Nursing

Nursing (27)

Wednesday, 12 July 2017 09:22

Parent Training Plan

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Parent Training Plan

Sensory/Motor Processing Disorder

Sensory integration dysfunction describes the inability of a child to process information that is communicated by the various body senses. The sensory processing disorders get classified into three categories namely sensory modulation disorder, sensory discrimination disorders and sensory-based motor disorder (Curtin, Molineux & Webb, 2009). Modulation is the brain’s regulation of own activity, in which a child may have sensory difficulty due to over-responsiveness or under-responsiveness. Children suffering from sensory-based motor disorder have a hard time navigating the world. Sensory discrimination disorder refers to the difficulty in discerning and assigning meaning to qualities of certain sensory stimuli, improper recognition, and interpretation of essential characteristics of sensory stimuli and poor detection of similarities or differences in qualities of stimuli. This section describes various types of sensory/motor processing disorders namely tactile, vestibular, proprioceptive, visual, and auditory.
Tactile
The tactile system is crucial in determining the mental, physical and emotional human behavior. Tactile stimulation is important for all people regardless of the age as it assists to keep us organized and to function. Tactile information is acquired through sensory receiving cells known as receptors inside our skin from head to toe. Any touch sensation of movement, pressure, temperature, vibration, and pain results in activation of tactile receptors.
Examples of behaviors when a child’s system has sensory under-responsiveness to tactile sense include the failure to react to tactile experiences such as injuries, being unaware of a dirty face and wet clothes and the constant touching of objects and people. When a child has over-responsiveness, they may experience tactile behaviors such as poor hygiene because of disliking the feel of water or a washcloth, Perceiving a simple touch as a threat, tags in clothing seem like needles piercing one’s skin and limited participation in art activities. Tactile discrimination experiences include poor fine motor skills, high pain tolerance, difficulty locating or naming items when one’s eyes are closed, the frequent dropping of items and poor speech articulation.
Family friendly activities to support the development of tactile sensory disorder
 Rubbing lotion on neck, arms, and legs using firm pressure
 Rubbing the skin briskly with a towel and wrap tightly in a towel for deep pressure after bath
 Carrying out sandwich activities such as placing the child in between couch cushions or mat and providing even pressure down onto their skin
 Doing art projects using different textures that include cotton balls, feathers, and foam
 Use of vibrating toys such as vibrating bug and bumble ball
Vestibular
The vestibular sense informs people of where their heads and bodies are concerning the earth’s surface. The system takes in sensory information about balance and movement from the eyes, neck, and body; then sends these messages to the central nervous system for processing and then assists in generating muscle tone that enables smooth and efficient movement (Wiener, Welsh & Blasch, 2010). An individual knows whether they are moving or standing still and whether objects are in motion or motionless concerning their bodies through communication by the vestibular system.
Vestibular dysfunction is associated with difficulties in processing language. Over-responsiveness in a child causes vestibular problems such as experiences of carsickness and avoidance of physical activities. Sensory under-responsiveness is linked to vestibular experiences such as failure to notice when one is being moved, failure to register movements effectively enough to decipher when one is dizzy and inability to notice when one is falling leading to decreased protective responses. Children who are sensory seeking may exhibit vestibular experiences such as the often love to spin and rock commonly known as roller coaster enthusiasts. Children who have vestibular-based discrimination have poor awareness of the body in space and failure to find out when they are falling.
Family friendly activities to support the development of vestibular sensory disorder
 Log rolling on flat surfaces or up and down an incline
 Blanket rides with the child pulling themselves towards the parents using a jump or other rope
 Therapy ball-bouncing on it in various positions, rolling over the ball on stomach or back with supervision
 Jumping up and down on a mini-trampoline
 Movement on swings with the child’s body placed in different positions and providing both linear and rotary input
Proprioceptive
Proprioception is the sensory information that informs us concerning own movement or the body position. The proprioceptive sense provides intake that assists in integrating touch and movement sensations. The receptors of the proprioceptive sense include muscles joint, tendons, ligaments as well as connective tissue and get activated by compression, elongation or traction (Ayres & Robbins, 2005). The proprioception plays a significant role in increasing body awareness, contributing to motor control and motor planning (praxis) as well as helps with body expression, the ability of a person to move their body parts economically and efficiently.
Proprioceptive Dysfunction refers to the inefficient processing of sensations perceived through the tendons, ligaments, muscles, connective tissue and joints. A child with poor proprioception experiences difficulty in interpreting sensations about the position as well as the head and limb motions. A child will have a poor sense of body awareness and body position. Proprioceptive discrimination is associated with experiences such as being rough with peers, clumsier as compared to peers of the same age, having difficulty using the correct force when picking up objects and also frequent pumping into objects. Children who have sensory seeking exhibit proprioception experiences such as bumping or crashing into and throwing themselves into furniture and may also be wearing tight clothing. Children who have over-responsiveness exhibit proprioception experiences such as distress caused by the necessity to move and avoidance of tight hugs or steps.
Family friendly activities to support the development of proprioceptive sensory disorder
 Allowing the child to climb/hang on things that include monkey bars, rock walls, climbing ropes and hanging rings
 Carrying, pushing and pulling objects such as stacking or moving chairs/books and riding a bike as it creates a calming sensation
 Playing games such as Twister and animal walks
 Playing with fidget toys such as play-doh, rubber bands, and stress relief balls
 Use of resistive surfaces such as sidewalk chalk on the driveway.
Visual
Vision is essential in the sensorimotor development of young children. Together with the vestibular and proprioceptive systems, it is responsible for providing feedback mechanism through which children develops, refine, self-monitor and integrate sensorimotor skills into daily functioning. When observing a baby who is sighted or who has low vision, it is easy to see the role the vision plays in the facilitation of sensorimotor development. It is the role of vision to stimulate, guide and verify an infant’s interactions with the environment.
Children with sensory over-responsiveness may experience visual related challenges such as distress caused by fluorescent lights, sensitivity to colors and also stress as result of flashing lights. Sensory under-responsiveness is associated with visual experiences such as staring into bright light, lining up toys/objects and also being overly drawn to spinning or stimulating objects.
Family friendly activities to support the development of visual sensory disorder
 Avoid sunlight and any other bright light by wearing sunglasses or hat inside and outside.
 The child may get motion sickness from too much visual input
 Avoid participation in activities with too many children as the children moving around stimulates the visual system
 Allow child to take frequent breaks so as to avoid eye strain and enhance focus
 Optometric vision therapy that involves eyes exercises
Auditory
Auditory processing disorder entails of the presence of normal hearing and the brain difficulty in interpreting what it hears.
Children with sensory over-responsiveness may experience auditory-related challenges such as voices seeming to be louder, may get bothered by high pitched sounds and frequencies and may get startled by unexpected sounds including doors slamming. Sensory under-responsiveness causes auditory problems such as failure to respond to noised or to call a person’s name and also may speak loudly.
Family friendly activities to support the development of auditory sensory disorder
 Engage child in finger plays, songs, and rhymes
 During play with the child, model and also encourage utilization of environmental and animal sounds
 Promote the use of sign language and gestures so as to facilitate the child’s attempts at communication
 Label items in the child’s environment as they expand their vocabulary
 Encourage the child to imitate facial expressions and movements with lips and tongue in a mirror.
Personal Reflection
Children who have sensory/motor processing disorders usually face a broad range of challenges because they are misunderstood, misguided, misdiagnosed and frustrated. Children with these disorders that include tactile, vestibular, proprioceptive, visual, and auditory can be helped and supported through different interventions and strategies. Parents can keep data about the child’s progress with an individual intervention/strategy by observing the improvements of the child’s condition. Parents play a crucial role in enabling the success of an intervention/strategy in managing a child’s condition; thus it is essential to develop a proper plan and assess its outcome frequently. Parent training enables parents to understand their children conditions and how to deal with them.

References
Ayres, A. J., & Robbins, J. (2005). Sensory integration and the child: Understanding hidden sensory challenges. Western Psychological Services.
Curtin, M., Molineux, M., & Webb, J. A. (2009). Occupational Therapy and Physical Dysfunction E-Book: Enabling Occupation. Elsevier Health Sciences.
Wiener, W. R., Welsh, R. L., & Blasch, B. B. (2010). Foundations of orientation and mobility (Vol. 1). American Foundation for the Blind.

Tuesday, 21 February 2017 06:23

Comprehensive Patient Assessment

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Comprehensive Patient Assessment


General Patient Information

• ML is a preparatory class teacher aged 56 years. She is of Hispanic origin, having been born and brought up by her Hispanic parents who moved to California in the early 30s. Mary is married and has two children, a son and a daughter who are in their teenage years.
• Source: the patient was her source and her reliability being fair



Current health status
• ML has been complaining of exacerbation of her back pain that has indicated an escalation within the last two weeks. Within the last few weeks, she has relied on a borrowed wheel chair to use around the house due to the pain. According to her, it starts as an aching pain that becomes sharp with a form of movement. The pain according to her gets worse if she spends long durations sitting and is normally relieved whenever she leans forward. Occasionally the pain radiates around her legs. The patient has a degenerative joint disease as well as spinal stenosis, indicating that she fell severally in her younger years, from where the pain started. The use of Lumbar x-rays and MRI in the WebCIS have indicated that there is the presence of severe spondylosis with the foraminal and central canal narrowing about the degenerative variations.



• ML has additionally reported a sore throat that has been prevalent for the past one week, with white pus in the back of her throat. The patient exhibits a mild cough producing clear sputum that has not subsided but does not have major dyspnea. The patient additionally says that the pain is mostly felt on her left side that she believes around her 8th rib space. She further says that she recorded a fever of more than 100 degrees Fahrenheit the previous week but negates any of the other constitutional symptoms as chills, night sweat or being afebrile. The ML has additionally denied having nausea, excessive fatigue, dysphagia, drooling or vomiting. ML has not taken any medication that was meant to relieve pain although she asserts that she has been improving over the past three days.
• ML had her menstrual cycle two years ago and reported that it was normal as the others that had passed. The pain in her back and sore throat has affected her sexual life over the past month; an attribute she believes has been affecting her husband also. Overall, ML asserts that she has always been satisfied with their sexual relations until the complications started emerging, making it hard uncomfortable.

Contraception Method
• The patient is neither pregnant, and neither has she been taking oral contraceptive nor any other form of hormone therapy.
Patient History
• ML has been treated for hypertension, allergic rhinitis, depression, tobacco abuse as well as diabetes mellitus 2. She has additionally been treated for GERD and colonial polyps.
• The use of Lumbar X-rays and MRI in the WebCIS have indicated that the presence of severe spondylosis along with central canal and narrowing of the foraminal due to the degenerative changes. She has been standing on a regime of methadone 40mg daily in an attempt to relieve her back pain.
• She had osteomyelitis in her second left toe, s/p amputation in 06/08/15, breast cancer 2004 s/p mastectomy and tamoxifen, left foot cellulitis exhibiting abscess from foreign body 2008 s/p and left medial malleolus fracture 2010.
• Regarding hospitalizations, ML has surgeries and procedures that involved the amputation of the left 2nd toe at disal phalanx, appendectomy in 2003, right mastectomy in 2004 and hysterectomy 2012.
Medications
• Dermotic Oil, 0.01% ear, drops bid
• Docusate Sodium 100mg prn
• Lipitor 80mg po qhs
• Neurontin 300mg, taken 900mg tid
• Mg-oxide 400mg, take 1600mg bid
• Nexium 40mg qd
• Citalopram HBR 40mg takes 1.5tabs qd
• Enalapril 2.5mg qd
• Aspirin 81mg qd
• Kenalog, 0.1% cream, applied bid
• Metformin HCl 850mg tid
• Furosemide 80mg bid
• Lidoderm, 5% patch, applied q12 hrs prn
• Wellbutrin SR 100mg bid
• Detrol LA 4mg qd
• Methadone 20mg
• The assessment of the allergies that the patient exhibits makes it apparent that she is allergic to valdecoxib, Vancomycin, and prednisone

Health Maintenance
• The details relating the maintenance of the patient’s health are not clear. The anticipation is that these records are going to be obtained from her PCP. The moment that her TTP will be treated with the follow up arranged with her PCP and additional screening is to be encouraged.

Family Medical History
• The father is MI at the age of 76, hypertension and is still alive. The mother, on the other hand, has colon cancer, diabetes, and hypertension and is still alive also. The overall assessment of her general family reveals that there have been significant cases of heart disease, stroke, and melanoma as well as breast cancer.
• The patient has been smoking for more than 25 years and is currently smokes two packets a day. She also takes alcohol three times a week.

Gynecologic History
• ML has two children, a son and a daughter who are both in their teens. She has never had any complications in giving birth, and neither has she ever miscarried.
• On the case of sexually transmitted infections, she asserts that she has previously had bacterial infections, with the worst one being herpes while she was in college. She has never contracted either hepatitis A or B viruses and her recent HIV test indicated that she was negative. She used acyclovir (Zovirax) and valacyclovir (Valtrex) in treating in herpes.
• ML’s menarches reveal that she had her last smear test in 2010 and was normal. All the subsequent smear tests have been normal. The 56-year-old patient had a last menstrual period two years ago and denied the presence of any rectal or vaginal bleeding. The assessment of a detailed comparison of her body density evaluation in 2010 against the one in 2016 indicates that there has been a slight decline in the overall bone mineral density at the hip. According to the patient, there was a mammography that was conducted three weeks ago and the results of the study indicated a normal outcome.



Personal Social History
• The patient has been living with her husband in California in an apartment with their two children. With the challenges that ML has been facing the children and her husband have been doing most of the work at home. Hispanic in the region maintains close, and the ties have been vital in the assessment of ML’s condition and seeking medical assistance. The Hispanic community in the region has even offered money assistance through contributions that are meant to assist her to seek specialized medical assistance.
• ML is a university graduate having majored in education and works as a preparatory teacher. The husband, on the other hand, is an IT specialist in of the multinational corporations in California. The although the family has not been experiencing financial difficulties, ML’s condition has made it impossible for her to work, making the husband the sole breadwinner.
• ML indicates that she has never suffered any form of abuse or forced sex from any part throughout her life. Her occupational does not exemplify any major issues that could contribute to her state of health. It, however, follows that the long durations spent supervising her students have been a constant trigger of her back pain.
• The patient asserts that she has been smoking for the greater part of her life and has been taking alcohol constantly, approximately three times a week but asserts that it has never been an issue of concern to her or the immediate family. She further does not engage in any additional exercise other than the normal works she takes in her class as well as the occasional walks around the school compound to check on her students.
• ML denies taking caffeine regularly and that she has been sleeping well before the start of the back pain. Additionally, she asserts that she checks on her diet well, ensuring that the food eaten is mostly organic and a balanced diet.


The Assessment of Systems
• The general assessment of the patient is clear that the patient denies having fatigue, chills fever and decrease in appetite. ML has been sleeping well until the back pains started when she could not sleep due to the pain in her back. She maintained a good PO intake until the previous study when started vomiting.
• Skin: the patient asserts that she does not have any rashes or lesions anywhere on her body
• HEENT: she asserts that she does not exhibit double vision, blurry vision as well as changes to her acuity. She never wears glasses
• The ears: she asserts that she has not recorded any changes top her hearing
• Assessment of the throat, nose/ mouth and teeth follows that the patient confirms to exhibit sore threat with minimal congestion although with pus at the back of her throat. She, however, denies dental pain and rhinorrhea.



• Cardiovascular- ML denies having any cases related to palpitation or chest pain. She further denies having any claudication in the lower extremities.
• Gastrointestinal: there are between 1 and three bowel movements occasioned by constipation that she relieves via the use of docusate sodium. She has not experienced any challenges that are associated with the black or bloody stool. She has additionally not experienced any form of abdominal pain or diarrhea.
• Hematopoietic: the patient indicates that she does not have any issues as excess bleeding or easy bruising.
• Genitourinary: ML indicates that she has been having intermittent urinary incontinence when she takes neurotin but has no dysuria, urgency or any increase in the frequency.
• Psychological and mental health: ML exhibits a normal affect in additional to a behavior that is normal to her stature and health situation.
Physical Exam
• Vital signs: weights 96kg, pulse 55, temp 35.2 degrees Celsius, RR 17, 99% on RA, height 155 cm and BMI 39
• General: a pleasant, healthy looking lady with some distress as a result of her back pain has been quiet and mildly drowsy.
• Skin: the skin does not have rashes or lesions on the upper extremities, the face, chest, back or abdomen.
• Lymph nodes: there were no cervical, periauricular, axillary lymphadenectomy
• Chest: scattered wheezes were heard bilaterally with no rhonchi. The egophony produced “E” sound similarly on all the lobes
• HEENT: no sublingual or scleral icterus, with the oropharynx being clear and mucus being moist. The pupils are round, equal moreover reactive to light.
• Neurologic: sensation and motor grossly intact
• Extremities: no clubbing, cyanosis or edema
• Heart: regular rhythm and rate without murmur gallop or rub


Laboratory Data
• 06/22/16– Na 144, BUN 13, K 5.7, Cl 102, Cr 1.3, BUN/Cr 13, Est GFR 49.02, Mg 1.2, Ca 8.3, P 4.2, AST 36, ALT 37, Anion gap 12
Differential Diagnoses
• The back pain: the back problem has been the major challenge for ML, with the narrowing of the spinal stenosis and foraminal due to the degenerative disease being the core cause of her situation. The alternative causes of the back pain as sprain or strain about the vertebral fracture, lumbar vertebrase, infection, neoplasm or referred pelvic pain being ruled out (Itz, et al., 2013). The assertion is that strain and sprain are accountable for almost 70% of the low back pain although the age-related degenerative changes; disc herniation and spinal stenosis are the subsequent common causes that account for almost 16% of chronic back pain (Pillastrini, et al., 2012). Considering the chronic nature as well as a rate of progress of ML’s disease, degenerative changes along with stenosis and herniation are the most probable causes of the pain.
• The prevailing attribute is that the most effective long term intervention is unclear, with the use of spinal surgery for the lumbar stenosis being fairly a well studied and the challenges considered. In this case, the fact ML has a high surgical risk due to the complications of osteomyelits, hypertension as well as advanced age; she is a poor candidate for surgery. The moderate gain that would be realized from surgery is not worth the risk of operating her. Physical therapy is an additional strategy that would be beneficial to ML in the early investigations and could be adopted for ML in future.
• The management strategy at this point will be on the controlling of the pain that ML has been experiencing. The patient has been on methadone regimen for a long time and has developed an emotional and physical reliance on the drug (Issack, et al., 2012). It is imperative that she continues taking methadone 20mg in the morning, 5gm at lunch, 10mg in the evening and 10 mg before going to bed. The management plan will encompass a careful avoidance of NSAIDs due to the possible side effects it has which include hypertension, diabetes and tobacco abuse (Olsen, et al., (2012). It is additionally necessary that she stays ambulatory with a supporting Walker allowing her to walk with some forward flexion.
• On the case of a sore throat, ML has been afebrile with the HEENT exam not being indicative of any signs of bacterial pharyngitis as exudates or tonsillar swelling. It is additionally evident that the physical exam is not indicative of pneumonia or any other infection that would warrant any form of antibiotic therapy (Balagué, Mannion, Pellisé, & Cedraschi, 2012). Considering the improvements she has noted along with the time course of the compliant, it is most probable that a self-limiting upper respiratory tract infection is the main cause and will not benefit from the use of pharmacotherapy. It is imperative that she contacts her healthcare specialists if symptoms as difficulty in swallowing, high fevers of challenges in breathing and worsening of the symptoms.
• The patient education in the management of the conditions will revolve around ensuring that she moves around more often. Additionally, addressing her alcohol and smoking pattern by reducing if not quitting will additionally be the issues she should take into consideration.
• The follow up care will encompass the ML reporting to the healthcare specialist for checkups on a weekly basis as well as whenever she believes that the symptoms are worsening.



References
Balagué, F., Mannion, A. F., Pellisé, F., & Cedraschi, C. (2012). Non-specific low back pain. The Lancet, 379(9814), 482-491.
Issack, P. S., Cunningham, M. E., Pumberger, M., Hughes, A. P., & Cammisa Jr, F. P. (2012). Degenerative lumbar spinal stenosis: evaluation and management. Journal of the American Academy of Orthopaedic Surgeons, 20(8), 527-535.
Itz, C. J., Geurts, J. W., Kleef, M. V., & Nelemans, P. (2013). Clinical course of non‐specific low back pain: A systematic review of prospective cohort studies set in primary care. European Journal of Pain, 17(1), 5-15.
Olsen, A. M. S., Fosbøl, E. L., Lindhardsen, J., Folke, F., Charlot, M., Selmer, C., ... & Hansen, P. R. (2012). Long-Term Cardiovascular Risk of Nonsteroidal Anti-Inflammatory Drug Use According to Time Passed After First-Time Myocardial Infarction A Nationwide Cohort Study. Circulation, 126(16), 1955-1963.
Pillastrini, P., Gardenghi, I., Bonetti, F., Capra, F., Guccione, A., Mugnai, R., & Violante, F. S. (2012). An updated overview of clinical guidelines for chronic low back pain management in primary care. Joint Bone Spine, 79(2), 176-185.

Tuesday, 21 February 2017 06:19

Hypertensive Disorders of Pregnancy: Preeclampsia

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Hypertensive Disorders of Pregnancy: Preeclampsia



Introduction
The hypertensive disorders of pregnancy are still the leading cause of maternal as well as perinatal morbidity and mortality. The working group that is concerned with High Blood Pressure during Pregnancy lists four categories of hypertension that are common with the women in pregnancy. Those categories include chronic hypertension, preeclampsia, gestation hypertension, and preeclampsia superimposed on chronic hypertension. In case the maternal blood pressure is found to be 140/90 mm Hg or higher on two occasions before the two weeks of gestation shows that there is chronic hypertension. To solve this problem, pharmacologic treatment is necessary as it prevents end-organ damage from the elevated blood pressure. In this article, there is the description of the preeclampsia disorder as one of the hypertensive disorders of pregnancy. Preeclampsia is the scenario when new-onset hypertension with proteinuria develops after 20 weeks of gestation.



Description of Disorder
According to Mammaro and his colleagues (2009), hypertensive disorders of pregnancy are the most common medical complications bedeviling women during pregnancy, and they affect 6 to 8 percent of women in the United States. Preeclampsia is one of those disorders, and it is a multiorgan disease process whose etiology is unknown, and its symptoms are hypertension and proteinuria that show up after 20 weeks or pregnancy. There are numerous theories of the pathogenesis of this disease the most common theory being immunologic. In a normal pregnancy, fetal syncytial trophoblasts are known to penetrate and even remodel the maternal spiral arteries thereby causing them to dilate and become flaccid. That remodeling accommodates the increased maternal circulation that is in required to ensure enough placental perfusion. That remodeling is however prevented in preeclamptic pregnancies whereby the placental cannot properly burrow into the maternal blood vessels resulting in intrauterine growth limitation and other fetal signs of disorder.

Studies have shown that the incomplete placentation results from maternal immunologic intolerance of some foreign genes of the fetus. The evidence supporting this theory is that preeclampsia is highly common during first pregnancies and it reduces as the length of time a woman lives with the father before she becomes pregnant decreases. Additionally, the risk of this disorder is also increased in the multiparous women who become pregnant by new partners. The other theories that support the pathogenesis of this disorder include angiogenic factors, cardiovascular maladaptation and vasoconstriction, platelet activation, genetic predisposition, and vascular endothelial damage. There are various factors associated with preeclampsia including antiphospholipid antibody syndrome, elevated body mass index, multiple gestations, nulliparity, and chronic hypertension, maternal age above 40 years, chronic renal disease, and pregestational diabetes mellitus.

Current Best Practices for Assessing and Managing Preeclampsia
The blood pressure of the women ought to be measured at every prenatal visit using a suitably sized cuff while the patient is in a seated position. The criterion for diagnosing a preeclampsia patient is performing systolic blood pressure or not less than 140 mm Hg or doing a diastolic blood pressure or not less than 90 mm Hg on two occasions of six hours or more apart. Preeclampsia is characterized by a mild or severe conditions based on the degree of hypertension or proteinuria as well as the presence of symptoms that result from the participation of the kidneys, liver, brain, and the cardiovascular system. Impending eclampsia can also be signaled by visual disturbances, hyperreflexia, and severe headache.

The mainstream for the treatment of preeclampsia is detecting it early enough and managing the delivery with the intention of minimizing both the maternal as well as the fetal risks. In case the gestation is at term, the baby should be delivered minus any problem. The decision for delivery involves the balancing of risks that can worsen preeclampsia against those of prematurity. Mammaro et al. (2009) also suggest the use of Magnesium sulfate as the drug of choice for the prevention and arrest of eclamptic seizures. That is because this drug has the additional advantage of reducing the progress of placental abruption. They also suggest the monitoring of the levels of serum Magnesium in the women with elevated levels of serum creatinine, decreased urine output, or absence of deep tendon reflexes. Lastly, intravenous hydration for oliguria should be administered cautiously so as to avoid pulmonary edema, cardiopulmonary overload, and ascites.

Comparison of the Best Practices Presented in the WHI Study and the Current Best Practices
Both the WHI and the article agree on the screening of women right from early pregnancy so as or identify the clinical risk markers. However, the WHI article suggests that there should be consultation with an obstetrician where necessary for those women with a history of previous preeclampsia markers and other strong clinical conditions like multiple pregnancies, significant proteinuria, antiphospholipid antibody syndrome at first antennal visit, the existence of a renal disease, or a preexisting condition of hypertension. These are symptoms that are also listed as the current best practices from the reference article. Both articles also reject the use of biomarkers or Doppler ultrasound velocimetry for women at mild or increased risk of preeclampsia except if that screening has been proven to improve outcome.

The differences in the best practices can greatly impact the health of pregnant women, and that can be fatal since they are the crucial time of their health. At this point is when women require being closely monitoring and assisting as appropriate because any disorder can lead to the death of the mother or the child, and in worst cases both the mother and the fetus may die. What was being considered as a best practice in the past may not work today since things do change and new ways of doing things are discovered from intense research. It is therefore of the paramount essence to make sure that the different researchers collaborate to determine the current best practices for the benefit of the women who are the victims of this disorder.
Whether the Current Best Practices should be used

According to me, the current best practices should be used in clinical practice because they have been thoroughly tested and proved to be working well. They are also supported by other researchers like Leeman and Fontaine (2008), Peters and Flack (2004), Zareian (2004), Marik (2009), and Shah (2007) among other researchers in the medical field. These best practices should also be applied because they are a result of intensive research with the collaboration of more than five renowned medical researchers who also compared their findings with other reliable sources from the relevant field.

Conclusion
Having a blood pressure that is higher than the normal in pregnant women can be very dangerous to not only the mother but also to the fetus. Therefore, it is crucial that they are diagnosed earlier and monitored for any deviations of the blood pressure from the normal so that they can be helped to prevent or properly manage preeclampsia. If not correctly monitored and managed, the impacts of high blood pressure can harm the kidneys and other internal organs of the pregnant mother and even result in low birth weight and even early delivery.

References
Leeman, L., & Fontaine, P. (2008). Hypertensive disorders of pregnancy. American family physician, 78(1).
Mammaro, A., Carrara, S., Cavaliere, A., Ermito, S., Dinatale, A., Pappalardo, E. M., … Pedata, R. (2009). Hypertensive Disorders of Pregnancy. Journal of Prenatal Medicine, 3(1), 1–5.
Marik, P. E. (2009). Hypertensive disorders of pregnancy. Postgraduate medicine, 121(2), 69-76.
Peters, R. M., & Flack, J. M. (2004). Hypertensive disorders of pregnancy. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 33(2), 209-220.
Zareian, Z. (2004). Hypertensive disorders of pregnancy. International Journal of Gynecology & Obstetrics, 87(2), 194-198.

Wednesday, 08 February 2017 16:29

Comprehensive Patient Assessment

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Comprehensive Patient Assessment
Name
Course
Course instructor
Date

General Patient Information
• ML is a preparatory class teacher aged 56 years. She is of Hispanic origin, having been born and brought up by her Hispanic parents who moved to California in the early 30s. Mary is married and has two children, a son and a daughter who are in their teenage years.
• Source: the patient was her source and her reliability being fair
Current health status
• ML has been complaining of exacerbation of her back pain that has indicated an escalation within the last two weeks. Within the last few weeks, she has relied on a borrowed wheel chair to use around the house due to the pain. According to her, it starts as an aching pain that becomes sharp with a form of movement. The pain according to her gets worse if she spends long durations sitting and is normally relieved whenever she leans forward. Occasionally the pain radiates around her legs. The patient has a degenerative joint disease as well as spinal stenosis, indicating that she fell severally in her younger years, from where the pain started. The use of Lumbar x-rays and MRI in the WebCIS have indicated that there is the presence of severe spondylosis with the foraminal and central canal narrowing about the degenerative variations.
• ML has additionally reported a sore throat that has been prevalent for the past one week, with white pus in the back of her throat. The patient exhibits a mild cough producing clear sputum that has not subsided but does not have major dyspnea. The patient additionally says that the pain is mostly felt on her left side that she believes around her 8th rib space. She further says that she recorded a fever of more than 100 degrees Fahrenheit the previous week but negates any of the other constitutional symptoms as chills, night sweat or being afebrile. The ML has additionally denied having nausea, excessive fatigue, dysphagia, drooling or vomiting. ML has not taken any medication that was meant to relieve pain although she asserts that she has been improving over the past three days.
• ML had her menstrual cycle two years ago and reported that it was normal as the others that had passed. The pain in her back and sore throat has affected her sexual life over the past month; an attribute she believes has been affecting her husband also. Overall, ML asserts that she has always been satisfied with their sexual relations until the complications started emerging, making it hard uncomfortable.
Contraception Method
• The patient is neither pregnant, and neither has she been taking oral contraceptive nor any other form of hormone therapy.
Patient History
• ML has been treated for hypertension, allergic rhinitis, depression, tobacco abuse as well as diabetes mellitus 2. She has additionally been treated for GERD and colonial polyps.
• The use of Lumbar X-rays and MRI in the WebCIS have indicated that the presence of severe spondylosis along with central canal and narrowing of the foraminal due to the degenerative changes. She has been standing on a regime of methadone 40mg daily in an attempt to relieve her back pain.
• She had osteomyelitis in her second left toe, s/p amputation in 06/08/15, breast cancer 2004 s/p mastectomy and tamoxifen, left foot cellulitis exhibiting abscess from foreign body 2008 s/p and left medial malleolus fracture 2010.
• Regarding hospitalizations, ML has surgeries and procedures that involved the amputation of the left 2nd toe at disal phalanx, appendectomy in 2003, right mastectomy in 2004 and hysterectomy 2012.
Medications
• Dermotic Oil, 0.01% ear, drops bid
• Docusate Sodium 100mg prn
• Lipitor 80mg po qhs
• Neurontin 300mg, taken 900mg tid
• Mg-oxide 400mg, take 1600mg bid
• Nexium 40mg qd
• Citalopram HBR 40mg takes 1.5tabs qd
• Enalapril 2.5mg qd
• Aspirin 81mg qd
• Kenalog, 0.1% cream, applied bid
• Metformin HCl 850mg tid
• Furosemide 80mg bid
• Lidoderm, 5% patch, applied q12 hrs prn
• Wellbutrin SR 100mg bid
• Detrol LA 4mg qd
• Methadone 20mg
• The assessment of the allergies that the patient exhibits makes it apparent that she is allergic to valdecoxib, Vancomycin, and prednisone
Health Maintenance
• The details relating the maintenance of the patient’s health are not clear. The anticipation is that these records are going to be obtained from her PCP. The moment that her TTP will be treated with the follow up arranged with her PCP and additional screening is to be encouraged.
Family Medical History
• The father is MI at the age of 76, hypertension and is still alive. The mother, on the other hand, has colon cancer, diabetes, and hypertension and is still alive also. The overall assessment of her general family reveals that there have been significant cases of heart disease, stroke, and melanoma as well as breast cancer.
• The patient has been smoking for more than 25 years and is currently smokes two packets a day. She also takes alcohol three times a week.

Gynecologic History
• ML has two children, a son and a daughter who are both in their teens. She has never had any complications in giving birth, and neither has she ever miscarried.
• On the case of sexually transmitted infections, she asserts that she has previously had bacterial infections, with the worst one being herpes while she was in college. She has never contracted either hepatitis A or B viruses and her recent HIV test indicated that she was negative. She used acyclovir (Zovirax) and valacyclovir (Valtrex) in treating in herpes.
• ML’s menarches reveal that she had her last smear test in 2010 and was normal. All the subsequent smear tests have been normal. The 56-year-old patient had a last menstrual period two years ago and denied the presence of any rectal or vaginal bleeding. The assessment of a detailed comparison of her body density evaluation in 2010 against the one in 2016 indicates that there has been a slight decline in the overall bone mineral density at the hip. According to the patient, there was a mammography that was conducted three weeks ago and the results of the study indicated a normal outcome.
Personal Social History
• The patient has been living with her husband in California in an apartment with their two children. With the challenges that ML has been facing the children and her husband have been doing most of the work at home. Hispanic in the region maintains close, and the ties have been vital in the assessment of ML’s condition and seeking medical assistance. The Hispanic community in the region has even offered money assistance through contributions that are meant to assist her to seek specialized medical assistance.
• ML is a university graduate having majored in education and works as a preparatory teacher. The husband, on the other hand, is an IT specialist in of the multinational corporations in California. The although the family has not been experiencing financial difficulties, ML’s condition has made it impossible for her to work, making the husband the sole breadwinner.
• ML indicates that she has never suffered any form of abuse or forced sex from any part throughout her life. Her occupational does not exemplify any major issues that could contribute to her state of health. It, however, follows that the long durations spent supervising her students have been a constant trigger of her back pain.
• The patient asserts that she has been smoking for the greater part of her life and has been taking alcohol constantly, approximately three times a week but asserts that it has never been an issue of concern to her or the immediate family. She further does not engage in any additional exercise other than the normal works she takes in her class as well as the occasional walks around the school compound to check on her students.
• ML denies taking caffeine regularly and that she has been sleeping well before the start of the back pain. Additionally, she asserts that she checks on her diet well, ensuring that the food eaten is mostly organic and a balanced diet.

The Assessment of Systems
• The general assessment of the patient is clear that the patient denies having fatigue, chills fever and decrease in appetite. ML has been sleeping well until the back pains started when she could not sleep due to the pain in her back. She maintained a good PO intake until the previous study when started vomiting.
• Skin: the patient asserts that she does not have any rashes or lesions anywhere on her body
• HEENT: she asserts that she does not exhibit double vision, blurry vision as well as changes to her acuity. She never wears glasses
• The ears: she asserts that she has not recorded any changes top her hearing
• Assessment of the throat, nose/ mouth and teeth follows that the patient confirms to exhibit sore threat with minimal congestion although with pus at the back of her throat. She, however, denies dental pain and rhinorrhea.
• Cardiovascular- ML denies having any cases related to palpitation or chest pain. She further denies having any claudication in the lower extremities.
• Gastrointestinal: there are between 1 and three bowel movements occasioned by constipation that she relieves via the use of docusate sodium. She has not experienced any challenges that are associated with the black or bloody stool. She has additionally not experienced any form of abdominal pain or diarrhea.
• Hematopoietic: the patient indicates that she does not have any issues as excess bleeding or easy bruising.
• Genitourinary: ML indicates that she has been having intermittent urinary incontinence when she takes neurotin but has no dysuria, urgency or any increase in the frequency.
• Psychological and mental health: ML exhibits a normal affect in additional to a behavior that is normal to her stature and health situation.
Physical Exam
• Vital signs: weights 96kg, pulse 55, temp 35.2 degrees Celsius, RR 17, 99% on RA, height 155 cm and BMI 39
• General: a pleasant, healthy looking lady with some distress as a result of her back pain has been quiet and mildly drowsy.
• Skin: the skin does not have rashes or lesions on the upper extremities, the face, chest, back or abdomen.
• Lymph nodes: there were no cervical, periauricular, axillary lymphadenectomy
• Chest: scattered wheezes were heard bilaterally with no rhonchi. The egophony produced “E” sound similarly on all the lobes
• HEENT: no sublingual or scleral icterus, with the oropharynx being clear and mucus being moist. The pupils are round, equal moreover reactive to light.
• Neurologic: sensation and motor grossly intact
• Extremities: no clubbing, cyanosis or edema
• Heart: regular rhythm and rate without murmur gallop or rub

Laboratory Data
• 06/22/16– Na 144, BUN 13, K 5.7, Cl 102, Cr 1.3, BUN/Cr 13, Est GFR 49.02, Mg 1.2, Ca 8.3, P 4.2, AST 36, ALT 37, Anion gap 12
Differential Diagnoses
1. The back pain: the back problem has been the major challenge for ML, with the narrowing of the spinal stenosis and foraminal due to the degenerative disease being the core cause of her situation. The alternative causes of the back pain as sprain or strain about the vertebral fracture, lumbar vertebrase, infection, neoplasm or referred pelvic pain being ruled out (Itz, et al., 2013). The assertion is that strain and sprain are accountable for almost 70% of the low back pain although the age-related degenerative changes; disc herniation and spinal stenosis are the subsequent common causes that account for almost 16% of chronic back pain (Pillastrini, et al., 2012).
a) Considering the chronic nature as well as a rate of progress of ML’s disease, degenerative changes along with stenosis and herniation are the most probable causes of the pain.
b) The prevailing attribute is that the most effective long term intervention is unclear, with the use of spinal surgery for the lumbar stenosis being fairly a well studied and the challenges considered. In this case, the fact ML has a high surgical risk due to the complications of osteomyelits, hypertension as well as advanced age; she is a poor candidate for surgery. The moderate gain that would be realized from surgery is not worth the risk of operating her.
c) Physical therapy is an additional strategy that would be beneficial to ML in the early investigations and could be adopted for ML in future.
d) The management strategy at this point will be on the controlling of the pain that ML has been experiencing. The patient has been on methadone regimen for a long time and has developed an emotional and physical reliance on the drug (Issack, et al., 2012). It is imperative that she continues taking methadone 20mg in the morning, 5gm at lunch, 10mg in the evening and 10 mg before going to bed. The management plan will encompass a careful avoidance of NSAIDs due to the possible side effects it has which include hypertension, diabetes and tobacco abuse (Olsen, et al., (2012). It is additionally necessary that she stays ambulatory with a supporting Walker allowing her to walk with some forward flexion.
• On the case of a sore throat, ML has been afebrile with the HEENT exam not being indicative of any signs of bacterial pharyngitis as exudates or tonsillar swelling. It is additionally evident that the physical exam is not indicative of pneumonia or any other infection that would warrant any form of antibiotic therapy (Balagué, Mannion, Pellisé, & Cedraschi, 2012).
• Considering the improvements she has noted along with the time course of the compliant, it is most probable that a self-limiting upper respiratory tract infection is the main cause and will not benefit from the use of pharmacotherapy. It is imperative that she contacts her healthcare specialists if symptoms as difficulty in swallowing, high fevers of challenges in breathing and worsening of the symptoms.
• The patient education in the management of the conditions will revolve around ensuring that she moves around more often. Additionally, addressing her alcohol and smoking pattern by reducing if not quitting will additionally be the issues she should take into consideration.
• The follow up care will encompass the ML reporting to the healthcare specialist for checkups on a weekly basis as well as whenever she believes that the symptoms are worsening.


References
Balagué, F., Mannion, A. F., Pellisé, F., & Cedraschi, C. (2012). Non-specific low back pain. The Lancet, 379(9814), 482-491.
Issack, P. S., Cunningham, M. E., Pumberger, M., Hughes, A. P., & Cammisa Jr, F. P. (2012). Degenerative lumbar spinal stenosis: evaluation and management. Journal of the American Academy of Orthopaedic Surgeons, 20(8), 527-535.
Itz, C. J., Geurts, J. W., Kleef, M. V., & Nelemans, P. (2013). Clinical course of non‐specific low back pain: A systematic review of prospective cohort studies set in primary care. European Journal of Pain, 17(1), 5-15.
Olsen, A. M. S., Fosbøl, E. L., Lindhardsen, J., Folke, F., Charlot, M., Selmer, C., ... & Hansen, P. R. (2012). Long-Term Cardiovascular Risk of Nonsteroidal Anti-Inflammatory Drug Use According to Time Passed After First-Time Myocardial Infarction A Nationwide Cohort Study. Circulation, 126(16), 1955-1963.
Pillastrini, P., Gardenghi, I., Bonetti, F., Capra, F., Guccione, A., Mugnai, R., & Violante, F. S. (2012). An updated overview of clinical guidelines for chronic low back pain management in primary care. Joint Bone Spine, 79(2), 176-185.

Wednesday, 08 February 2017 16:28

Hypertensive Disorders of Pregnancy: Preeclampsia

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Assignment 1: Application – Best Practices
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Course
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Hypertensive Disorders of Pregnancy: Preeclampsia
Introduction
The hypertensive disorders of pregnancy are still the leading cause of maternal as well as perinatal morbidity and mortality. The working group that is concerned with High Blood Pressure during Pregnancy lists four categories of hypertension that are common with the women in pregnancy. Those categories include chronic hypertension, preeclampsia, gestation hypertension, and preeclampsia superimposed on chronic hypertension. In case the maternal blood pressure is found to be 140/90 mm Hg or higher on two occasions before the two weeks of gestation shows that there is chronic hypertension. To solve this problem, pharmacologic treatment is necessary as it prevents end-organ damage from the elevated blood pressure. In this article, there is the description of the preeclampsia disorder as one of the hypertensive disorders of pregnancy. Preeclampsia is the scenario when new-onset hypertension with proteinuria develops after 20 weeks of gestation.
Description of Disorder
According to Mammaro and his colleagues (2009), hypertensive disorders of pregnancy are the most common medical complications bedeviling women during pregnancy, and they affect 6 to 8 percent of women in the United States. Preeclampsia is one of those disorders, and it is a multiorgan disease process whose etiology is unknown, and its symptoms are hypertension and proteinuria that show up after 20 weeks or pregnancy. There are numerous theories of the pathogenesis of this disease the most common theory being immunologic. In a normal pregnancy, fetal syncytial trophoblasts are known to penetrate and even remodel the maternal spiral arteries thereby causing them to dilate and become flaccid. That remodeling accommodates the increased maternal circulation that is in required to ensure enough placental perfusion. That remodeling is however prevented in preeclamptic pregnancies whereby the placental cannot properly burrow into the maternal blood vessels resulting in intrauterine growth limitation and other fetal signs of disorder.
Studies have shown that the incomplete placentation results from maternal immunologic intolerance of some foreign genes of the fetus. The evidence supporting this theory is that preeclampsia is highly common during first pregnancies and it reduces as the length of time a woman lives with the father before she becomes pregnant decreases. Additionally, the risk of this disorder is also increased in the multiparous women who become pregnant by new partners. The other theories that support the pathogenesis of this disorder include angiogenic factors, cardiovascular maladaptation and vasoconstriction, platelet activation, genetic predisposition, and vascular endothelial damage. There are various factors associated with preeclampsia including antiphospholipid antibody syndrome, elevated body mass index, multiple gestations, nulliparity, and chronic hypertension, maternal age above 40 years, chronic renal disease, and pregestational diabetes mellitus.
Current Best Practices for Assessing and Managing Preeclampsia
The blood pressure of the women ought to be measured at every prenatal visit using a suitably sized cuff while the patient is in a seated position. The criterion for diagnosing a preeclampsia patient is performing systolic blood pressure or not less than 140 mm Hg or doing a diastolic blood pressure or not less than 90 mm Hg on two occasions of six hours or more apart. Preeclampsia is characterized by a mild or severe conditions based on the degree of hypertension or proteinuria as well as the presence of symptoms that result from the participation of the kidneys, liver, brain, and the cardiovascular system. Impending eclampsia can also be signaled by visual disturbances, hyperreflexia, and severe headache.
The mainstream for the treatment of preeclampsia is detecting it early enough and managing the delivery with the intention of minimizing both the maternal as well as the fetal risks. In case the gestation is at term, the baby should be delivered minus any problem. The decision for delivery involves the balancing of risks that can worsen preeclampsia against those of prematurity. Mammaro et al. (2009) also suggest the use of Magnesium sulfate as the drug of choice for the prevention and arrest of eclamptic seizures. That is because this drug has the additional advantage of reducing the progress of placental abruption. They also suggest the monitoring of the levels of serum Magnesium in the women with elevated levels of serum creatinine, decreased urine output, or absence of deep tendon reflexes. Lastly, intravenous hydration for oliguria should be administered cautiously so as to avoid pulmonary edema, cardiopulmonary overload, and ascites.
Comparison of the Best Practices Presented in the WHI Study and the Current Best Practices
Both the WHI and the article agree on the screening of women right from early pregnancy so as or identify the clinical risk markers. However, the WHI article suggests that there should be consultation with an obstetrician where necessary for those women with a history of previous preeclampsia markers and other strong clinical conditions like multiple pregnancies, significant proteinuria, antiphospholipid antibody syndrome at first antennal visit, the existence of a renal disease, or a preexisting condition of hypertension. These are symptoms that are also listed as the current best practices from the reference article. Both articles also reject the use of biomarkers or Doppler ultrasound velocimetry for women at mild or increased risk of preeclampsia except if that screening has been proven to improve outcome.
The differences in the best practices can greatly impact the health of pregnant women, and that can be fatal since they are the crucial time of their health. At this point is when women require being closely monitoring and assisting as appropriate because any disorder can lead to the death of the mother or the child, and in worst cases both the mother and the fetus may die. What was being considered as a best practice in the past may not work today since things do change and new ways of doing things are discovered from intense research. It is therefore of the paramount essence to make sure that the different researchers collaborate to determine the current best practices for the benefit of the women who are the victims of this disorder.
Whether the Current Best Practices should be used
According to me, the current best practices should be used in clinical practice because they have been thoroughly tested and proved to be working well. They are also supported by other researchers like Leeman and Fontaine (2008), Peters and Flack (2004), Zareian (2004), Marik (2009), and Shah (2007) among other researchers in the medical field. These best practices should also be applied because they are a result of intensive research with the collaboration of more than five renowned medical researchers who also compared their findings with other reliable sources from the relevant field.
Conclusion
Having a blood pressure that is higher than the normal in pregnant women can be very dangerous to not only the mother but also to the fetus. Therefore, it is crucial that they are diagnosed earlier and monitored for any deviations of the blood pressure from the normal so that they can be helped to prevent or properly manage preeclampsia. If not correctly monitored and managed, the impacts of high blood pressure can harm the kidneys and other internal organs of the pregnant mother and even result in low birth weight and even early delivery.
References
Leeman, L., & Fontaine, P. (2008). Hypertensive disorders of pregnancy. American family physician, 78(1).
Mammaro, A., Carrara, S., Cavaliere, A., Ermito, S., Dinatale, A., Pappalardo, E. M., … Pedata, R. (2009). Hypertensive Disorders of Pregnancy. Journal of Prenatal Medicine, 3(1), 1–5.
Marik, P. E. (2009). Hypertensive disorders of pregnancy. Postgraduate medicine, 121(2), 69-76.
Peters, R. M., & Flack, J. M. (2004). Hypertensive disorders of pregnancy. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 33(2), 209-220.
Zareian, Z. (2004). Hypertensive disorders of pregnancy. International Journal of Gynecology & Obstetrics, 87(2), 194-198.

Friday, 20 January 2017 03:45

Emergency Management in Healthcare Issues

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Emergency Management in Healthcare Issues



Abstract
The fundamental objective of emergency management is to safeguard life as well as prevent injury during dynamic situations. Various stages of emergency management are critical for government agencies, business, and private organizations as well as nonprofit groups. Emergency management processes, policies, and documents in healthcare organizations must ensure that each particular facility can respond adequately to incidents that could potentially create mass casualties. The significance of ensuring competent emergency management in a healthcare organization is to protect as well as be able to save the lives of patients, employees, and communities that a healthcare organization’ serves. Emergency management is however faced with various crucial healthcare concerns that adversely affect the processes and lead to adverse consequences. The paper explores four critical healthcare issues in emergency management namely mechanism of injury (MOI), communication and media relations, triage challenges and logistical issues. The paper also describes various improvements, measures, and strategies employed so as to minimize the adverse outcomes of the various healthcare concerns discussed in the paper.


 


Introduction
Emergency management processes, policies, and documents in healthcare organizations must ensure that each specific facility can respond adequately to incidents that could potentially create mass casualties. These events that could cause emergencies include natural catastrophes (earthquakes, hurricanes, tornadoes, fires, floods or blizzards), unintentional events (plane or train accidents, power failures or any accidents involving biological, nuclear or chemical contamination), or intentional incidents (terrorist attacks or domestic disturbances). It is critical that all the healthcare professionals in a healthcare facility get involved in creating emergency management processes, policies, and documents that are best suited to the facility’s specific needs based on its hazard vulnerability analysis. The significance of ensuring competent emergency management in a healthcare organization is to protect as well as be able to save the lives of patients, employees, and communities that a healthcare organization’ serves. In the event of a disaster, communities expect that healthcare facilities provide medical care to the injured. However, in some occurrences, the medical organizations and their employees fall victim of the events; therefore, should adequately prepare to cater for the community needs in these events as well as safeguard its staff and facilities. The emergency management standards needed healthcare organizations should take a holistic approach so as to manage an emergency that entails preparing a coordinated response and also anticipating challenges and ensuring self-sufficiency. The best practices of emergency management in care facilities require planning and preparation efforts as well as complete and total support from all the staff in the organization from the facility administration to frontline staff. Healthcare organization emergency management activities vary and can be grouped in various ways that include surge capacity, communication, volunteer management, security concerns, hazmat/CBRNE preparedness, volunteer management, collaboration and integration with public health, education and training, drills and exercises, trauma centers, emergency department disaster operations and drills and exercises. Emergency management is however faced with various crucial healthcare concerns that adversely affect the processes and lead to adverse consequences. The paper explores four critical healthcare issues in emergency management namely mechanism of injury (MOI), communication and media relations, triage challenges and logistical issues.



Mechanism of Injury (MOI)
MOI describes the manner in which a patient traumatic event took place that is the forces that act on the body to cause damage. It may include a high-speed motor vehicle crash, a gunshot wound to the torso, or a fall from a standing height. Assessing as well as evaluating MOI can assist in predicting the likelihood of various injuries having occurred and estimate its severity. Knowing the specific details about MOI of a patient can give insight into the energy forces involved and may assist trauma care providers to predict the injury types and in some instances, patient outcomes (Brown, et. al. 2011). Prehospital caregivers report MOI as a communication standard when handing off care to the emergency department and trauma personnel. Similarly, patients who present to the emergency department for emergency health treatment will often relate the MOI by describing the particular chain of the incidents that led to their injuries.



The most common injury producing mechanisms for patients are blunt trauma and penetrating trauma. Blunt trauma is caused by impact forces such as those sustained in a motor vehicle crash, a fall, a blast effect from an exploding bomb, and also an assault with kicks, fists or a baseball bat. The energy that gets transmitted from a blunt trauma mechanism, especially the rapid acceleration-deceleration forces entailed in high-speed crashes or fall from a great height, produces injury by tearing, shearing and also compressing anatomic structures. Trauma to blood vessels and soft tissues takes place. Penetrating trauma is as a result of injuries caused by sharp objects and projectiles. These kinds of injuries include wounds from ice picks, knives and other comparable implements and also bullets (gunshot wounds {GSWs} or pellets. The injuries can also be caused by fragments of metal, glass or other materials that become airborne on the event of an explosion (shrapnel). All the mechanisms have the risk for particular injury patterns and severity that the trauma providers take into consideration when planning diagnostic evaluation and management strategies. Specific injury mechanisms that include gunshot wound to the chest or abdomen or also a stab wound to the neck get highly linked to life-threatening outcomes that they automatically require the immediate intervention by a trauma team for a rapid and coordinated resuscitation response.



One of the most common practices for victims of blunt or penetrating trauma who have experienced MOI forceful enough to damage the spinal column possibly is the prehospital spinal immobilization (Morrissey, 2013). All significant MOIs regardless of signs and symptoms of spine injury requires full-body immobilization that is typically defined as a cervical collar getting applied and the patient being secured to a backboard with head stabilizers in place. It’s however, problematic to use MOI alone as the key indicator for prehospital spinal immobilization. Besides, the harmful sequelae and potential harm of the spine immobilization require consideration in all field protocols. The spine injury assessment guidelines and algorithms that allow for the selective immobilization of injured patients need to be examined appropriately. In the event of a catastrophe, it is not only the community that gets affected but also communication infrastructure get damaged, and the healthcare organization’s power or facilities get destroyed leading to communication failure. It is, therefore, essential that healthcare facilities develop a plan to maintain communication pathways both within the care organization as well as with critical community resources.



Communication and Media Relations
Effective communication is fundamental t successful daily operations of medical facilities and becomes even more critical during crisis events. Excellent communication inside and outside of a healthcare facility during an emergency assists in ensuring the smooth implementation of Emergency Operations Plans. The success or failure of Emergency Operations Plans gets determined by the timely access to communication that allows for an efficient flow of critical information. Communication requires both the use of proper equipment in the event of a crisis as well as the verbal and written interaction with employees and the community. Public health officials, as well as journalists, play a significant role in disseminating information concerning the occurrence of events necessitating for emergency services. The media has been very informative about crisis situations that occur in different parts of the globe. For example, the media was the primary source of information about persons trapped after hurricanes Katrina and Rita slammed into the Gulf Coast of the US (Lowrey, et. al. 2007). Issues in healthcare relating to communication in disaster preparedness and response are associated with frustration and inadequacy to coordinate and execute disaster operation plans. Communication with the general public concerning emergencies should be in conjunction with the public relations department (Kapucu, Arslan & Demiroz, 2010).



Healthcare organizations get required to develop emergency communication strategies as part of the organization’s emergency operations plan and should include in the plan the manner in which it will sustain ongoing communication with employees, the public and the community throughout a crisis. Healthcare facilities should also strive to standardize its communication both internally as well as externally. In the facility, internal communication patterns develop and also change so as to fit the day-to-day needs of administration, management, and care. External communication in a healthcare organization entails the communication between the facility and external staff and private physicians, other healthcare organizations, public safety services (such as emergency medical services), medical testing laboratories, medical examiners and the general public seeking medical treatment or information.



Various problems associated with communication lead to shortfalls during disaster events. The failures are as a result of unpredictable nature of wire-based and cellular telephones and the incompatible radio frequencies when employing hand-held radios. Human errors can also lead to communication problems in health care organizations. Journalists and news organizations also contribute to the communication problem by disseminating inaccurate, incomplete and sensational coverage that may result in public misunderstanding the threats. Studies have determined that journalists covering crisis events lack sufficient expertise in science and medicine, therefore, are unprepared (Lowrey, et. al. 2007). Journalists focus on providing information to the public about health risks although they feel obligated to go beyond passive dissemination of the information. They, therefore, may adopt a wary and even skeptical stance about the government agencies and spokespeople. Public information officers in healthcare have also been faulted by journalism advisors to have contributed to the communication problem since they lack the authority to provide access to information and experts. The public information officers are not allowed by their seniors to give the journalists the information and experts they seek and also may not have adequate information about what information and experts are available or helpful.



Various measures can be undertaken to enhance effective communication during emergencies. By identifying the vulnerabilities in the current healthcare communication systems, steps can be implemented to address the challenges and enhance the health system preparedness. Infrastructure support is also an essential consideration when examining whether adequate safeguards have been implemented to support the supports we will use during crisis occurrences. It is also important to reduce turnover in the media and news organizations as the seasoned journalists able to effectively communicate healthcare issues during emergencies leave to join other fields. Different communications modes that include paging, radio, television, email and mobile phones can be employed to provide information during disasters. The integration of social media and networking sites such as Twitter and Facebook in communication during emergencies can assist the emergency management community that includes the medical and public health professionals in responding adequately to catastrophes and other occurrences (Merchant, Elmer & Lurie, 2011). Networking sites get used by an extended part of the society hence can effectively help individuals, communities, and healthcare agencies to share emergency plans and develop emergency networks. Location-based service applications that include Foursquare and Loopt provide an opportunity to enhance preparedness by improving the public awareness of crisis situations in their geographic area. Social media has also become a critical component in recovery efforts after the occurrence of crisis events. An example of the effective use of social media in crisis situations is the 2010 Haiti’s earthquake in which Ushahidi an open source web platform that uses crowdsourced information to support emergency management linked medical providers requiring supplies to those who had them (Merchant, Elmer & Lurie, 2011). Also, victims of the earthquake used Facebook to reach out for help after the disaster had occurred.



Triage Challenges
Triage describes the process that places the right patient in the right place at the right time to receive the right level of care. The process of triage prioritizes the patients to receive care first and is regarded as the cornerstone of good disaster management. Accurate triage enables disaster nurses to do the greatest good for the greatest number of casualties (Aacharya, Gastmans & Denier, 2011). Triage is necessary for managing causalities both in peace and wartime. Appropriate triage decision assists in saving the lives as well as the limbs of a vast number of patients. Although the fundamentals of triage remain consistent wherever it is carried out, undertaking triage in a disaster situation presents unique challenges, and the success of the process may be highly dependent on the competence and experience of the nurse and the other healthcare professionals. The critical point of triage is that not every patient who requires a particular form of medical care that includes medicine, therapy, surgery, intensive care bed, transplantation can gain immediate access to it. The triage nurse must accurately make a decision which patients require care, in what order should they be treated, and in situations of severely constrained resources, the patients who should not receive care at all. Some of the competencies and personality traits of a good triage provider are clinically experienced, calm and cool under stress, sense of humor, good judgment, and leadership, decisive, creative problem-solver, knowledgeable of available resources and experienced and knowledgeable concerning anticipated casualties.



Various challenges take place if patients are rapidly discharged from triage. One, the patients may fail to complete the registration process. Two, the lack of education delivered to the patient concerning the diagnosis. Three, the perception on the part of the patient that not being examined in a medical room with a gurney implies they are being kicked to the curb without adequate treatment.



Logistical issues
Emergency logistics management has emerged as a prominent global theme as catastrophes, either artificial or natural may take place anytime around the globe with enormous impacts. Unlike business logistics, the definition of emergency logistics remains ambiguous. Logistics in business is described as the process of planning, implementing and controlling the efficient, effective flow and storage of goods, services, and related information from the point of origin to the point of consumption for the aim of conforming to consumers’ requirements at the lowest total cost. Logistics in emergency management hence can be adapted from the above definition. It gets described as the process of planning, managing as well as controlling the efficient flows of relief, information and services from the points of origin to the points of destination to meet the urgent needs of the affected individuals under crisis circumstances (Sheu, 2007).



Extreme calamity incidents pose severe logistical challenges to emergency as well as aid organizations active in planning, preparation, response and recovery operations since the disturbances they cause have the potential to turn normal conditions suddenly into chaos. Under the circumstances, the delivery of the critical supplies that include food, water, and medical supplies becomes a tough task. It is as a result of the severe damage to the physical and virtual infrastructure as well as the limited or nonexistent transportation capacity. The recovery process is made quite challenging by the prevailing lack of knowledge concerning the nature and problems of emergency supply chains. Hence causing the design of reliable emergency logistics systems to be hampered by insufficient knowledge concerning formal and informal supply chains operate and interact, techniques to analyze and coordinate the flows of priority and nonpriority goods, as well as scientific methods to analyze logistic systems under extreme conditions.



Various studies have been undertaken with the aim of determining the different critical logistical issues that have plagued the response to certain disasters. The research on the response of Hurricane Katrina determined various logistical issues. They include collapse of the communication infrastructure, magnitude of the requirements, lack of integration between federal as well as state logistics systems, understaffing and lack of adequate training, inefficiencies in prepositioning resources, lack of planning for the handling and distribution of donations, limited asset visibility as well as procurement (Holguín-Veras, et. al. 2007). The logistical issues following Hurricane Katrina that in August 2005 devastated the US Gulf Coast give a perfect example of the importance of enhancing the efficiency of supply chains to the site of a hazard. These logistic issues led to the formulation of certain improvements so as to better respond to future risks. The improvements include executing measures to enhance asset visibility, developing a comprehensive emergency logistics training program, developing regional blanket purchasing agreements, executing proactive donation coordination plans, and developing regional compacts for prepositioning of critical supplies.



Conclusion
In emergency management, it is essential to evaluate the MOI of a patient as it assists in predicting the likelihood of various injuries having occurred and estimate its severity. Communication in emergency management is critical as it plays various roles that range from developing a competent media relations during contingencies to controlling rumors to balancing the public’s right to information with the organization’s need to safeguard its interests. Also, importantly, communication and public relations maintain, monitor as well as prioritize relations with the various organization stakeholders. Triage is a very challenging health issue associated with managing clinical and support activities. It is, however, important as a management tool and also in enhancing reliability and consistency in emergency management during a crisis. A comprehensive emergency management plan must address the aspect of logistical responsiveness across all the four phases of emergency management namely planning, preparedness, response, and recovery. All the stages of emergency management entail of an element of logistical readiness and intervening measures that can be carried out to stave off some of the effects of a disaster. The logistics staff must acknowledge the complexity of crisis response and need to appreciate interdisciplinary solutions based on lateral thinking as well as concerted strategies.




References
Aacharya, R. P., Gastmans, C., & Denier, Y. (2011). Emergency department triage: an ethical analysis. BMC emergency medicine, 11(1), 1: DOI: 10.1186/1471-227X-11-16
Brown, J. B., Stassen, N. A., Bankey, P. E., Sangosanya, A. T., Cheng, J. D., & Gestring, M. L. (2011). Mechanism of injury and special consideration criteria still matter: an evaluation of the National Trauma Triage Protocol. Journal of Trauma and Acute Care Surgery, 70(1), 38-45: doi: 10.1097/TA.0b013e3182077ea8
Holguín-Veras, J., Pérez, N., Ukkusuri, S., Wachtendorf, T., & Brown, B. (2007). Emergency logistics issues affecting the response to Katrina: a synthesis and preliminary suggestions for improvement. Transportation Research Record: Journal of the Transportation Research Board, (2022), 76-82. DOI: 103141/2022-09
Kapucu, N., Arslan, T., & Demiroz, F. (2010). Collaborative emergency management and national emergency management network. Disaster Prevention and Management: An International Journal, 19(4), 452-468: DOI: http://dx.doi.org/10.1108/09653561011070376
Lowrey, W., Evans, W., Gower, K. K., Robinson, J. A., Ginter, P. M., McCormick, L. C., & Abdolrasulnia, M. (2007). Effective media communication of disasters: pressing problems and recommendations. BMC Public Health, 7(1), 1: DOI: 10.1186/1471-2458-7-97
Merchant, R. M., Elmer, S., & Lurie, N. (2011). Integrating social media into emergency-preparedness efforts. New England Journal of Medicine, 365(4), 289-291: DOI: 10.1056/NEJMp1103591
Morrissey, J. (2013). Research Suggests Time for Change in Pre-hospital Spinal Immobilization. Journal of Emergency Medical Services.
Sheu, J. B. (2007). Challenges of emergency logistics management. Transportation research part E: logistics and transportation review, 43(6), 655-659.

 

Tuesday, 10 May 2016 23:44

Bioethics Committee

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Introduction

It is a standard requirement for health care facilities to have a bio ethics committee to tackle ethical issues and find the right mode of resolving the issue. Patients have certain rights that health care providers must ensure they adhere to when rendering their services. Similarly, health care professionals have certain obligations that they are required to adhere to, when serving the patient. The ethics committee often intervenes in cases where a complaint has been forwarded. In an effort to determine the precise functions and operations of the bioethics committee, I interviewed Mrs. Cain. Mrs. Cain is the chair of the ethics committee at Fairview Hospital and oversees the functioning of the committee.


Functions of the Committee

The bio ethics committee at Fairview hospital was established with the sole purpose of being an advisory body for the health care facility. As an advisory body the ethics committee facilitates discussions and resolution of ethical matters that arise sat the health care facility. The bio ethics committee exclusively deals with ethical matters and issues that the committee focuses on are thus tied to ethical considerations.  It is by reviewing the various ethical issues that arise that ethics committee is able to guarantee the provision of effective health care services to patients (Nelson, & Elliot, 2012). According to Mrs. Cain, the ethics committee strives to recognize the needs, interest and rights of patients, as well as other participants working at Fair view hospital. The guiding mission of the ethics committee is to serve patients and ascertain that their interests are protected


The ethics committee at Fairview hospitals renders several services. First, the committee strives to educate the health care professionals, and support staff at the hospital on the need to uphold ethical practices when executing their tasks. The committee also assists patients and their next of kin to understand the scope of medical ethics. The committee also offers consultation services to health care providers, patients and their next of kin when faced with medical problems that have an ethical perspective. The ethics committee also plays a vital role in the development and review of existing hospital policies. Members of the committee strive to ensure that the policies that Fairview hospitals adheres to abide by the expected ethical standards. The committee regularly revises existing hospital policies to ensure that they tally with the current professional and patient ethical standards. Some of the institution’s policies include policies on organ donation, informed consent and the use of life sustaining medication.


Membership and Duties

 Bio ethics committee members consist of a diverse pool of experts and stakeholders who participate in the provision of health care services.  Selection for membership is based factors such as an individual’s position of the welfare and care for the sick, their perception of ethical matters, as well as their reputation in their community and profession. Health care professionals such as the head physician, the therapist, nursing administrator, psychiatrist and chief surgeon make up ethics committee members. Other non medical members include the hospital chaplain, a social worker, and patient and community representative.


The committee also has a quality improvement manager who looks at the overall performance of the facility. The committee members are required to familiarize themselves with the ethical tenets surrounding the delivery of health care services (Nelson, & Elliot, 2012). When faced with different ethical dilemmas, the ethics committee invites guest members. Guests are selected from diverse disciplines depending on their professional and the ethical issue at hand.


The members and stakeholders of Fairview hospital are involved in the decision making processes by the committee.  The committee takes up ethical matters by choice or as presented by patients or their next of kin. The committee can also look into ethical matters forwarded by the executive committee of the health care facility. As mentioned earlier, the ethics committee plays a consultative role at the health care facility. Patients and their families can place their ethical complaints with the committee. The committee members will strive to understand the nature of the grievance, and agree on the best approach to come up with a solution.


A breach of ethical conduct means that an interdisciplinary meeting will be held to review the case. A final decision with regard to a case is made after a critical review and evaluation with all committee members. Overall, the ethics committee strives to consider and resolve any ethical dilemmas that may arise in the health care facility. The committee, after reviewing an ethical problem, makes recommendations on the appropriate course of action.



Impact of the Ethics Facility to the Committee

The presence of the bio ethics committee has enabled health care facilitates such as Fairview hospital to guarantee patients quality healthcare services. A health care facility that is keen on following the ethical standards of health care service delivery ascertains quality patient care. Health care professionals such as physicians and nurses are able to render their services without making any ethical breaches.


Health care professionals are also able to make informed decisions when faced with difficult medical scenarios. The issue of informed consent can, for instance, put a health care professional at an ethical cross road. Informed consent is a process by which a patient makes a medical decision about his or her health. A health care professional has the ethical duty of notifying the patient on all developments related to his or her health (Nelson, & Elliot, 2012). A legal and ethical dilemma can arise if a health care profession can, for instance, perform a surgical procedure without notifying the patient. The ethics committee thus familiarizes health care professionals with essential steps they need to undertake when performing their duties.


The presence of ethics committee has been essential in assisting health care professionals, patients and their next of kin in making the right medical decisions. The consultative aspect of the ethics committee, assists health care professionals and patients experiencing difficulties in making medical decisions. The ethics committee acts a guide assisting these groups make the right choice (Wenger, & Glick, 2013). The intervention offered by the ethical committee has assisted physicians, patients and their next of kin overcome ethical dilemmas that come about with ineffective decisions. The ethics committee assists the professionals or patients understand the medical options they have and effects of each decision.


Ethics committees have enhanced communication between physicians and patients. Since the ethics committee serves an education function, it familiarizes health care professionals and patients/next of kin on essential ethical tenets on medical care. With this knowledge, the physicians and the patient can engage in productive and interactive communication regarding proper health care and quality of life. Effective communication enables patients to raise their personal concerns and preferences with regard to treatment and effective health care services (Nelson, & Elliot, 2012). The ethics committee enables physicians to be fully equipped with diverse knowledge on effective patients care while adhering to ethical medical practices.

The ethics committee has also assisted in effective problem solving in situations where the facility or a health care professional is faced with an accusation that is ethical in nature. The committee reviews the situations and analyzes the options that the physician had, before making a decision (Wenger, & Glick, 2013). The committee can make a decision, or forward its recommendation to a higher organ such as the medical board, so that appropriate action is undertaken. The ethics committee thus ensures that physicians or patients get a fair hearing and resolve the ethical problem presented.


Conclusion

Health care facilities such as Fairview hospital must have an effective ethics committee that exclusively reviews the ethical matters that arise within the facility. The health care profession is very delicate as it involves health care services to human beings. The physicians and nurses need an ethics committee to guide them with regard to ethical decisions. Patients and their families also need the ethics committee to guide them in decision making, as well as listen to their complaints when they arise. An effective committee is one that has integrated persons from various professions. A multidisciplinary team ensures that the committee has the expertise to handle any ethical issue presented. An effective committee assists in resolving conflict between patients and health care providers in the case of appropriate patients care.



Reference

Nelson, A. & Elliot, B. (2012). Ethics committee. Critical access hospital retrieved from http://geiselmed.dartmouth.edu/cfm/resources/cahe/cah_guide.pdf

Wenger, N. & Glick, S. (2013). Hospital ethics committees in Israel. Journal medicine of ethics. Vol. 28. 177-182

Thursday, 24 March 2016 20:19

Formal Educational Preparation in Nursing

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Introduction
Quality patient care is an essential factor in the delivery of effective health care services. However, this can only be achieved if a well educated nursing force is available. In fact, research has indicated that fewer medication errors, reduced mortality rates, and positive outcomes are associated with the level of preparedness of nurses at the baccalaureate and graduate levels. To enhance highly qualified nursing workforce, American Association of College of Nursing is committed to working collaboratively because education enhances clinical competency and effective care delivery. This paper, therefore, looks at the nursing work force of today, highlights research that relates education to outcomes, and outlines the ability of four year colleges to enhance nursing education level in the United States.


Differences in Competences between Nurses Based on Degree Level
According to Dianne Moore (West Cost University, 2009), difference between baccalaureate degree in nursing and associate degree in nursing exists. A nurse with a baccalaureate degree in nursing has more opportunities to work in health care setting offering a variety of opportunities for professional growth. The Baccalaureate prepared nurses can also be bedside nurses, case managers, educators, administrators, discharge planners, and work in community clinics, public health, and home health. In fact, in the armed forces, the nurse officer in the nurse corps must have a baccalaureate degree in nursing. The associate degree nursing, on the other hand, is limited to providing a direct hand on patient care, which is more restricted to specific types of health care settings such as skilled care nursing and long term care facilities, hospitals, physician’s offices, and clinics.

Pertaining to the nursing programs, a difference also exists between baccalaureate degree nursing and associate degree nursing. In the baccalaureate program, 125 credits are required as opposed to the 72 credits that are required in the associate degree nursing program. The baccalaureate curriculum also has a different focus, whereby it emphasizes on evidence based nursing and leadership, and additional courses are offered in the curriculum, for example, statistics, research, public health, and critical thinking. Therefore, the additional units prepare baccalaureate nurses to pursue graduate study, which leads to an advanced degree in nursing.

Opposed to the baccalaureate students, students pursuing the program of associate degree in nursing are focused on learning the technical aspects of nursing that are appropriate to the provision of direct care to patients and the families, especially in acute care settings. Therefore, students who undertake associate degree program in nursing learn the knowledge and skills that are required to care for individuals and families during medical conditions restoration after treatment, and they usually practice a highly restricted level of nursing. Additionally, students in the associate nursing degree programs are known to have fewer units, and they are only taught on the basics of leadership as an additional since it is needed for supervision of other health providers. Therefore, the associate degree nursing do not prepare nursing students for graduate study.

Off course an individual may think that being a bedside nurse and not a manager is noble. However, the baccalaureate degree nurses do provide excellent direct patient care. This is because such nurses use research based practice, which enhance better patient outcome, as opposed to the associate degree nursing who are limited by their education to the practical skills. The baccalaureates nurses are, therefore, are excellently whole rounded individuals in the health care since they can effectively provide patient care, management, and even educational services. Indeed, the baccalaureate nursing program offers potentially high flexibility to pursue various types of nursing care within the health care setting.
The baccalaureate degree nursing graduates are today being preferred in many hospitals than the associate degree graduates. This idea has encouraged many nursing staffs in hospitals to go back to school and better their education to achieve baccalaureate degree in nursing so as to become effective in the delivery if the nursing services. Moreover, baccalaureate degree nurses are paid more than their colleagues with associate nursing degree.

It can be argued that baccalaureate degree nurses and associate degree nurses may not have a difference in their level of skill competency when they are graduating, however, within a year the baccalaureate degree nurses tend to show the development of clinical judgment, better problem solving, and greater critical thinking skills. These three skills are important for acute patient care in hospitals and other health care settings.

Perhaps, all nurses are professionals since they receive academic skills in their respective nursing schools and moreover certify the subject professional organization. American Association of College Nursing, therefore, is committed to enhancing competence education outcome s of nursing across all levels. Professional nursing implies participating in all aspects that pertain to effective health care. Therefore, a professional nurse regardless of the curriculum program must be actively involved in research, participate in politics that affect the profession of nursing, achieve effective education programs, and more so focus on delivery of effective health care (American Association College of Nursing, (2012). Adopting the baccalaureate degree nursing program, therefore, is important.


References
West Coast University, (2009). The Differences between Associate Degree Nurses and the Baccalaureate Degree Nurses. Dianne Moore: Author. Retrieved From, http://www.westcoastuniversity.net/deanscorner/print.php?article=22 On June 21, 2013.
American Association College of Nursing, (2012). Fact Sheet: Creating a More Qualified Nursing Workforce.

Thursday, 24 March 2016 19:42

Communication

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In his video, Thomas Goetz addresses how healthcare professional can exploit some underutilized resources (people). He states that people have failed to utilize information dispensed to them. This has posed a major challenge in management of lifestyle diseases such as diabetes, heart disease and obesity which require behavior change. According to Thomas Goetz, behavior change is a long standing problem in healthcare. Despite doctors and other healthcare professionals depending on behavior change, there is little that is being done to change the worrying state of the situation. Doctors should strive to give information that educate, inform and help patients make better decisions and choices in life.


Thomas Goetz sites dentistry as one of the medicine fields that have effectively used behavior change to improve preventive health. He gives an example of Connecticut study where researchers studied a cohort the of population. In the research, efficacy rather than fear was demonstrated as the main force behind behavior change. The sense of efficacy as the driving force behind behavior change was also demonstrated by Bandura, who concluded that if a person believes they have the potential to change their behavior, and then they are more likely to adopt the positive behavior.


Therefore, in healthcare, the attitude and conviction of the patient is a strong force behind betting better. However, healthcare practitioners are not able to manipulate this concept among patients. Thomas Goetz notes that instead of using fear to pass behavior change information, healthcare practitioners should use personalized information. It is crucial for healthcare providers to give client specific information pertaining the potential outcome of their condition. They should connect personalized data with the lives of the patient.


Information should always be connected with emotions and actions. Despite the importance of personalized data in healthcare, many institutions have challenges in gathering and maintaining such information. There is lack of a complete feedback system between action and information given. Healthcare practitioners do not use the information to achieve the desired change. Thomas Goetz contrast how commercial adverts are craftily made compared to behavior change adverts, which are poorly done. Lack of good faith in the development and dissemination of health information is a major challenge. He gives a classical example of Scwatz and Woloshin, who used pharmaceutical advert to reach out the audience.


The advert gave particular information that relates to the audience. The audience is given information on the effectiveness of the drug, and then given choices. To describe how packaging of information is crucial, Thomas Goetz gives another example of lab test results. Lab report results are presented in a way that makes them unclear, not only for patients, but also to doctors. However, a proper presentation of the same lab report can be used to change behaviors among client. Thomas Goetz explains how itemization of the report can be effective in passing the relevant information. Healthcare providers can also use other strategies to simply and consequently personalized information. Through simplified versions of blood and CRP tests, Thomas Goetz demonstrates how healthcare providers can improve how they communicate with patients, and how they can use the information to influence decisions and choices made patients.


Personalization of risks while conducting PSA test is another effective way information can be used to communicate effective with patients. Identifying targets of any information is crucial in deciding how it will be packaged and passed. In conclusion, Thomas Goetz argues practitioners and patients to develop feedback report, which helps breaking down of information into understandable units that will help in decision making.


Healthcare is undergoing a massive transformation in terms of technologies, procedures, treatments and medications. Healthcare providers are expected to adopted these new technologies and procedures in their daily activities (Barbara, 2002). Use of technology in healthcare has increased efficiency in management of patient information. Electronic health records has transformed management of health records and consequently saved a lot of time. Physician have been given able time with patient because they do not have to saunter from one part of the hospital to other searching for a client’s information.


However, the revolutionary concept of technology in healthcare is not with challenge. Many healthcare institutions are adopting new technology to gain a competitive edge. Purchase and installation of some of these electronic devices is costing healthcare facilities a lot of money. Technology use is also being hampered by social factors such as the age of the physicians. With the use of EHR, maintenance of patient privacy has become a huge challenge.


Conclusion
Healthcare facilities and practitioners depend heavily on effective communication to achieve behavior change or even help patient decide. However, most health information is being communicated in unorganized, complex and not user friendly manner. There is a need to change the way information is packaged in healthcare setup. Physician should use language that is easy to understand, personalize information, offer specific and precise information that will help the patient understand the alternatives they have so as they can make informed decisions.


References
Thomas Goetz: It's time to redesign medical data. Retrieved from http://www.ted.com/talks/thomas_goetz_it_s_time_to_redesign_medical_data.html
Barbara L. M. (2002). Medical Informatics for Better and Safer Health Care. Retrieved http://www.ahrq.gov/data/informatics/informatria.htm on 17/6/2013

Thursday, 24 March 2016 19:34

Medicine’s Future

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Abstract
The future of the health care is affected by the exponentially growing technology. Improved healthcare, ability to perform sophisticated procedures together with reduced health care costs come as a result of advanced technology. Exponential technology will connect patients and the physicians through the internet. IPhone technology is one of the exponential technology areas that will lead to more effective diagnosis as it finds a lot of applications in modern medicine.


Diagnostic procedures, such as CT scans, PET scans and the MRI scans will also improve to more sophisticated forms that ensure high resolution. Robotic technology is also one of the areas that will enhance advance in surgical procedures, as well as empowering physically disabled individuals. Stem cell technology will expand it he future to ensure that pathological conditions such as cancers are effectively managed. Medicine’s future will, therefore, be achieved through exponential technology.

The exponentially growing technology is affecting our future of health and wellness in many perspectives including low cost gene analysis to the ability to perform powerful bio informatics to the connection of the internet and the social networks. Therefore, understanding these exponential technologies is paramount. Off course we often think linearly, but if we start thinking exponentially, we can perceive the effects on our surrounding technologies most of, which can be leveraged so as to impact the future of our own health and health care, and also to address other major challenges that affect the health care today, the increasing costs to the aging population included, inadequate use of information in the current world, the fragment of care, and the difficulty in adoption of innovation. One of important things that can be done is moving the curve to the left. Perhaps, most of our money is spent on the last 20 percent of life.
If this could be spent in incentivizing positions in the health care system and on our own self in an effort orient the curve to the left and eventually improve our health and also leverage the technology. An excellent example of exponential technology, which is in our pockets, is the iPhone4. This technology is dramatically improving, and the iPhone 8 can imaginary do a lot of things such as diagnostics, for example, measuring an individual’s blood pressure and sending the result to the respective physician. The iPhone has different types of applications, and it can be possibly modified to include diagnostic applications.
The speed of computers is improving, and this means that there is more ability to do more things with them; in fact, it is surpassing the ability of the human mind in many cases. Computational speed has found most application in imaging since it presents the ability to perform body imaging in real time and with high resolution. Therefore, multiple technologies at PET and CT scans and molecular diagnostics are being layered in order to perform things at different levels.
In fact, MRI; which is done today, has the highest resolution, therefore, enhancing fine details of the body tissues. Advances, therefore, are geared towards reengineering the existing MRI technology to generate real time fMRI. The fMRI technology will monitor the condition of a brain in real time and present information that will lead to effective management of the underlying medical condition for example, effective psychoactive drugs. The scanners for this new technology will be smaller, less expensive, and portable than the existing form.

The scan in the next couple of years will also have increased speed and resolution. Paradigm shift, therefore, exist in healthcare whereby moving is towards the biomedicine, information technology, wireless technology, mobile, and to the digital medicine, and even a stethoscope is now digital. There is also an advance in medical records whereby electronic medical records now exist. Merging medical data is also another emerging idea so that physicians and patients can access their data whenever they are through applications in devices such as iPad technology.
In fact, this application has been approved to allow physicians and radiologists to access the patient’s data. This is a typical Skype-type visit whereby the patient does not have to physically visit the doctor, but to present the information online, and get the physician make a diagnosis on the other and finally give feedback to the patient. Steps are also taken to generate devices that will measure an individual’s steps by caloric out take, watches that will measure heartbeats, and even diagnostic mirrors.
Robotic technology is also expected to go further to a step that it will perform scar-less surgery, and robotic wheelchairs innovated to give super ability to the disabled. Introduction of ipills will also help surgeon diagnose gastrointestinal disorders through remote monitoring. Stem cells are also expected to be stored and regenerated in the future through cell culture so as to form identical body tissues that can be used to replace the pathological parts, therefore, effective in the management pathological disorders such as cancers.


Reference
TED, (2011). Medicine’s Future, Kraft Daniel: Author. Retrieved From, http://www.ted.com/talks/lang/en/daniel_kraft_medicine_s_future.html On June 11, 2013.
Examiner, (2013). How Technology has Transformed Medicine. Retrieved From, http://www.examiner.com/article/how-technology-has-transformed-medicine On June 2013.
NCBI, (2012). Science and Technology for Disease Control. Retrieved From, http://www.ncbi.nlm.nih.gov/books/NBK11740/ On June 11, 2013.

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