Shelly is a 4-year-old preschooler who lives with her parents and younger brother. She and her brother attend a local daycare center during the week while their parents are at work. In the evenings she and her brother take a bath and then their parents read to them before bedtime at 8 PM. Shelly’s daycare class includes many children her age and she enjoys playing outside with them. Although snack times are planned, Shelly would rather play and does not always finish her beverages.

Shelly’s mother calls the clinic and tells the nurse practitioner that Shelly has been “running a fever of 101 F for the past 2 days” and although her temperature decreases to 37.2 C (99 F) with Tylenol, it returns to 38.4 C (101 F) within 4 hours of each dose. Further, her mother says that Shelly complains that “it hurts when I pee-pee”. Shelly’s mother also has noticed that her daughter seems to be in the bathroom “every hour”. She makes an appointment to see the nurse practitioner this afternoon.

The potential diagnosis is UTI.

1.  What other assessment data would be helpful for the nurse practitioner to have?

2.  What are the organisms most likely to cause an UTI?

3.  What is the pharmacological treatment for Shelly? Keep in mind safe dosing.

4.  What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?

APA guideline 

Less than 15 % similarity

 

This assignment is the first step in an ongoing project throughout the course. It is important to formulate your question carefully and specifically – you will be using this question to guide your evidence collection in future modules.

This paper will be in APA format and 2 – 3 pages in length – it must include a title page, page numbers, running head, properly formatted headings, citations, and references. An abstract is not required          

Please address the following areas:

Introduction

• Overview of topic you selected, and why you believe it is a problem

Body

• Discussion of patient/population of interest
• Discussion of intervention of interest
• Discussion of comparison of interest
• Discussion of outcome of interest

Conclusion

• This shouldinclude the complete PICO(T) question written in a grammatically correct, clear, succinct sentence.                                                                    

Comment 1

As a mental health community, outside support and resources are vital to this population. External stakeholders are important for the success of my project for many reasons. External stakeholders provide resources and information that will be essential in providing the best available treatment necessary for postpartum depressed women. A stakeholder can be defined as “a person, group or organization that has interest or concern in an organization. Stakeholders can affect or be affected by the organizations actions, objectives and policies” (Stakeholders, n.d.).  Without our patients and support, their business satisfaction and overall reputation goes down. The idea is also vice versa, without their support and business, we have no references and resources to give to our patients. Some of our stakeholders include National Alliance on Mental Health (NAMI), housing options and shelters. A lot of our resources are outpatient and long-term inpatient care. This support is important because women with postpartum depression will need continuous care after their inpatient stay. They need other community resources to draw from. These resources will help them in a crisis situation.

How we can go about securing this support is through the patient themselves. We keep referring our patients to their resources, which drives business for both companies. Also, when these patients receive exceptional care they will support the businesses and tell other patients with the same mental health problems. Another secure point would be donations. Donations always help the cause, and show our support for their business and impact. Also, promotion is another security. Promotion on how well their business is with individuals with postpartum depression. Securing these stakeholders will be key to my capstone because of all the information that I can obtain and use as research.

Comment 2

As a nurse it is my job to protect my patients and give them the best care that I can. I and other nurses and health care workers cannot achieve this without the assistance of internal and external stakeholders. According to Landau (2017), a stakeholder is either an individual, group or organization who is impacted by the outcome of a project. They have an interest in the success of the project, and can be within or outside the organization that is sponsoring the project” (para 1). Stakeholder support is vital for health care because they are the ones that provide the resources or finances for the necessary resources. They are necessary for my project because I am able to use them for information and help implement my project. For example, the DON has given me permission to use the facility and its resources to gather information. Without the approval of the DON, I would not have access to the facility and the residents. My mentor is also a stakeholder and gives me direct information about the patients and assists with my research about my project. I am able to gain more information from him and the wound care doctor that will assist the care of my patients, treat their wounds, increase their safety, and increase their overall outcome.

In order for me to be successful, I will need to gain and secure their support. I have already gained it, but I can secure it by keeping them interested in my project. The main objective of my project is increasing quality improvement regarding patient care and decreasing incidences of pressure ulcers in nursing homes. I will work with my mentor and meet with him at least once a week, so I can see and learn how he treats the patients wounds. I will try to go on the days when the wound doctor is there, so I can learn how she assesses the wounds and decides what treatment would best suit the patient. Shadowing my mentor would show him and the DON how invested I am in my project and secure their support.

Comment 3

One technological implementation process that I found to be useful for my capstone project is the PPD ACT app for your cellphone. This app is designed to help “doctors better understand the underlying biology and genetic risks of postpartum depression in order to better serve affected women” (Health Power for Minorities, 2015). The app has 2 integral parts:

            Part 1: The app asks the user questions about their experiences with childbirth, mood, and anxiety symptoms after the birth. The responses to these questions will allow the app to point the users in the right direction to doctors in the area, and who would be most effective for treatment.

            Part 2: The second part is the app will have a DNA kit mailed to the individual. The individual will then get a collection of their saliva and have it mailed back to the company. This saliva will then be analyzed and show researchers is there is any difference in women with postpartum versus non-postpartum, and develop treatments and more effective care. (Pact for the Cure, 2017).

This technology could be useful to my capstone project because If I could see the results of the DNA samples, it could provide me with more effective ways to care for postpartum women. It could show me if breastfeeding or medications help the best with postpartum depression decrease. I will be able to provide my patients with the most effective treatment and possibly stop the symptoms in future cases. This research could help stop postpartum depression entirely and give the health care professionals a heads up advantage.

Comment 4

In this modern and fast evolving era where technological advances are appearing and changing at a glance, it is not possible to progress without the implementation of the right technologies. For prevention of occurrence of urinary tract infection and to fight for its cure, the use of technology is crucial. Here, one should incorporate technologically advanced solutions to achieve project objectives. The technology implemented should be easy to use and understandable for all level of users including the nurses and the doctors. It should be available for access easily without any reliability (Parry, 2013). For measurement of this, symptoms can be mentioned on an app which can deduce to the patient if they have urinary tract infection or not. In this way, lots of the caregivers can predict and preliminary resolve problems and can accomplish EBP goal.

Another application would be to use more sensitive methods of detecting bacteria causing UTI (E. coli or Klebsiella) and crucial for UTI indicators, methods like an Accucheck machine. The writer has already seen the type of machine for PTT, and PT/INR used even 10 years ago. The complication with the UTI detection is that it uses microbiological approach for bacteria detection and requires time to grow them. Methods of molecular biology, which are also used in forensics, are useful for the application. The methods can potentially detect a single molecule of DNA in the solution, thus speeding up detection of UTI and fast streaming the process of the treatment. In case a UTI is suspected, a provider starts antibiotics immediately. Therefore, UTI is already strongly suspected even after urinalysis and C&S results are used primarily to confirm the diagnosis and which antibiotic to use.

The doctors, however, should guide the patients not to misuse the app and to not go for self-medication under the influence of the app. If they feel that anything is dangerous, they should reach out to the hospital authorities at earliest instead of relying on the app to give some lifesaving instructions. It should be made clear that the app is for daily prevention implementation purpose rather than self-medication.

Child abuse and maltreatment is not limited to a particular age and can occur in the infant, toddler, preschool, and school-age years. Choose one of the four age groups (infant, toddler, preschool, or school age) and discuss the types of abuse that are most often seen in this age. Discuss warning signs and physical and emotional assessment findings the nurse may see that could indicate child abuse. Discuss cultural variations of health practices that can be misidentified as child abuse. Describe the reporting mechanism in your state and nurse responsibilities related to the reporting of suspected child abuse.