aware and eat less saturated and non-saturated fats. Eating food such as sardines, tuna and fruits and vegetables are better for them. This is long-term solutions and can be very effective as it helps not to worsen the individual’s condition and can even contribute to their healing. Having healthier foods can be very costly compared to frozen and ready-made meals which tend to be high in saturated fats. Many people may feel as buying all the fruit and vegetables to be a financial burden. (nhs.uk, 2019)

Furthermore, another care strategy which can help to support individuals who are suffering from coronary heart disease can be medicine. There are many different drugs that can be used to treat coronary heart disease, for example, aspirin or other blood thinners as it can reduce your blood from clotting which helps to prevent construction to your coronary arteries, beta blockers is a medication used to help slow your heart and decrease the blood pressure ,it decreases the demand for oxygen in ones heart so if an individual has suffered a heart attack beta blocker will help reduce the risk of forthcoming attacks. Also, the use nitro-glycerine can come in forms of a tablet, spray or patches and it helps to control one’s chest pain, this is done by temporality dilating the coronary arteries which will reduce the heart demand for blood (Mayoclinic.org. 2019). This is a short-term solution as medication can not cure coronary heart disease however can help to prevent future complications. The right medication will help them to manage their symptoms effectively. There are many side effects to CHD medication for example beta blocker can cause to suffer a slow heartbeat, diarrhoea and nausea, blurred vision and sleep disturbance (insomnia) (nhs.uk. 2017). Therefore, this can cause problems for individuals wanting to go about their everyday life.

Lastly, another care strategy which can help to support individuals who are suffering from coronary heart disease can be an exercise program where they have daily or weekly exercise sessions. This can be as simple of walking at least half an hour a day or two and half hours a week, research shows people who fit reasonable active like walking burn more energy than those who go to the gym. People who exercise tend to have a better blood pressure than those who do not. As those with high blood pressure are at a higher risk of developing CHD as high blood pressure puts added force against the arty walls. Exercise helps to reduce the risk of heart attack and will help improve their quality of life. This is a long-term fix as it helps to prevent future problems with individuals health. Exercise for all CHD patients may not help us some may have suffered from mobility issues due to the disease, therefore, making it more difficult or unlikely. (Exerciseismedicine.com.au. 2019)


Evaluate the effectiveness of health and social care practitioners and agencies working together to deliver the care pathways for one of the chosen physiological disorders.

Coronary heart diseases involve many different agencies working tither to provide care for individuals who suffer from it.

Strengths:

A strength of multiagency working can be early identification, which leads to earlier intervention. As individuals will disclose information to their professionals and when diagnosing an issue, the other professionals may be able to identify something which either the other professional hadn’t yet noticed, or the patient had to disclose crucial information to them which can be relevant however seemingly insignificant. This can happen when an individual start to show symptoms of coronary heart disease, for example, an individual who has a history of ingestion their GP doctor may not be able to identify the problem at first as the individual may not notice it either, however after a systems such as a heart attack doctors a cardiologist will be able to diagnose the CHD and prevent other systems from progressing such as heart failure which can lead to death with no transplant.

Another strength of multiagency working is a Better quality of services, as they will often be quicker rather than your GP requesting a specialist to come on your case each time they need a cardiologist, it is better if your GP work alongside them to better your holistic health. Also working in a team with a variety of resources help to solve issues which may arise faster, which means that your recovery time and the extent of the damage that has caused is minimal. They can work together to come up with the best possible way to treat your conditions, and different perspectives help to see a different way to approach it.

Another strength of multi-agency work is different professional will combine their skills and expertise to provide the best holistic care. They all play a vital role in individual health care; if they work together they can come up with the best solutions to keep the induvial healthy and comfortable for example cardiologist may advise the nutritionist to provide less saturated unsaturated fats in their meal plan. If your nurses which you see every day may notice that your struggling, after surgery, or diagnoses they will disclose this information to a psychologist who may be able to help them through it. Also when you work as a team, they are all able to maintain that individuals in all areas of their life, as they may be feeling down when the other professionals see them, it is essential that they are encouraging and aware of how their patient is feeling.

Weakness:

A disadvantage of multi-agency work, issues that may arise for example when more than two or more professionals are working together is lack of communication.Poor communication in healthcare can lead to horrible results for the health of the patient, this can be due to the lack of respect they each have for one another’s professions. Coronary heart disease has many professional working tother to provide the best holistic care for their patients. For example, a cardiologist may feel as their opinion matters more than a dentist who is qualified in medicine. Also, GP and dietician jobs overlapping this can cause unnecessary stress an inconveniences for the patient as they are providing them with the same information again and even asking the same questions and running the same test.

Moreover, another issue which may arise when two or more professionals work together is neglect; this is due to professionals not identifying clear roles and responsibilities between one and another. The lack of clarity will confuse them, and they will feel uneasy about the quality of their healthcare, as they are unable o identity, which is doing what for them. This can happen when a health care professional, for example, cardiologist and GP doctor order the same test this is because they are not working tother properly, which means they are wasting resources and time — also neglecting how the patient feels which will indirectly slow their recovery. (Scie.org.uk. 2019)

Furthermore, conflict and animosity between health care, which are providing holistic care for an individual, is a problem. This is because they are unable to work side by side and will often not value the other professional’s skills and expertise when dealing with their patient which will lead to delay in treatment and they will be may be unable to prevent heart intervention. This can cause their condition to worsen for example an individual who see her doctor at the GP due to chest pains, fatigue and nausea; which are signs which indicate to heat attack conflict between the health professional. However, they will request second opinions or other health care professionals, which may be better for them; however, the patient needs them to stay focus and refrain from involving their feelings.



Evaluate the care strategies that can be used to support individuals with one of your chosen physiological disorders


Complementary therapy is a strategy that is used to support individuals who suffer from coronary heart disease. Nutritional therapy is very useful services which aim to provide patients with information and resources that are needed in order for them to stay healthy and well. This will help them manage their condition as they are able to eat the right food which their body needs and stay away from food groups which will make them weak so for example if an induvial with coronary heart disease eats food that is high in salts and unprocessed foods and fried food this is not benefiting them however can worsen their condition. However, if they eat foods such as salmon, tuna and vegetables and fruits and whole grain bread this is better for their body. Nevertheless, nutritional therapy is a lifestyle change that must be made by the patient themselves. It is great that we provide them with the meal plans however it is there job to follow to and a dietitian or GP do not have any power over them to make sure they change as they can only advise.

Moreover, care strategy which aims to help individuals who suffer from coronary heart disease can be the use of medication. A very useful medication that is provided to individuals is blood thinners this will lessen the chance of your blood clotting, this will help to prevent obstruction of the arteries if left untreated this can lead to someone’s death. Nitro-glycerine this is a tablet, spray or even patch that can help control an individuals chest pain by dilating your coronary artery, this will help to reduce your hearts demand for blood. Though this might help the individual if they stay on top of all their medication it is very possible when an individual reaches old age for their memory to become disorientated and therefore they may not remember to take their medication, therefore, this treatment plan that they are on may not be as effective as it could have been.(Mayoclinic.org. 2019)

Additionally, care strategy that aims to help individuals is being able to learn about their disorder so they are better equipped to manage the small things on their own. As they will have all the necessary tools and skills to better manage the disorder, for example, someone who suffers from coronary heart diseases may be taught about better dieting option available which will benefit them. Learning and implementing this will help them understand why it may not benefit them to eat and what can happen to them if they do therefore acting as a deterrent. The weakness of managing the disorder is teaching individuals how to may prove difficult as there may be barriers if communication between the patient and the health care professionals. For example language barriers finding an interpreter, when patients aren’t able to voice they will start to feel frustrated and helpless.

Furthermore, care strategy which aims to help individuals who suffer from coronary heart disease is rehabilitation strategy this can be with a psychologist who will assess the needs of the individuals and create a care plan which is best suited from them. It aims to help people overcome mental and emotional disorders that individuals may be facing due to the disorder the was diagnosed. For example, some individuals who are diagnosed with coronary heart disease can fall into depression and start to become withdrawn from those around them. This is bad for both their physical and mental health and therefore by providing a care strategy we are able to support them to be better and this can be done by prescribing anti-depressants. However, a weakness is not all areas may have the faculties needed for that individual, therefore, meaning they may have to travel far, this is can cause that induvial not seek help as they don’t believe that it is not worth it.




Bibliography


         Mayoclinic.org. (2019).

Coronary artery disease – Diagnosis and treatment – Mayo Clinic

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https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/diagnosis-treatment/drc-20350619


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         Barnesjewish.org. (2019).

Coronary Artery Disease | Atherosclerosis St Louis Missouri Myocardial Infarction – Heart & Vascular Center – Barnes-Jewish Hospital

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https://www.barnesjewish.org/Medical-Services/Heart-Vascular/Coronary-Artery-Disease


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    Heart disease and food

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Heart disease and food

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         Exerciseismedicine.com.au. (2019). [online] Available at: http://exerciseismedicine.com.au/wp-content/uploads/2016/11/2014-CHD-FULL.pdf [Accessed 3 Jun. 2019].

Pathophysiology of Downs Syndrome

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Down syndrome is defined as a congenital disorder that occurs because of a chromosomal defect with chromosome 21.  It is the most commonly occurring chromosomal condition according to the National Down Syndrome Society.  Around 6,000 babies in the United States are born with Down syndrome every year.  Worldwide it is estimated to be between 1 in 1,000 to 1 in 1,100 births according to the World Health Organization.  This disorder does not occur more often in certain individuals but instead affects all races and economic levels equally (ndss).  In addition, it doesn’t have a higher chance of affecting someone based on where the person or their family lives and it doesn’t discriminate based on gender.  According to the CDC though, in the United States African Americans born with the disorder have a lower chance of surviving past their first year of life compared with white infants.  The reasons for why African Americans may have a lower chance of survival has not been discovered yet (Weatherspoon).

Down syndrome is a genetic condition, but it is not normally hereditary.  Often times it is due to a random cell division error during the creation of the father’s sperm or mother’s egg (My Child Without Limits).  The only risk factor that may attribute to an increased risk of a baby being born with Down syndrome is the mother’s age when she gets pregnant.  The risk of a baby being born with Down syndrome increases when the mother is 35 or older.  According to the National Down Syndrome Society, women who are 35 have an increased chance of around 1 in 350 of having a baby who is born with Down syndrome.  The risk increases even more the older the women is when conceiving a child.  At age 40, a woman has a 1 in 100 chance and by age 45, the chances of having a baby with the disorder is 1 in 30.  Although the risks increase with age, around 80% of babies that are born with the disorder are born to moms who are younger than 35.  This is due to a higher fertility rate among the younger generation, women younger than 35 are having more babies than those over 35.  The higher birth rate contributes to the number of babies that are born with Down syndrome to mothers who are at a younger age (Weatherspoon).

An individual who has Down syndrome is usually diagnosed with the disorder when they are born.  The life expectancy for those born with Down syndrome has increased dramatically though in recent decades.  Due to advancements in treatments, the death rate has fell by roughly 41% from 1979 to 2003 (Weatherspoon).  It has skyrocketed from the average life span being around 25 in 1983, to people living to the age of 60 in recent years (ndss).  Many individuals diagnosed with the disease will exhibit similar physical traits such as small stature, low muscle tone, upward slanting eyes, and a flatted facial profile and nose.  In addition to physical traits, individuals often exhibit intellectual and developmental symptoms as well.  Some of the cognitive impairment problems include impulsive behavior, delayed language and speech development, and a slower rate of learning (NIH).  It is important to understand though that each individual is different, they may exhibit these traits at different degrees and some may not experience these traits at all.

Diagnosis of Down syndrome occurs both when the baby is in utero and when he/she is born.  Screening tests and diagnostic tests are offered to women of all ages who become pregnant.  Screening tests help to indicate the chances that the baby will be born with Down syndrome.  Based on the screening test, the mother might opt to have diagnostic tests run to diagnose whether the baby actually has the disorder.  Diagnostic tests include chorionic villus sampling and amniocentesis.  Chorionic villus sampling is when fetal chromosomes are analyzed from cells taken from the placenta.  This test normally occurs in the first trimester of a woman’s pregnancy.  The amniocentesis test is taken during the second trimester.  It is when the chromosomes of the fetus are analyzed from a sample of the amniotic fluid.  When the baby is born, the diagnostic test that is used to confirm the diagnosis is a genetic analysis test.  This test includes analyzing the chromosomes in a sample of blood taken from the baby (Mayo Clinic Staff).

There are three types of Down syndrome that a person can be diagnosed with.  The three different types include trisomy 21 or nondisjunction, mosaicism, and translocation.  Despite which type that individual has, the disorder is caused by the person having an extra portion of chromosome 21 present in some or all of their cells. The presence of the added chromosome 21 alters the DNA causing the individual to have 47 chromosomes rather than the normal 46.  The additional genetic material alters fetal development and causes the characteristics of Down syndrome. The cause of the extra chromosome present in the cells is still unknown.  The additional part of the chromosome can either originate from either the mother’s egg or the father’ sperm.  According to the National Down Syndrome Society, around 5% of Down syndrome cases can be traced back to the father (ndss).

The first type of Down syndrome is called trisomy 21 or nondisjunction.  This type is the most common out of the three, accounting for 95% of the cases.  Trisomy 21 affects the number of chromosomes within the cells.  It causes three copies of chromosome 21 to be present rather than the normal 2 copies that cells normally have.  This occurs either before or during conception when one of the pairs of chromosome 21 from either the sperm or egg fails to separate.  This results in the embryo having an additional chromosome 21 from either the mother or father.  This extra chromosome is replicated in every cell of the body as the embryo develops.  The presence of the extra chromosome attribute to the individual displaying characteristics of Down syndrome (ndss).

The second type of Down syndrome is called mosaicism or mosaic Down syndrome.  This is the least common type of the disorder, accounting for only 1% of all Down syndrome cases.  Mosaic Down syndrome is when there is a mixture of two types of cells.  Some of the cells in the body contain the normal 46 chromosomes while other cells contain 47 chromosomes.   The cells that contain 47 chromosomes is a result of the extra chromosome 21.  According to research, individuals with this type of Down syndrome may exhibit fewer characteristics of Down syndrome than those with the other two types (ndss).  This may be due to the fact that some of the body’s cells have the normal 46 pairs of chromosomes while only a partial number of cells have the extra chromosome.

The third type of Down syndrome is called translocation.  Translocation occurs in roughly 4% of individuals who are diagnosed with Down syndrome.  It occurs when an extra full or partial copy of chromosome 21 attaches it itself to another chromosome.  Individuals total number of chromosomes in their cells remain 46, but the extra chromosome 21 latches on to chromosome 14 normally.  This extra genetic material from chromosome 21 causes individuals to exhibit characteristics and symptoms of Down syndrome.  Translocation is the only type that has a hereditary factor to it.  There is no hereditary factor in either mosaicism and trisomy 21.  The hereditary factor causes around one-third of the cases of Down syndrome that occurred due to translocation.  This means that around 1% of all Down syndrome cases were caused by a hereditary factor.  The rate of risk of for translocation to occur again is about 10-15% if the mother is the carrier of the gene or around 3% if the father is the carrier (ndss).

Down syndrome is not a disorder that is able to be cured by any treatments or medications.  Treatments that are used are often meant to help to decrease the risks of the individual developing additional problems or helping with current problems that accompany Down syndrome.  It is important that treatments are started early in the individual’s life in order to help improve their quality of life.  One complication that many individuals face are developing a heart defect.  Half the children that are born with Down syndrome have some type of congenital heart defect.  This may require the infant to have heart surgery right away after they are born.  Another complication includes developing GI abnormalities in the esophagus, trachea, anus, or intestines.  A third complication is those with Down syndrome are at an increased risk for injury to the spinal cord.  This occurs due to misalignment of the top two vertebrae in the neck, it can cause them to overextend their neck.  Additional complications include a risk for obesity, sleep apnea, immune disorders, seizures, hearing and vision problems, and leukemia (Mayo Clinic Staff).

A medical treatment that is currently being used aims to affect brain activity to help improve the individual’s ability to learn and understand.  One characteristic that is often associated with those who have Down syndrome is their learning and understanding capabilities is delayed.  Being developmentally delayed signifies a child that is not achieving normal milestones within the normal age range.  It is taking them longer to develop skills that other children have already developed by a certain age.  This makes it important to start treatments and therapy early so that it can help the individual live a more productive life. One treatment involves taking amino acid supplements and a medication called Piracetam.   Piracetam is thought to help improve the brain’s ability to learn and understand.  This medication may be able to help overcome barriers that individuals face who are developmentally slow and help boost their learning capabilities (My Child Without Limits).

Beneficial therapy is often introduced in addition to medical treatments to help improve the individual’s life.  A child with Down syndrome may suffer from a delay in one or more of the developmental milestones.  The five developmental milestones include gross motor skills, fine motor skills, language skills, cognitive skills, and social skills.  There are different types of therapies that aim to help improve these skills to help them live a more productive life.  Three types of therapy that are often used for people with Down syndrome include speech therapy, occupational therapy, physical therapy, and behavior therapy.  Speech therapy is used for children who have developmental delays involving speech and language development.  It is very useful in helping children who may not understand language, have a hard time being able to effectively communicate and other problems involving their speech.  Occupational therapy helps individuals with Down syndrome be able to live their life more independently.  Physical and cognitive disabilities can often make every day activities hard, occupational therapy can help these individuals improve their ability to function in these areas.  Physical therapy can help with balance and coordination for individuals with Down syndrome.  Behavior therapies are often helpful because often times individuals with Down syndrome may be impulsive or act out.  This type of therapy focuses on reducing behavior problems and helps to promote individuals to learn how to adapt to situations (My Child Without Limits).

Medical research is always being continued in order to help better understand and help treat Down syndrome.  One way that researchers allows researchers to understand more about the disorder is by using an animal model to learn more about Down syndrome.  They have found that there are similarities in mice and human chromosomes, this allows researchers to be able to find and understand potential treatments.  One test that is being tested on mice is administering neuroprotective peptides to mice before they are born.  These peptides are important for brain development and the researchers observed that they allowed the mice to perform learning and memory tasks better as adults.  A second test involves administering the drug memantine to mice.  This drug is currently used in individuals who suffer from Alzheimers disease.  The goal of this drug is to help improve cognitive abilities in young adults (NIH).  There will always be future research to help better understand Down syndrome and find ways to help those with the disorder live longer and more productive lives.

In summary, Down syndrome is a congenital disorder that is caused by cells containing an extra chromosome 21.  It is the most common chromosomal condition occurring in 6,000 babies in the United States a year.  There are three types of the disorder including trisomy 21 which is the most common, mosaicism, and translocation.  Characteristics exhibited by those who have Down syndrome often includes short stature, delayed language and speech, and cognitive impairment.  There is no cure for Down syndrome, but that doesn’t mean that those who have it cannot live a life of quality.  The average life span has increased exponentially from the 1980s and individuals have been living to the age of 60.  Early treatment, along with different types of therapy are key to helping those with Down syndrome live a happy and productive life.


Works Cited

  • Huether, Sue, and Kathryn McCance.  Understanding Pathophysiology.  Elsevier, 2017.
  • Mayo Clinic Staff.  “Down syndrome.”  Mayo Clinic, 8 March 2018, https://www.mayoclinic.org/diseases-conditions/down-syndrome/diagnosis-treatment/drc-20355983.  Accessed 24 November 2018.
  • My Child Without Limits.  “Down Syndrome Treatment.” MyChildWithoutLimits.org, 2018, http://www.mychildwithoutlimits.org/understand/down-syndrome/down-syndrome-treatment/.  Accessed 24 November 2018.
  • ndss.  “Down Syndrome.”

    National Down Syndrome Society

    , 2018, https://www.ndss.org/about-down-syndrome/down-syndrome/.  Accessed 23 November 2018.
  • NIH.  “Down Syndrome: Research Activities and Scientific Advances.”

    Eunice Kennedy Shriver National Institute of Child Health and Human Development

    , 21 June 2018, https://www.nichd.nih.gov/health/topics/down/researchinfo/activities.  Accessed 24 November 2018.
  • Smith, George F., and Stephen T. Warren. “The Biology of Down syndrome.” Annals of the New York Academy of Sciences 450.1 (1985): 1-9.
  • Weatherspoon, Deborah.  “Down Syndrome: Facts, Statistics, and You.”

    Healthline

    , 31, October 2018, https://www.healthline.com/health/down-syndrome/down-syndrome-facts#1.  Accessed 24 November 2018.

Barriers in social work training towards human trafficking | SOCW 8610 – Action Research Project | Walden University

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1.  In one to two sentences, what was the social problem that prompted you to search the literature to find out more? Write in complete sentences using a scholarly tone.

2. Now that you have read and summarized some of the recent literature to understand your problem, and given what other researchers are exploring, what meaningful gap have you identified that your study will address? (What have others not yet explored about this problem that you will contribute with your study?)

3.  Based on all of the above information (social problem, literature review, gap), in one sentence, what is your research problem?

4.   Framework (Conceptual or Theoretical)

What theory(ies)   and/or concept(s) support (frame) your study and who are the original   authors? Provide an in-text citation with your response, and the complete APA   reference entry with summary in the Background section.

How do these theories and/or concepts relate to your research problem, purpose, and the nature of your study?

5.  Research Question(s) and Hypotheses (if applicable)

List the question(s) that you plan to use to address the social work practice-focused research problem. Your question(s) must align with your study purpose and include the variables and/or concepts and how they will be examined.

6.   Nature of the Study

What systematic approach/method and research   design do you plan to use to address your research question(s)?

To address the research questions in this study, (choose method) the specific research design will include (Choose approach) Reference entry for the work on which this research   design is based:

For your planned research design, what   type of data will you need and what data   collection tools and sources will provide it?

What data points from these sources do you plan to   use to answer your research question(s)?

Replace this text with your response.

What limitations, challenges, and/or barriers might   you need to address while conducting this study (e.g., access to   participants, access to data, requirements for storing data, separation of roles   or other ethical considerations, instrumentation fees, etc.)?

(Rubric Standard | Feasible   > Can   a systematic method of inquiry be used to address the problem; and does the   approach have the potential to address the problem while considering   potential risks and burdens placed on research participants? )

7. Significance

How   will your study address the meaningful, social work practice-specific issue   that you identified and therefore contribute to social work professional   practice, contributing to positive social change?

Rubric Standard | Impact   > Does   this project have potential to affect positive social change?

Rubric Standard | Objective > Is the topic approached in an objective manner?

References should not be more than 5 years

Analyze the Affordable Care Act (ACA), comparing and contrasting several different scenarios and analyzing how the ACA influences financial decision making.

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Analyze the Affordable Care Act (ACA), comparing and contrasting several different scenarios and analyzing how the ACA influences financial decision making.

In this assignment, you will analyze the Affordable Care Act (ACA), comparing and contrasting several different scenarios and analyzing how the ACA influences financial decision making and ethical considerations for healthcare insurance coverage.
President Obama signed the Affordable Care Act into law on March 23, 2010 (White House, 2013). Since its inception, the debate has continued about the pros and cons of the Affordable Care Act (ACA).
For this assignment, you will research the ACA from several different perspectives. You are to compare the ACA relative to the following scenarios:
• A 45-year-old morbidly obese person with a Body Mass Index (BMI) ≥ 30 is seeking bariatric surgery for weight loss with an anticipated cost of $15,000 to $35,000 depending upon the region of the U.S. The individual has not tried other measures such as a weight-loss program or exercise.
• An employer that is considered a small business with 49 full-time employees is seeking to hire 5 more employees in the next year. The employer currently does not offer health insurance for employees, but does provide a stipend of $200 a month for each employee.
• A college-graduate young adult is currently 25 years of age and will turn 26 in two months. The young adult is employed part-time but is seeking full-time employment.
Based on your analysis of the scenarios and the module readings, Argosy University online library resources, and the Internet, address the following:
• Analyze the aspects of the Affordable Care Act that are applicable to each of the aforementioned individuals relative to the following:
o What are the potential benefits of the ACA?
o What is the potential negative impact of the ACA?
o What, if any, ethical considerations might there be for any of the three scenarios?
• Identify at least three websites where consumers can learn more about the ACA. Provide a short synopsis about each explaining your choice and the benefit of the information to consumers.

Causes and Treatments of Sepsis

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Sepsis is a major cause of morbidity and mortality in hospitals today. It has been defined as ‘the body’s response to an infection when organisms invade the body’ (Baudouin 2008). It’s an infection which is caused by micro organisms or bacteria’s that invade the body. Sepsis can lead to acute organ dysfunction followed by multi-organ failure and death. In the early stages of sepsis the immune response can be characterised as a systemic inflammatory response syndrome (SIRS) (Chamberlain 2008). This is the body’s response to a variety of severe clinical insults. It is characterised by the presence of two or more of the following features: Temperature >38°C or <36°C, Heart rate > 90/min, Respiratory rate > 20/min or PaCO2 <4.3kPa, White cell count > 12 x 109/l altered mental status, blood glucose>7.7mmol/l in absence of diabetes (LTHTR Sepsis Care Pathway 2009).Sepsis is defined as SIRS in response to infection (I, Mackenzie 2001).

The surviving Sepsis campaign was launched in October (2002) aiming to increase awareness of sepsis, severe sepsis and septic shock among healthcare staff and the general public, develop evidence based guidelines for the management of severe sepsis and ensure that guidelines are put to practice globally. In the Nice Clinical guideline 50- acutely ill patients in Hospital they made key recommendations to ensure early identification of the acutely ill patient and prevent deterioration of condition thus reduce patient mortality, morbidity and length of stay, to reduce ICU admissions and re admission.

Initial management of a critically ill patient includes:

  • Immediate assessment of the airway, breathing and circulation
  • Baseline observations HR, RR, BP, O2 sats, capillary refill, EWS and AVPU to assess level of consciousness
  • A brief history
  • A limited examination of the relevant systems of the body.
  • A secondary assessment after stabilisation of the patient including a more thorough history, detailed examination by system and appropriate investigations. The golden hour an early window of opportunity immediate resuscitation with oxygen and fluids prevents secondary injury to organs as a result of hypoxemia and hypovalaemia helping to reduce mortality and morbidity. The timing of clinical intervention is essential to the survival of septic patients (Chamberlain 2008).

Respiratory failure is common and may develop at any stage so repeated assessments are necessary. A depressed conscious level is the most common cause of airway obstruction (I, Mackenzie 2001). A clear airway does not indicate effective breathing. Failure of gas exchange may be caused by lung problems (pneumonia, lung collapse, pulmonary oedema), failure of the mechanics of ventilation. Respiratory failure is suggested by signs of respiratory distress including dyspnoea, increased respiratory rate, use of accessory muscles, cyanosis, confusion, tachycardia, sweating. The diagnosis is made clinically but may be confirmed by pulse oximetry and arterial blood gases. Patients with a depressed conscious level may not react normally to hypoxia and signs of respiratory failure may be difficult to detect. Patients with inadequate ventilation, gas exchange or both require ventilatory support. This usually necessitates intubation and mechanical ventilation although in some patient’s gas exchange and oxygenation can be improved by the application of continuous positive airway pressure (CPAP) by face mask or non-invasive ventilation. As per LTHTR sepsis care pathway (2009) high flow oxygen to be given to maintain a target of >94% using a non rebreath mask. Oxygen to be reduced when patient stable. In critically ill patients, high concentration oxygen should be administered immediately and this should be recorded afterwards in the patient’s health record (BTS guideline for emergency oxygen use in adult patients 2008).

Tachycardia and hypotension are almost universal findings in the septic patient and result from a number of cardiovascular problems. In early sepsis, and in patients who have been partially or fully fluid resuscitated, the low blood pressure and high heart rate are associated with a high cardiac output and a low peripheral vascular resistance with warm peripheries and bounding pulses. In contrast, patients who have not been significantly resuscitated or have presented late in the course of their illness have a low cardiac output and high systemic vascular resistance. These patients are peripherally cold, sweaty, with weak, thready pulses and they need urgent resuscitation. However resuscitation aims to restore circulating volume, cardiac output and reversal of hypotension (I, Mackenzie 2001).

Initially infuse i/v crystalloid or colloid rapidly guided by the clinical response. The optimal resuscitation fluid however, remains the subject of debate. Fluid resuscitation of severe sepsis may consist of natural or artificial colloids or crystalloids. Fluid challenge should be administered and repeated based on response (increase in blood pressure and urine output) and tolerance (V, Jean-louis 2004). Administering large volumes of fluid to patients with known cardiac disease or myocardial dysfunction related to their acute illness is a problem. Ronco, C et al (2004) argued that it is the quantity of fluid given rather than the type of fluid explaining that more crystalloid is needed to achieve the same effect as colloid but colloids are more expensive and carry their own risks. Adequacy of fluid infusion can be facilitated by repeated fluid challenges in which a pre defined amount of fluid e.g. 250 or 500mls is in fused over a set time. Sherman et al (2007) states that aggressive volume resuscitation and administering broad spectrum antibiotics should be given early to all septic patients using 2-4litres of normal saline. All patients should be monitored closely to see the response to resuscitation (urine output mental status, BP). If the patients blood pressure is <90mmhg or lower than >40mmgh lower than the patients normal BP fluid challenges nacl 0.9% 500ml given over 5-10mins (ALERT 2003). LTHTR Sepsis Care Pathway 2009 states if patient hypotensive give up to 3 boluses of 500ml (0.9% Saline) to maintain MAP>65/systolic 100mmgh. Urinary catheter hourly urine measurements.

Perform investigations to confirm or clarify problems that are clinically evident, or to look for complications that are likely. Bloods including FBC, coagulation screen, U&E, Liver function, Amylase, cardiac enzymes, Glucose, lactate and ABG’s. Other tests may include a blood glucose, ECG and chest x-ray. You may consider sending samples for microbiology to confirm the presence of infection, i.e. blood cultures should be taken, sputum if suspecting chest infection and mid-stream urine (MSU) or catheter specimen of urine f suspecting urine infection. Blood cultures are only to be taken when there is clinical need to do so and not as routine (DOH 2007). Indepth search for the source of sepsis with rapid institution of appropriate antibiotic therapy. Delayed or initially ineffective antibiotic therapy has been shown to be associated with worse prognosis and if it is important that all likely microbial culprits are covered by the empiric antibiotic which can be altered when culture results are available (Ronco, C et al 2004).

Monitoring is not dependent on expensive equipment, but it requires the continuous presence of trained nursing staff. Clear documentation aids the assessment of subtle changes in the patient’s clinical state. Patients with severe SIRS / sepsis should have observations recorded hourly. Record body temperature, pulse, blood pressure, urine output, CVP, respiratory rate and SpO2 (if available). Accurate fluid balance is essential. An accurate Early Warning Score is essential as per LTHTR trust protocol along with every set of observations taken. EWS used widely throughout the trust it acts as an assessment of recognising deterioration in patients an identifies at risk patients. It requires the charting of observations such as systolic BP, HR, RR on a regular basis each is given a score from 0-3 and then added together to give an EWS. This is then used to trigger further assessment of the patient by senior nursing or medical staff and referral to critical care outreach who support nurses at ward level to tackle early detection and treatment to prevent intensive care admissions. Early detection and recognition of a patient that is deteriorating is vital (DOH 2007).

The initial antibiotic prescription is a ‘best guess’, and will depend on the clinical picture of the patient, local patterns of antibiotic resistance and the local availability of antibiotics. It should be broad enough to cover the most likely pathogens, but not so broad as to encourage antibiotic resistance. The advice of a local microbiologist or infectious diseases specialist is valuable. Surviving Sepsis Campaign (2008) states the choice of antibiotics should be guided by the susceptibility of likely pathogens in the community and the hospital, as well as any specific knowledge about the patient, including drug intolerance, underlying disease, the clinical syndrome.  The regimen should cover all likely pathogens since there is little margin for error in critically ill patients. There is ample evidence that failure to initiate appropriate therapy promptly (i.e., therapy that is active against the causative pathogen) has adverse consequences on outcome. Although restricting the use of antibiotics, and particularly broad-spectrum antibiotics, is important for limiting super infection and for decreasing the development of antibiotic resistant pathogens, patients with severe sepsis or septic shock warrant broad-spectrum therapy until the causative organism and its antibiotic susceptibilities are defined. Shermon et al (2007) states that early use has been clearly demonstrated to reduce the mortality in sepsis an if no known source of infection is present then give broad spectrum antibiotic therapy to cover aerobic and anaerobic infections. LTHTR Sepsis Care Pathway (2009) states antibiotics to be given in first hour and all antibiotics to be reviewed after 48hours.

Medical staff have been implicated in the spread of infectious agents between patients. All staff must wash their hands before and after attending to a patient. Equipment should not be shared between patients if possible, but where this is necessary the equipment should be thoroughly cleaned between patients. Staff should protect themselves and their clothes from becoming contaminated with biological material by wearing disposable aprons and gloves. Visitors should be discouraged from moving between patients. Wounds, including drain sites and intravenous cannulae sites, should be inspected, cleaned and dressed at regular intervals. Intravenous cannulae and central lines should be removed as soon as practical. Ensure correct documentation is filled in i.e. Vascular access device tool, wound charts and care plans as per trust protocol.

In conclusion sepsis remains a major cause of morbidity and mortality in hospitals today. Many authors have looked at best practice in the early recognition and treatment of sepsis. It is vital that nurses and clinicians recognise and treat critically ill patients for the best outcome to reduce the risk of deterioration and potential cardiac arrests. NPSA (2007) Recognising and responding appropriately to early signs of deterioration in hospitalised patients. Within LTHTR trust and other trusts there are many policies in ensuring this with the early recognition policy, early warning scores to help assist the staff on recognising the deteriorating patient and sepsis care pathway to assist with the treatment of the deteriorating patient. With the use of these policy’s and the help of critical care outreach teams within the trust early recognition and treatment within the golden hour reduces the morbidity and mortality thus educing admissions into the intensive care unit. It appears that there remains much discussion into which fluid works best during fluid resuscitation. Trust protocols should be followed. Recognition of ‘at risk’ patients can only be achieved by appropriate and timely assessment and monitoring. Nice made key recommendations in patients at risk policy, assessment and monitoring, response, critical care and staff competencies the LTHTR policy ‘Procedure for the timely recognition and response for patients at risk of deterioration’ encompasses these key recommendations. There is no predictive scoring system which gives accurate predictions of outcome for individual patients. Survival from an episode of severe sepsis is dependent the patient’s age, previous health and the time delay before the onset of medical intervention, as well as the appropriateness and quality of medical care. Few countries have limitless resources, and so difficult decisions face all intensive care doctors when deciding between the potential benefits for one critically ill patient and need for provision of healthcare to several less critically ill patients (I, Mackenzie 2001).

Word Count 2008

Define the scope ethical issue.

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Define the scope ethical issue.

the ethical issue is Short hospital stay post-mastectomy or other radical surgery
1. Define the scope ethical issue.
2. Examine the scope of the issue as it relates to nursing and principles identified in codes of ethics.
3. Identify at least two positions taken on this issue by scholarly experts in the ethics discipline.
4. Explore the future for the issue as it relates to nursing practice.

What Is Considered Normal And Abnormal Types Of Cognitions And Behaviors What Does The Bible Say About Abnormal Or Deviant Behavior How Does The BibleS Directives Differ From What Is Currently Considered Normal Or Abnormal In Your Culture Or En

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  After reading Chapter 1-2 which is attached, discuss the concept of “abnormality” from a Biblical perspective. What is considered “normal” and “abnormal” types of cognitions and behaviors? What does the Bible say about abnormal or deviant behavior? How does the Bible’s directives differ from what is currently considered “normal” or “abnormal” in your culture or environment? How can the Bible’s teachings inform a person’s concept of abnormality? Integrate into your discussion the 4 D’s – Dysfunction, Distress, Deviance, and Dangerousness. 

Cite all sources in APA format. Must include a Bible verse and application and 1 outside source cited in APA format (in at least 200–250 words). Must Utilize at least 1 journal or book reference (besides the course textbook), cited in current APA format. Be sure your references are scholarly, peer-reviewed, book or journal articles only. Please do not use websites as references of information. Direct quotes will not be counted toward the word count. Also, must include a Bible scripture reference within your thread. Include an application of the passage to the topic about which you are writing, and not just a quote with a one-line explanation.