Read the article “Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing” by Christine Tanner, which is linked below:

Link to article

In at least three pages, answer the following questions:

1. What do you feel are the greatest influences on clinical judgment? Is it experience, knowledge, or a combination of those things?
2. In your opinion, what part does intuition play in clinical judgment? How do you think you’ll be able to develop nursing intuition?

Additional sources are not required but if they are used, please cite them in APA format.

  

Mr. Hayato is a 65 year old male brought to ER with severe SOB resp rate 40 pulse ox 93%. Past History of emphysema and longstanding chronic obstruction pulmonary disease (COPD) secondary to tobacco use and still smokes 2 PPD (packs per day) for 50 years. 

Acute respiratory distress 

COPD

Peripheral vascular disease

Hospital Stay: ABG’s ph 7.32 PCO2 60.6 PO2 56.2 

In ER, endotracheal intubation  with a # 8 endotracheal tube occurred and patient was placed on ventilator at 15 breath/min with FiO2 at 100%, peep + 5, Tidal volume 400. His CXR showed right lower pneumonia and ETT was at 5 cm above the carina. ABGs were used each morning to guide setting on ventilator setting. His ETT was 21 cm at the lip. His arterial blood gases continue to deteriorate. !00 % was decreased to 80% and peep was increased to +8. The nurse then notices that the patient is getting more tachypneic with tracheal deviation to the right and absent breath sounds on the left with subcutaneous emphysema present.  Please answer questions below:

1. What is the difference between COPD and emphysema? 

2. What is lung compliance and resistance? How are these lung functions affected by COPD?

3. Is this an acceptable placement of the ETT? 

4. What does his initial arterial blood gases indicate?

5. What other type of external ventilation could have been used prior to intubation? 

6. Why can’t the patient stay on 100% oxygen for long periods of time? 

7. What is peep and why is it important for the lungs? What happens when peep is increased and the barometric pressure is changed in the lungs? 

8. What has occurred and what action does the nurse need to take?

9. What has caused the tracheal deviation and what precautions does the nurse need to know about chest tubes? 

10. What is subcutaneous emphysema?

Placement of ETT -https://www.radiologymasterclass.co.uk/tutorials/chest/chest_tubes/chest_xray_et_tubes_anatomy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237149/

https://www.medicalnewstoday.com/articles/322161.php#types

Oxygen- https://science.howstuffworks.com/question4931.htm

Chest tubes- wps.prenhall.com/wps/media/objects/737/755395/chest_tubes.pdf

To support your work, use your course and text readings and also use resources from the University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format. You may use this APA Citation Helper as a convenient reference for properly citing resources.

TASK

Post your initial response to one of the two topics below.

Impementing Change

Topic 1

Change in our work and personal lives is often a stress inducing event. The goal of the change agent should be to mitigate stress as much as possible. 

• Share your experience with change, good or bad.
• If it was “good” experience, what made it good? 
• And if “bad” what made it bad? 
• How to these experiences align with best practices in implementing change in an organization?

Topic 2

Your manager asks you to implement a new process in your unit. Knowing that an important first step in implementing change is to evaluate and document the current process, you tell your manager this but he or she says ‘there is not enough time to do this”.

• How would you make the case to you manager that skipping this step may not provide the outcome that the manager is looking for in this new process?

 

Using the classroom resources or South University Online Library, research the tympanic membrane and the thyroid gland. In a Microsoft Word document of 4-5 pages formatted in APA style, address each of the following criteria.

• Two focused health assessment histories
  • One assessment related to the tympanic membrane and the other focused on the thyroid gland.
  • The assessments can be hypothetical patients or patients you have had in the past (remember HIPAA if you are describing a previous patient).
• A description of the normal and abnormal findings of the tympanic membrane.
• Information on how to examine the thyroid gland using both the anterior and posterior methods.
• A concise note in the subjective, objective, assessment (be sure to include the NANDA diagnosis as well as the medical diagnosis), and plan (SOAP) format with each patient’s encountered findings.
  • For a review of SOAP notes:
  • SOAP Documentaion
• Information about laboratory/diagnostic tests used for screening clients with tympanic membrane or thyroid gland issues.
  • Include the expected normal results for each test.

On a separate references page, cite all sources using APA format. Please note that the title and reference pages should not be included in the total page count of your paper.

• Use this APA Citation Helper as a convenient reference for properly citing resources.
• This handout will provide you the details of formatting your essay using APA style.
• You may create your essay in this APA-formatted template.

 SOAP documentation

 SOAP documentation is a problem-oriented technique whereby the nurse identifies and lists the patient’s health concerns. It is commonly used in primary health-care settings. Documentation is generally organized according to the following headings: 

S = subjective data Example: What is the patient experiencing or feeling, how long has this been an issue, what is the frequency, intensity, duration, what makes it worse or better, any past history, family history, home monitoring results (BP, weight, glucose monitoring), etc. 

O = objective data Example: Results of the physical exam, relevant vital signs, what the nurse observes, etc. 

A = assessment Example: What is the nursing diagnosis or medical diagnosis (for existing problems), identification of the problem, etc. P = plan Example: What interventions are done during the visit, what is the follow-up, what medications have been prescribed or changed, what further testing or investigations are required, when will the patient be seen again, etc. Sample chart note: S: In for refills and review of diabetes. Home glucose monitoring – taking BG readings 3 times/week in morning only (fasting). Average BG 7-8. Has been trying to avoid sugary snacks but has just quit smoking so is finding this difficult. Walking 5 times/week for 30 minutes. 

O: Blood work – A1C 7.2 (was 7.3), LDL 1.9, Ratio 3. BP 118/70. HR 72 regular. A: Diabetes (A1C not at target) 

P: Provided with information on A1C, diabetes and targets. Provided with support and information related to nutrition and strategies to reduce sugary snacks. Reviewed blood glucose testing and will check postprandial sugars 2/week until next visit. 1. Encouraged to book eye exam 2. Due for foot exam next visit 3. Increase metformin to 1000mg bid 4. Repeat BW in 3/12 (annual inc nephropathy screening) – encouraged to check glucometer with bloodwork 5. RTC 3/12 

 

Week 2: Question for Discussion

(Wk # 2: May 11 to May 17 – Main post under Assignment by Wed, May 13 at 11:59 PM EST). 

Students are required to post a minimum of three times per week (1 main post answering the question 100% before Wednesday at 11:59 PM EST and 2 peer responses by Sunday at 11:59 PM EST). The three posts in each individual discussion must be on separate days (same day postings / replies will not be accepted).

Chapter 4 – Traditional Chinese

Questions:  
Choose one of the tonic herbs (discussed on page #60 of your textbook) used in traditional Chinese medicine and answer the following questions? 
1. Is this herb used in the United States? What are the health benefits of this herb?
2. Is there any research study done on this herb? Mention the research study and discuss results of it. 

Guidelines: The answer should be based on the knowledge obtained from reading the textbook, no just your opinion. Is there are 4 questions in the discussion, you must answer all of them. 

Grading Criteria: Student mentions if this herb is used in US (20 points). Health benefits (30 points). Mention research study (20 points). Discuss results of research study (30 points).