NR 442 Case Study 04-Community Assessment Part 1

Name

Chamberlain University

NR-442 Community Health Nursing

Prof. Name

Date

Case Study 04 – Community Assessment Part 1: Shoe Leather/Windshield Survey and Key Informant Interview

Case Study Synopsis

As a public health nurse, you are tasked with conducting a community assessment to contribute to a newly updated strategic plan aimed at preparing a nearby community for future growth and development. This assessment is an opportunity to identify the community’s strengths and weaknesses, as well as provide recommendations for improving the overall health and wellness of the population.

Concepts Covered

• Health promotion
• Health policy

Public Health Nursing Interventions Addressed

• Disease and health event investigation
• Consultation
• Policy development and enforcement

Suggested Readings

• Edelman & Kudzma’s Health Promotion Throughout the Life Span, Ch. 8: Health Promotion and the Community
• Nies & McEwen’s Community/Public Health Nursing, Ch. 6: Community Assessment
• Stanhope & Lancaster’s Foundations for Population Health in Community/Public Health Nursing, Ch. 12: Community Assessment and Evaluation
• Stanhope & Lancaster’s Public Health Nursing, Ch. 17: Community as Client: Assessment and Analysis

Estimated Completion Time

• Case study only: 2 hours
• Plus review questions: + 30 minutes
• Plus discussion questions: + 1 hour
• Total: 3.5 hours

Case Study Objectives

1. Identify relevant and appropriate data and information sources for community assessment.
2. Gather demographic, geographic, governmental, health care, cultural, and socioeconomic data of the community.
3. Conduct a preliminary analysis of data from the windshield survey and community assessment to identify strengths and weaknesses.
4. Propose recommendations for a strategic plan based on community assessment findings.

Introduction

The city manager has requested a community assessment from you as part of a city council initiative to update their 6-year strategic plan. The goal is to prepare for the community’s future growth and development. This is an excellent opportunity to examine the strengths and weaknesses of the community while offering suggestions for improving the health and wellness of the population. You begin by conducting a preliminary search for information about the city.

Population:

• Total population: 22,791
• Female: 52.2%, Male: 47.8%
• Under 18 years: 34.8%
• 19–64 years: 61.2%
• Over 65 years: 4%
• Ethnic composition: 56.8% Caucasian, 9% Black or African-American, 23.4% Hispanic or Latino, 10.8% Other

Location:

• Livability score: 86
• Low crime rate
• Low cost of living
• Temperate weather with warm summers and mild winters
• Local amenities available

NR 442 Case Study 04-Community Assessment Part 1

Primary Industries:

• Manufacturing: Computer technology, hardware, and software
• Non-manufacturing: Public education, government, health care, farming/ranching

Economic Information:

• Per capita income: $73,977
• Persons below poverty level: 7.4%
• Unemployment rate: 3.4%
• Home ownership rate: 65.1%

Educational System:

• One public high school with two public middle schools and six elementary schools
• One Higher Education Center offering workforce readiness programs
• Five private universities and two public universities

Recreation:

• High School football
• Hunting, fishing, hiking, and biking
• Two community parks with swimming pools
• YMCA and various annual events (e.g., Crawfish Festival, Old Tyme Festival)

Health Care Facilities:

• Head Start Program, Urgent Care Clinic, Pediatric Clinic, Primary Care Clinic
• Rehabilitation and Skilled Nursing, Fire Department/EMS, Alzheimer’s/Respite Day Care Center

Air Quality: 70 (National Air Toxic Assessment)
Water Quality: 79 (Water Shed Quality)

Transportation:

• Railroad terminal, taxi service, bus service

Media:

• One storefront radio station, weekly newspaper, public library

NR 442 Case Study 04-Community Assessment Part 1

Scenario and Community Assessment

Windshield Survey

The windshield survey begins by observing the outskirts of the community, taking note of agricultural land, the flat terrain, the river, and the climate. Observations include the presence of crop dusters, raising concerns about the impact of pesticides and herbicides on food and water supplies. This prompts further research into these environmental health risks. Key questions arise regarding the community’s race/ethnicity, housing conditions, homelessness, littering, availability of parks, and presence of a railroad track.

Key Informant Interviews

You conduct interviews with local health care providers, public officials, and community members to better understand the health concerns of vulnerable populations. One key informant is the school nurse, who shares that the community struggles with high rates of cancer (particularly breast cancer), farm-related accidents, and obesity. These issues warrant further investigation to assess their causes, including environmental factors.

Social Determinants of Health (SDOH)

Further interviews with the school nurse reveal insights into the social determinants affecting student health. Reviewing the Culture of Health website together, you identify prevalent community factors such as air quality, access to health services, and individual behaviors, which contribute to health disparities in the area.

Emergency Health Care Access

During a conversation with the school nurse, a student is brought in following a football injury. The school nurse notes that a nearby railroad track blocks EMS access, which could delay emergency care, especially in time-sensitive situations. This issue becomes a priority for further policy development.

Data Collection and Health Trends

After evaluating various health trends and risk factors, the public health nurse identifies the need to prioritize several community problems. The primary concern is the accessibility of emergency services, with the railroad tracks creating a barrier to timely care. Recommendations are made to address this, including policy interventions aimed at improving emergency response times and potentially building another health care facility on the other side of the tracks.

Public Health Nursing Interventions

Public health nurses play a crucial role in the community assessment by collecting data, identifying health risks, and offering solutions to improve community health. This includes collaborating with local stakeholders to develop policies that address health concerns, such as farm-related accidents, cancer prevention, and obesity. Interventions focus on health promotion, disease prevention, and the strengthening of health systems.

Conclusion

As the community assessment concludes, data has been gathered, and interviews with stakeholders have provided valuable insights. The next steps involve analyzing the data and prioritizing community health needs. Through the assessment process, you have identified potential health risks, environmental concerns, and barriers to healthcare access that require intervention and policy development to improve the community’s overall well-being.

NR 442 Case Study 04-Community Assessment Part 1

References

Cui, E. R., Beja-Glasser, A., Fernandez, A. R., Grover, J. M., Mann, N. C., & Patel, M. D. (2019). Emergency medical services time intervals for acute chest pain in the United States, 2015–2016. Prehospital Emergency Care, 24(4), 557–565. https://doi.org/10.1080/10903127.2019.1676346

NR 449 Week 7 RUA Presentation

Name

Chamberlain University

NR-449 Evidence-Based Practice

Prof. Name

Date

AHR Quality Indicators: A Comprehensive Overview

Presented by: Aissatou Diallo, Alyssa Harrison, Ashley James, Safina Ortiz, and Maame Seiwaa

Problem Identification

The key quality indicators identified in this research focus on critical infection control practices, such as proper hand hygiene, appropriate use of personal protective equipment (PPE), and the prevention of infections. These factors are essential in reducing healthcare-associated infections (HAIs) and improving patient outcomes.

Impact on Nursing Practice

Failure to adhere to infection control practices like handwashing and correct PPE use can lead to severe consequences, including higher mortality and morbidity rates. These lapses also result in increased healthcare costs, which affect the efficiency and sustainability of healthcare systems. Preventing HAIs is crucial to ensuring the well-being of patients and improving the overall quality of care.

The Research Process

The research process was comprehensive, involving multiple databases and terms to gather evidence supporting best practices in infection control:

• Databases Utilized:

  • Chamberlain Online Library
  • Centers for Disease Control and Prevention (CDC)
  • World Health Organization (WHO)
  • Agency for Healthcare Research and Quality (AHRQ)
  • CINAHL (Cumulative Index to Nursing and Allied Health Literature)
  • PubMed

• Terms Searched:

  • Evidence-Based Practice Research
  • Quality Indicators
  • Hand hygiene and Personal Protective Equipment (PPE)
  • Infection Control

The research utilized various methodologies, including observational studies, randomized control trials, surveys, and video-reflexive ethnography.

Research Findings

A variety of studies were reviewed, providing valuable insights into infection prevention:

• Study Types:

  • 5 Observational Studies
  • 1 Randomized Control Trial
  • 1 Randomized Trial
  • 2 Surveys

• Key Findings:

  • The research emphasized the significant impact of proper hand hygiene and PPE use in reducing infection rates.
  • A randomized control trial (Kim, E.- Gyeong, & Jeong, I. S., 2019) showed that experimental groups had higher rates of accuracy in hand hygiene (p < 0.001) and PPE donning/doffing (p < 0.001) compared to control groups.

Summary of the Validity of Qualitative Evidence

A survey conducted across 183 US hospitals, involving 11,282 patients, reported that 4% of patients had at least one healthcare-associated infection (HCAI). The most common microorganisms identified were Clostridium difficile, with the majority of infections being surgical site infections (SSIs), pneumonia, and gastrointestinal infections. A previous study by the same group found a 6% rate of HCAIs, with Staphylococcus aureus as the most frequently detected microorganism.

Summary of the Validity of Quantitative Evidence

The research draws on historical figures like Dr. Ignaz Semmelweis, who advocated for hand hygiene to reduce maternal mortality. The transmission of organisms through improper hygiene practices has long been a critical issue in healthcare, and early interventions like chlorinated lime hand washing helped reduce infection rates significantly.

NR 449 Week 7 RUA Presentation

Practice Changes

Several practices can be implemented by both patients and healthcare providers to minimize the risk of infections:

• For Patients:

  • Wear masks during hospital stays.
  • Maintain proper hand hygiene.
  • Adhere to prescribed antibiotics and report signs of infection promptly.
  • Get vaccinated to prevent flu and other infections.
  • Allow environmental staff to clean hospital rooms effectively.

• For Healthcare Providers:

  • Ensure proper PPE training and fit, including FFP2 masks.
  • Provide face-to-face training courses and hard-copy modules for in-service education, ideally twice a year.

Recommendations for Implementation

To improve infection control and ensure the effective use of PPE, the following recommendations are made:

• Availability of private patient isolation rooms (Sujan C Reddy, et al., 2019).
• Administrative enforcement to limit movements within isolation rooms (Sujan C Reddy, et al., 2019).
• Visual display training for hospitalized patients on appropriate PPE use.
• Policies regulating PPE use by providers during care (Sujan C Reddy, et al., 2019).
• Leadership-driven education on proper PPE use (Sujan C Reddy, et al., 2019).
• Healthcare surveillance to detect infection spread patterns (Sara Dequeker, 2019).
• Vaccination of healthcare providers and patient screening for infections (Sara Dequeker, 2019).

Conclusion

Proper handwashing and the correct use of PPE are essential in preventing infections in healthcare settings. Adopting these practices can significantly reduce the rates of healthcare-associated infections, ensuring better outcomes for patients and improved nursing practice.

References

• Alrubaiee, G. G., Baharom, A., Faisal, I., HayatibKadir, S., Daud, S. M., Basaleem, H. O. (2021). Implementation of an educational module on nosocomial infection control measures: A randomized hospital-based trial. BMC Nursing, 20(1), 1-10. https://doi.org/10.1186/s12912-020-00587-2

• Arianpoor, A., Zarifian, A. A., Askari, E. (2020). Infection prevention and control idea challenge contest: A fresh view on medical education and problem solving. Antimicrobial Resistance & Infection Control. https://doi.org/10.1186/s13756-020-0688-y

• Haque, M., Sartelli, M., McKimm, J., & Abu Bakar, M. (2018). Healthcare-associated infections: An overview. Infection and Drug Resistance, 11, 2321–2333. https://doi.org/10.2147/IDR.S177247

NR 449 Week 7 RUA Presentation

• Neuwirth, M. M., Mattner, F., Otchwenah, R. (2020). Adherence to personal protective equipment use among healthcare workers caring for confirmed COVID-19 and alleged non-COVID-19 patients. Antimicrobial Resistance & Infection Control. https://doi.org/10.1186/s13756-020-0688-y
• Dequeker, S. (2019). Quality Indicators for Infection Prevention and Control in Belgian Acute Care Hospitals. NSIH Symposium 2019. Retrieved from https://www.wiv-isp.be/nsih/download/symposium%202019/Sara%20Dequeker_Quality%20indicators.pdf
• Shang, J., Needleman, J., Liu, J., Larson, E., & Stone, P. W. (2019). Nurse staffing and healthcare-associated infection, unit-level analysis. The Journal of Nursing Administration, 49(5), 260–265. https://doi.org/10.1097/NNA.0000000000000748

NR 449 Week 7 RUA Presentation

• Reddy, S. C., Valderrama, A. L., Kuhar, D. T. (2019). Improving the use of personal protective equipment: Applying lessons learned. Clinical Infectious Diseases, 69(Supplement_3), S165-S170. https://doi.org/10.1093/cid/ciz619

NR 449 Week 3 RUA – Topic Search Strategy

Name

Chamberlain University

NR-449 Evidence-Based Practice

Prof. Name

Date

Clinical Question

The clinical issue addressed in this paper is the impact of health literacy on disease prevention, particularly in the context of asthma in children. According to the CDC (2022), “Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” Health literacy plays a significant role in healthcare because individuals who do not understand health information may struggle to take proper care of themselves, leading to poor outcomes. A clear example of this would be a situation where a nurse provides a parent with a consent form for a blood transfusion for their child, but the parent does not sign it due to not understanding the form.

This misunderstanding could delay the blood transfusion, potentially harming the child. Factors such as education, health history, socio-economic status, age, and access to healthcare influence a person’s level of health literacy. Improving health literacy could reduce avoidable hospitalizations by 26%, hospital readmissions by 9%, and emergency department visits by 18% (United Health Group, 2020). The selected PICOT question for this paper is: “In children diagnosed with asthma, does low health literacy compared to high health literacy play a role in reduced disease management?” This paper aims to explore the differences in health outcomes for children with asthma and how their condition is affected by varying levels of health literacy. This paper will also discuss the search strategy used to identify credible sources on the topic.

Levels of Evidence

The PICOT question in this paper relates to the prognosis of asthma in children, focusing on how health literacy influences disease progression. Prognosis refers to the likely course of a disease. To answer this question, both qualitative and quantitative research is required. Quantitative research is necessary to measure the extent of health literacy in parents or caregivers and the resulting impact on the child’s health management. For instance, we need to quantify how health literacy levels influence the management of asthma symptoms in children. Qualitative research is essential to gather subjective data from parents, caregivers, healthcare providers, and patients themselves about how the level of health literacy has affected the child’s health outcomes.

Search Strategy*

The PICOT question in this paper focuses on two primary topics: health literacy and asthma. To address these, I began by searching for articles related to pediatric health literacy and asthma. Using the Chamberlain University library, I searched for “pediatric health literacy with asthma” and limited the search to articles published between 2017 and 2022, yielding 76 results. The first article titled “The Impact of Caregiver Health Literacy on Pediatric Asthma: An Integrative Review” was found, but the article link was broken. I then turned to the NIH Library of Medicine and searched again. I found 136 results and located the article at the top of the list, with free access to the full text. This article, by Abrams (2020), explores how caregiver health literacy affects pediatric asthma.

NR 449 Week 3 RUA – Topic Search Strategy

For the second article, I searched “asthma management in children” in the Chamberlain University library, filtered by publications from 2017-2022, and selected an article that complemented the group’s PICOT question. The article titled “Designing an Indoor Air Quality Monitoring App for Asthma Management in Children: User-Centered Design Approach” (Kim, Park, & Ackerman, 2021) discusses the creation of an air quality monitoring app aimed at improving asthma management in children.

Conclusion

In conclusion, health literacy plays a critical role in improving healthcare outcomes by helping individuals make informed health decisions for themselves and their loved ones. One way to address low health literacy is through evidence-based research, which enhances understanding of its impact on healthcare, particularly for children with asthma. The more we learn about health literacy and its influence on disease management, the better we can improve healthcare strategies and patient outcomes.

NR 449 Week 3 RUA – Topic Search Strategy

Table: Summary of Search Strategy

References

Abrams, E. (2020). The impact of caregiver health literacy on pediatric asthma: An integrative review. Pediatric Allergy Immunology Pulmonology, 33(3), 110-116. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9353981/

Improving health literacy could prevent nearly 1 million hospital visits and save over $25 billion a year. (2020). United Health Group. https://www.unitedhealthgroup.com/content/dam/UHG/PDF/About/Health-LiteracyBrief.pdf

NR 449 Week 3 RUA – Topic Search Strategy

Kim, S., Park, Y., & Ackerman, M. (2021). Designing an indoor air quality monitoring app for asthma management in children: User-centered design approach. JMIR Formative Research, 5(9), e27447. https://www-proquestcom.chamberlainuniversity.idm.oclc.org/publiccontent/docview/2575368864?pqorigsite=primos

What is health literacy. (2022). Centers for Disease Control and Prevention. https://www.cdc.gov/healthliteracy/learn/index.html

NR 449 Week 2 The Research Process

Name

Chamberlain University

NR-449 Evidence-Based Practice

Prof. Name

Date

The Research Process

The research process and the nursing process share many similarities, but there are key differences. While the nursing process is focused on providing care at the individual client level, nursing research aims to improve nursing practice at a broader level. The ultimate goal of nursing research is to enhance nursing practice by identifying problems and developing effective solutions. Problem statements in nursing research describe the gap between what is currently known and unknown. One of the first steps in research is developing a research question, which directly precedes selecting a research design. Reviewing existing literature can highlight studies that may be replicated and contribute to answering the research question.

A critical aspect of the research process involves selecting the appropriate research design, which can vary depending on the type of data being collected. Below is a table that outlines different research designs and their corresponding descriptions:

NR 449 Week 2 The Research Process

NR 449 Week 2 The Research Process

The research process itself follows a systematic sequence of steps:

1. Determine the problem.
2. Review the literature.
3. Design the study.
4. Collect the data.
5. Analyze the data.
6. Communicate the results.
7. Implement practice change.

Additionally, it is important to match the research characteristics to the appropriate research type, such as the objectivity of data in quantitative research or the personal involvement of the researcher in qualitative research.

Types of Research Studies

Research studies can either focus on primary or secondary data collection. Primary data collection is prospective, where data is gathered for the first time. In contrast, retrospective studies use data previously collected for another purpose. When data is collected over a long period, it is called a longitudinal study, whereas a cross-sectional study collects data at a single point in time.

Research questions guide the direction of a study. For example, to assess the effectiveness of a fall prevention intervention, an experimental prospective quantitative study would be appropriate. If exploring obstacles to a pressure ulcer prevention regimen, a qualitative study using focus groups might be the best choice.

Quantitative research is particularly valuable in providing strong evidence for nursing practice, as it enables researchers to make confident inferences about the effectiveness of interventions.

Evidence and Research Design

When reviewing literature, researchers often encounter different types of evidence with varying levels of credibility. For example, clinical practice guidelines are considered the highest level of evidence, followed by systematic reviews, randomized clinical trials, and expert opinions. These sources are ranked in descending order of credibility.

Research studies, especially those that are well-conducted, can guide nursing practice by identifying effective interventions. When analyzing a study, nurses must be vigilant about the validity of its findings, considering factors such as sample size, bias, and potential threats to validity.

NR 449 Week 2 The Research Process

PICOT Question and Hypothesis

The PICOT format is commonly used to develop research questions. It consists of the following elements:

• P: Population or problem of interest
• I: Intervention or exposure being studied
• C: Comparison group or intervention
• O: Outcome to be measured
• T: Time frame for the study

A null hypothesis suggests no difference between groups, whereas an alternative hypothesis predicts a significant difference. Identifying the appropriate hypothesis and selecting the correct research design is crucial for answering the research question effectively.

Conclusion

Nursing research plays a vital role in advancing practice and improving patient care. Through systematic inquiry and the use of appropriate research designs, nurses can gather evidence to support interventions and inform clinical decisions. By following the research process and carefully evaluating sources of evidence, nurses ensure that the findings can be applied in practice to improve patient outcomes.

References

Pickham, L. A., et al. (2018). Clinical effectiveness of wearable patient sensors in improving care delivery and patient outcomes. Journal of Nursing Research.

Tan, Y. J., et al. (2020). Perceptions and challenges of nurses regarding pressure injuries caused by medical devices. International Journal of Nursing Practice.

Alsulami, Z., et al. (2014). Perceptions of registered nurses on double-checking medications in pediatric care. Journal of Pediatric Nursing.

Relihan, A., et al. (2010). Distractions during medication administration: A quantitative analysis. Journal of Nursing Administration.

NR 449 Week 2 The Research Process

Parker, R. P., et al. (2017). Reducing catheter-associated urinary tract infections in an acute care setting. American Journal of Infection Control.

Luwang, B. J., et al. (2021). Research on medication errors: A case study. Journal of Clinical Nursing.

NR 325 Pre-Simulation – Carl Rogers

Name

Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

Nursing Education and Practice

In the realm of nursing education, delivering safe and effective patient care is of utmost importance. This paper examines nursing practice and explores the multiple dimensions of care outlined within the NCLEX-RN test plan. These dimensions encompass various aspects crucial for nursing competency, including a safe and effective care environment, management of care, safety and infection control, health promotion and maintenance, psychosocial integrity, and physiological integrity. Additional categories such as basic care and comfort, pharmacological and parenteral therapies, risk reduction, and physiological adaptation also play an essential role in this framework. The NCLEX-RN test plan is instrumental as a practice readiness guide, aligning nursing education with the core competencies required for professional nursing. This approach highlights the critical role of clinical self-assessment in professional growth, guiding nursing students toward personal and professional development.

NR 325 Pre-Simulation – Carl Rogers

Activity statements within the NCLEX-RN test plan are specifically designed to cover each element of nursing care, providing invaluable guidance to prepare individuals for the multifaceted demands of nursing practice. This research delves into the importance of these components, illustrating their contribution to fostering skilled, confident nursing practitioners. A unique clinical experience during a rotation at a medical-surgical unit highlighted the value of these competencies, especially when managing a patient recovering from clavicle surgery after a motorcycle accident. This experience enhanced my nursing skills, particularly in areas like physiological integrity and infection control. For example, I managed the patient’s postoperative pain, monitored vital signs, adhered to sterile techniques during dressing changes, and remained vigilant for any signs of infection.

Personal Growth and Future Goals

Through this clinical experience, I recognized areas for further development, particularly in health promotion and psychosocial integrity. Moving forward, I aim to improve in these aspects by educating patients on injury prevention and lifestyle adjustments (health promotion) and by enhancing my ability to assess and support their psychological well-being (psychosocial integrity). According to UWorld (n.d.), understanding the social and emotional influences on a patient’s health allows healthcare providers to offer holistic care, addressing both physical and mental needs. To further develop these skills, I plan to actively seek new clinical experiences that involve these client needs. Collaborating with experienced nurses in health promotion and psychosocial integrity will allow me to gain practical insights and mentorship. Embracing these strategies will shape me into a well-rounded nurse capable of handling diverse patient needs across various clinical settings.

NCLEX-RN Test Plan and Competency Development

The NCLEX-RN test plan delineates essential elements that support a secure and effective care environment, encompassing management of care, infection control, health promotion, psychosocial integrity, and physiological needs. Emphasizing these domains ensures aspiring nurses are prepared to deliver safe, effective care in varied healthcare environments. Developing competency in these areas is vital to maintaining patient well-being and preparing for the NCLEX-RN. A solid grasp of these domains supports future nurses in meeting patient care standards across healthcare settings and underpins the NCLEX-RN strategy.

NR 325 Pre-Simulation – Carl Rogers

Table 1: Key Components of NCLEX-RN Dimensions and Nursing Practice

References

NCSBN. (n.d.). 2023 NCLEX-RN test plan. Retrieved from https://www.ncsbn.org/publications/2023-nclex-rn-test-plan

NR 325 Pre-Simulation – Carl Rogers

UWorld. (n.d.). NCLEX-RN® Test Plan. UWorld Nursing. Retrieved from https://nursing.uworld.com/nclex-rn/test-plan

NR 325 Pre-Simulation – Carl Rogers

Name

Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

Scenario Overview

Carl Rogers, a 67-year-old African American male with a 20-year history of type II diabetes mellitus, was directly admitted to the medical unit from his physician’s office on Tuesday at 1530. He has a stage II non-healing ulcer on his right heel, and upon arrival, his admission paperwork was completed, and pain medication administered. Additional medical orders include a dressing change and insulin administration, which have yet to be implemented. This scenario takes place at 1700 on Tuesday.

Comparison of Long- and Short-Acting Insulin

1. Long-Acting Insulin:

Long-acting insulin primarily controls hyperglycemia for both type 1 and type 2 diabetic patients. It aids in maintaining blood glucose levels between meals and overnight. The onset for long-acting insulin ranges from 0.8 to 4 hours. Unlike other forms, long-acting insulin does not have a defined peak, reducing the risk of hypoglycemia due to the absence of peak action time (Lewis et al., 2017). The duration spans from 16 to 24 hours. Common types include glargine (Lantus), detemir (Levemir), and degludec (Tresiba).

2. Short-Acting Insulin:

Known as mealtime or bolus insulin, short-acting insulin has a quick onset of action, supporting meal absorption during food intake. The onset ranges from 30 minutes to an hour, with a peak time of 2 to 5 hours and a duration of 5 to 8 hours. Administered 30 to 45 minutes before a meal, it aligns with meal absorption and has a higher risk of hypoglycemia due to its longer duration of action.

NR 325 Pre-Simulation – Carl Rogers

Dietary Education for Type II Diabetes Mellitus

For individuals with Type II diabetes, maintaining a balanced diet is crucial. Weight management is often recommended, especially for those who are overweight or obese. A balanced intake of carbohydrates, fats, and protein is essential to help maintain blood glucose levels. Carbohydrates are an important source of energy, fiber, vitamins, and minerals, tailored individually to meet each patient’s needs. Fiber intake should ideally range from 25 to 30 grams per day. Fat intake, specifically trans-fat, should be minimized with cholesterol limited to 200 mg daily. Protein intake varies, but high-protein diets are typically discouraged for patients aiming for weight loss. Collaboration with a dietitian in meal planning enhances adherence, helping the patient establish realistic health goals (Lewis et al., 2017).

Wound Care Best Practices for Diabetic Foot Ulcers

Effective wound care for diabetic foot ulcers aims at promoting fast healing and preventing infection. Diabetic patients are at increased risk for complications, thus necessitating vigilant wound management. To prevent infection and subsequent complications like necrosis or amputation, wounds require regular, sterile dressing changes. Proper wound dimensions should be documented during initial assessment, establishing a baseline for monitoring healing progress. Hands should be washed, and gloves worn during care. Medicated dressings are sometimes prescribed to create a protective barrier and promote healing. Debridement may be necessary to remove dead tissue and support the growth of healthy tissue.

References

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (10th ed.). St. Louis: Elsevier.

NR 325 Pre-Simulation – Carl Rogers

Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2017). Digoxin. Davis’s Drug Guide for Nurses (15th ed.). Philadelphia, Penn.: F.A. Davis.

Table 1: Comparison of Long- and Short-Acting Insulin

NR 325 Pre-Simulation – Carl Rogers

Table 2: Dietary Recommendations for Type II Diabetes

Table 3: Wound Care Best Practices

NR 325 Exam 2

Name

Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

Exam #2 Topics Review

1. Neurological Conditions

Head Injury

When managing a patient with a head injury, it is essential to anticipate seizures. Patients are generally placed on anticonvulsant medications as a preventative measure. Key signs and symptoms include cerebrospinal fluid (CSF) leakage and notable discoloration.

Increased Intracranial Pressure (ICP)

ICP management requires monitoring specific symptoms and positioning the patient with their head elevated at 30 degrees. Monitoring is typically achieved with specialized devices, and prompt management of these signs and symptoms is crucial to prevent further complications.

Stroke

Understanding the various types of strokes, including ischemic and hemorrhagic, is essential for providing effective management. Immediate CT scans help determine stroke type, guiding appropriate treatment interventions. Management includes maintaining a patent airway, conducting a swallow study, and using thrombolytic therapy where appropriate. Attention to left-sided versus right-sided strokes is also essential for tailored interventions.

Transient Ischemic Attack (TIA)

Often referred to as a “mini-stroke,” a TIA requires immediate management to prevent escalation.

Seizures

Seizure management includes understanding different types, implementing safety precautions, and providing medication therapy as appropriate. Specific considerations are necessary for managing seizure status epilepticus and determining suitable seizure medications based on patient needs.

Meningitis

Key symptoms of meningitis require prompt attention. Management focuses on symptom control and specific tests, such as a lumbar puncture, to confirm the diagnosis.

Parkinson’s Disease

Parkinson’s disease presents with unique symptoms that require monitoring.

Alzheimer’s Disease

A form of dementia, Alzheimer’s disease is characterized by specific symptoms, and its management involves addressing memory loss and behavioral symptoms.

2. Other Conditions Affecting Brain and Nervous System

Intracranial Pressure (ICP)

Normal ICP values are essential for understanding increased pressure levels, which may be caused by edema. Management includes monitoring pressure and administering intracranial diuretics as needed.

Cranial Nerves

Knowledge of cranial nerves, their names, and functions is essential, as well as understanding the cerebellum’s role in balance, tested through the Romberg Test.

Myasthenia Gravis

Myasthenia gravis often leads to paralysis, and priority care includes performing Tensilon testing.

Amyotrophic Lateral Sclerosis (ALS)

ALS results in progressive muscle weakness and wasting. Care for ALS patients involves specific interventions to address priority needs.

Guillain-Barré Syndrome

Management focuses on priority care to address respiratory and muscle weakness symptoms.

Multiple Sclerosis (MS)

MS management involves understanding the unique presentation of the condition, appropriate treatment, and priority care measures.

Delirium

Patients with acute confusion present with specific symptoms that require careful management, with a focus on safety measures.

3. Gastrointestinal and Hepatic Conditions

Spinal Cord Injury

Different spinal cord injury levels, such as T12 and C9, affect patient outcomes differently. Management includes addressing complications and providing physical, occupational, and speech therapy.

Gallbladder Disease

Gallbladder inflammation and gallstones may necessitate surgical intervention. Post-operative care requires specific management to ensure patient recovery.

Pancreatitis

Both acute and chronic pancreatitis have distinct symptoms, with acute cases often associated with hypocalcemia. Chronic pancreatitis management involves lab value monitoring and priority care for patient stabilization.

Hepatitis

Understanding the types of hepatitis and their modes of transmission is crucial for effective disease management.

Cirrhosis of the Liver

Cirrhosis is an end-stage liver disease with incurable status. Patients may experience symptoms such as edema and weight gain. Medication and nutritional management are integral to care, along with addressing complications such as varices and bleeding.

Pancreatic Cancer

Risk factors for pancreatic cancer often include a history of chronic pancreatitis. Priority care measures aim to manage symptoms and support the patient’s overall quality of life.

Liver Cancer

Liver cancer requires risk factor assessment and specific priority care interventions.

NR 325 Exam 2

Table 1: Neurological Conditions

NR 325 Exam 2

References

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.).

NR 325 Adult Health Final Exam Concept Reviews

Name

Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

Focused Gastrointestinal Physical Assessment Techniques

In conducting a focused gastrointestinal (GI) physical assessment, ensure the patient is in a supine position with knees slightly flexed and the head of the bed raised slightly. The patient should also empty their bladder before the assessment. The evaluation sequence is as follows:

• Inspection: Observe the abdomen for any skin changes, umbilicus positioning, symmetry, contour, concavity, or protuberance. Check for hernias, masses, and any observable movements.

• Auscultation: Auscultate before percussion and palpation. Use the stethoscope diaphragm for high-pitched sounds and the bell for lower pitches. Listen to all four quadrants, starting in the right lower quadrant (RLQ), for at least two minutes to determine if bowel sounds are normal, hypoactive, or hyperactive.

NR 325 Adult Health Final Exam Concept Reviews

• Percussion: This technique helps estimate liver size and detect fluid, distention, or masses. Start below the umbilicus at the right midclavicular line and percuss upwards to detect dullness. Move to the nipple line, percuss downwards, and listen for changes indicating the liver’s upper border.

• Palpation: Start with light palpation to assess tenderness, sensitivity, muscular resistance, masses, and swelling. Follow with deeper palpation for organ assessment and mass detection. Keep fingers together, use fingertip pads, depress the abdominal wall approximately 1 cm, and palpate all four quadrants, starting with the RLQ. Monitor for both verbal and non-verbal indications of discomfort.

NR 325 Adult Health Final Exam Concept Reviews

Endoscopic and Biopsy Procedures

Gastrointestinal Blood Studies

1. Amylase (Pancreas and Small Intestine): 40-140 U/L
2. Lipase (Pancreas): 0-160 U/L
3. Total Bilirubin (Liver, Gallbladder): 0.3-1.0 mg/dl
4. AST (Liver): 0-35 U/L
5. ALT (Liver): 4-36 U/L
6. PT (Warfarin-related clotting): 11-13.5 seconds
7. aPTT (Heparin-related clotting): 22-35 seconds
8. Cholesterol (Blood Vessels): Total cholesterol – less than 200 mg/dL; LDL – less than 100 mg/dL; HDL – 40 mg/dL or higher
9. Serum Ammonia (Production: Intestines, Kidneys; Consumption: Liver, Muscles): 6-47 mmol/L (10-80 mcg/dL)

NR 325 Adult Health Final Exam Concept Reviews

References

American Nurses Association. (2020). Nursing: Scope and Standards of Practice. 4th ed. Nursing Publishers.

NR 325 Care Plan 2 Diagnosis

Name

Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

Care Plan for Nursing Diagnoses and Patient Goals

This care plan addresses three main nursing diagnoses with specified goals, interventions, rationales, and evaluations. Each diagnosis is approached with a focus on patient comfort, skin integrity, and hygiene, aligning with the principles of end-of-life and supportive care. Given that the patient is a Ward of the State, the plan does not incorporate significant family involvement or patient education. Instead, the focus remains on providing high-quality, compassionate care to meet the patient’s needs.

Table 1: Nursing Diagnoses, Goals, Actions, and Evaluations

NR 325 Care Plan 2 Diagnosis

References

Deglin, J. H., & Vallerand, A. H. (2011). Davis’s drug guide for nurses (12th ed.). Philadelphia, PA: F.A. Davis.

Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., … Angus, D. C. (2016). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315(8), 801-810. doi:10.1001/jama.2016.0287

NR 325 Care Plan 2 Diagnosis

Tromp, M., Hulscher, M., Bleeker-Rovers, C. P., Peters, L., van den Berg, D. T., Borm, G. F., … & Pickkers, P. (2010). The role of nurses in the recognition and treatment of patients with sepsis in the emergency department: A prospective before-and-after intervention study. International Journal of Nursing Studies, 47(12), 1464-1473.

NR 325 Week 3 Case Study

Name

Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

NR 325 Adult Health II – Case Study #1

Patient Profile

P.J., a 74-year-old female, presents with a complex medical history. She was recently discharged following a 14-day hospitalization for a gangrenous open cholecystectomy in which her gallbladder was removed. Postoperatively, P.J. experienced a bile leak due to gangrene that extended into the common bile duct. She has a history of diabetes and now reports diminished vision in her left eye, persisting for the last seven days. Her current medications include valsartan 160 mg/25 mg daily (ARB for hypertension), amitriptyline 25 mg daily (antidepressant), aspirin 81 mg daily (NSAID), and alprazolam 0.25 mg as needed every six hours for anxiety (benzodiazepine).

Subjective Data

P.J. describes her vision in the left eye as “fuzzy and distorted.” She states, “I survived that horrid ordeal with my gallbladder, and now I have trouble with my vision.” She is unmarried but has a supportive network of friends and caretakers.

Objective Data

• Physical Examination: Blood pressure 119/79 mmHg, pulse 82 beats/min, temperature 97.7°F, respirations 16 breaths/min.
• Mental Status: Alert and oriented to person, place, and time.
• Respiratory Examination: Diminished breath sounds in the bilateral lower lobes posteriorly, likely due to postoperative atelectasis. Potential early signs of pneumonia warrant further assessment for adequate oxygenation. Oxygen saturation is 96% on room air.

NR 325 Week 3 Case Study

Table of Potential Causes of Blurry Vision, Focused Assessment, and Diagnostic and Dietary Interventions

Case Study Progress

Following an ophthalmologist consult, P.J.’s initial eye exam reveals a scar in the central macular area, indicating age-related macular degeneration (AMD). The ophthalmologist recommends preventing further vision loss with photodynamic therapy.

1. Early Signs of Age-Related Macular Degeneration (AMD)

• Early signs of AMD include blurry or distorted central vision, difficulty in recognizing faces, and the need for brighter light when reading.

2. Risk Factors for Macular Degeneration

• Known risk factors include smoking, hypertension, female gender, short body stature, family history, a diet deficient in carotene and vitamin E, and prolonged sun exposure.

3. Diet-Related Teaching for AMD Prevention

• P.J. should consume foods rich in antioxidants, carotene, vitamin E, vitamin C, and vitamin B12, such as leafy greens, eggs, nuts, whole grains, fruits, and vegetables.

NR 325 Week 3 Case Study

NR 325 Adult Health II – Case Study #2

Patient Profile

S.H. is a 25-year-old male presenting to the emergency department with severe vertigo and vomiting lasting for one day. He reports recurrent vertigo spells accompanied by right-sided tinnitus for the past month. He becomes nauseous upon attempting to sit up, experiences worsened vertigo with head movement, and has been crawling out of bed to avoid falls. S.H. currently complains of nausea.

Subjective Data

• Reports that vertigo is exacerbated with head movement, accompanied by nausea.
• S.H. has a history of tinnitus on the right side with increased severity of vertigo symptoms.

Objective Data

• Physical Examination: Blood pressure 139/72 mmHg, pulse 90 beats/min, temperature 97.7°F, respirations 22 breaths/min.
• Neurological Findings: Spontaneous nystagmus in the right eye.
• Vomiting and Diaphoresis: Two episodes of vomiting within the last 30 minutes, intermittent diaphoresis.

Diagnostic Studies

• Audiogram: Severe sensorineural hearing loss at 35.0 dB, with low-frequency impairment in the right ear.
• Weber Test: Right-sided sensorineural hearing loss.

Discussion Questions

1. Definition of Vertigo vs. Dizziness

• Vertigo refers to a sensation of spinning, where the patient feels as if the room is moving around them. Dizziness, by contrast, is a feeling of unsteadiness without the sensation of movement.

2. Potential Diagnosis for S.H.

• Based on the symptoms, including vertigo, tinnitus, and sensorineural hearing loss, S.H. likely has Ménière’s disease.

3. Additional Diagnostic Tests for Vertigo

• Additional tests may include the Romberg test, MRI, CT scan, and vestibular function testing.

4. Causes and Risk Factors of Ménière’s Disease

• Causes include trauma, viral infections, and potential genetic predisposition.

5. Priority Nursing Diagnoses for S.H.

• The primary concern is safety, as S.H. is at high risk of falling due to severe vertigo and associated symptoms.

6. Discharge Teaching for S.H.

• S.H. should be cautioned about the sedative effects of prochlorperazine and diazepam and advised to avoid activities requiring alertness, such as operating heavy machinery, until his symptoms stabilize.

NR 325 Week 3 Case Study