Let’s suppose you have just started working in a long-term care facility, as a nurse, and you have a client who has been living there for several years. He/she does not want to participate in any activities, only comes out of their room for meals, walks a bit hunched over with a cane, is not well groomed, and does not seem to have made any true friendships with the other residents. This person can be male or female and seems to be angry most of the time when interacting with others.

How would you go about establishing a rapport with this person? If the client accepts you, what questions would you ask him/her in order to identify the reasons for why they do not participate in activities and what did the client tell you? Depending on their answer, do you think they suffer from low self-esteem, disturbed body image, fears of some kind, anxiety, or hopelessness? Finally, list several interventions you would find in the care plan that could help this person to gain happiness in life and why they may be helpful.

 Research recent (within the last 5 years) Electronic Health Records (EHR) implementation issues by searching online or within the Rasmussen library. Discuss at least 2 issues identified, such as healthcare providers’ issues (physicians, nurses, and other users). Explain the challenges. How could these be mitigated? What do you think should be done? Reflect from your own experiences if you have encountered challenges, either professionally or as a patient, with EHR. 

Case Study, Chapter 31, Assessment and Management of Patients With Hypertension

1. Joan Smith, 55 years of age, is a female patient who presents to the intensive care unit with the diagnosis of intracranial hemorrhage. The patient stopped taking her antihypertensives suddenly because of the cost of the medications and she recently lost her job to outsourcing. The patient is slightly drowsy and complains of a headache and blurred vision. The patient’s blood pressure is 220/130 mm Hg upon presentation.

(Learning Objective 6)

1. According to the definitions set by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7), which type of hypertensive crisis is the patient currently experiencing?
2. Describe the treatment goals for handling the hypertensive crisis and apply the goals to the case study. Determine the current mean arterial pressure (MAP) and the goals for treatment.

The physician orders nicardipine hydrochloride (Cardene) 25 mg/250 mL, NS for peripheral IV starting at 2.5 mg/hr, and titrate by 2.5 mg/hr every 15 minutes to reach the goal for the first hour, which is to achieve 25% reduction of the initial MAP. 

• Call the physician if the dosing range of 15 mg/hr has been reached and the MAP is still not at target goal for the first hour of treatment, or up to four dose increases.
• Lower the BP within 6 hours to 160/100 mm Hg.
• Adjust the IV rate so that the IV fluids plus the nicardipine IV drip are equal to 100 mL/hr, in total. Call the physician if the IV fluids must go above 100 mL/hr to provide the nicardipine.

c. Explain what rate to set initially for both the nicardipine drip and the NS maintenance fluids.

d. Explain the process of titrating the nicardipine drip for the first hour to achieve the final MAP goal of 25% reduction of the original MAP. 

2. The community health nurse is preparing a program about hypertension for a local community center. The focus of the program is on the reduction of risk factors and compliance for those who have been diagnosed with high blood pressure. The target population includes older adults. (Learning Objectives 1 to 4) 

1. The nurse focuses on primary hypertension because it accounts for 90% to 95% of hypertension in the United States. What risk factors does the nurse include for this population?
2. The nurse prepares to discuss the changes in how the JNC 7 defines hypertension. What ranges and descriptions should the nurse include?
3. Because this is a gerontologic audience, the nurse needs to review why blood pressure increases with age. Explain how the structural and functional changes of aging contribute to higher blood pressure in the older adult.
4. What information does the nurse include about lifestyle modifications that may decrease risk of hypertension (or complications associated with diagnosed hypertension)?

Assignment: Application: Planned Change
in a Department or Unit

Health care organizations are continuously immersed in change from the emergence of new policies, to promote quality care and improve patient safety to keeping pace with the rapid growth in knowledge and best practices. Establishing a solid framework for planning and implementing change is a wise move, as it provides a foundation for the extensive coordination that will be needed to successfully facilitate the change.

For this Assignment, you propose a change at the department or unit level and develop a plan for guiding the change effort.

To prepare:

• Review Chapter 8 in the course text. Focus on Kurt Lewin’s change theory, and contrast it with other classic change models and strategies.
• Reflect on problems, inefficiencies, and critical issues within a specific department, unit, or area in your organization or one with which you are familiar. Select one issue as a focal point for this assignment, and consider a change that could be made to address the issue.
• Think about how the change would align with the organization’s mission, vision, and values as well as relevant professional standards.
• Using one of the change models or strategies discussed in Chapter 8, begin formulating a plan for implementing the change within the department/unit. Outline the steps that you and/or others should follow to facilitate the change effort. Align these steps to the change model or strategy you selected.
• Determine who should be involved in initiating and managing the change. Consider the skills and characteristics that are necessary to facilitate this change effort.

Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following:

• Identify a problem, inefficiency, or issue within a specific department/unit.
• Describe a specific, realistic change that could be made to address the issue.
• Summarize how the change would align with the organization’s mission, vision, and values as well as relevant professional standards.
• Identify a change model or strategy to guide your planning for implementing the change. Provide a rationale for your selection.
• Outline the steps that you and/or others would follow to facilitate the change. Align these steps to your selected change model or strategy.
• Explain who would be involved in initiating and managing this change. Describe the skills and characteristics that would be necessary to facilitate the change effort.