Answer the following questions in three well-developed paragraphs (450–500 words) using APA formatting, integrating two evidence-based resources to include clinical practice guidelines 

RR is 48-year-old woman who comes to see you at the V. A. homeless clinic. The major complaint is a six-day history of worsening cough, productive of green sputum. There have been fever and chills with complaints of pain in the right mid-back with deep breathing or coughing. Further history reveals a history of tobacco use of one pack of cigarettes a day for 30 years. There is an inconsistent health history as a result of PTSD and homelessness. On examination, the skin is warm and clammy, pale; RR appears to not feel well; the temperature is 100.5° F; respiratory rate is 24 breaths per minute; pulse is 98 beats per minute; blood pressure is 120/75 mm Hg; and saturation of oxygen is 96 percent on room air by pulse oximetry.

Auscultation of the lungs reveals rales in the right lower-posterior lung field. The remainder of the examination is within normal limits.

1. What organism(s) do you most      suspect and why?
2. What antibiotic would you      recommend to treat RR with and why?
3. What is the mechanism of action      of this antibiotic?
4. Do you have any counseling points      for RR ?

Post a 1 page (not over 250 words) overview of at least three challenges in the implementation of electronic health records and provide an example of each challenge. Develop strategies for addressing each challenge based on what has been demonstrated to be successful. Cite your resources. Use at least 3 References

FYI: •If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process? •Reflect on the reactions of others during the implementation process. Were concerns handled effectively?

THIS IS A DISCUSSION RESPONSE APA 6TH ED. USING IN TEXT CITATIONS AND REFERENCES.

According to Chinn and Kramer (2014), personal knowing is a process of Self-knowing that is conscious; it is developed deliberately to know fully who you are and to understand your actions and relationships. Personal knowing allows you to take past experiences and reflect on that to develop yourself into a better person to more adequately care for patients. Personal knowing is not just internal reflection of also how people perceive you through your actions. In order to develop personal knowing you can ask the questions “Do I do what I know?” and Do I know what I do?” This allows the person to recognize and hold themselves accountable for providing the best, unbiased care.

A professional strength that I possess would be that I have a great attention to detail when it comes to patient care and my job. When it come to patient assessment, I can quickly notice a change in condition or behavior. I pay attention to a patient’s appearance such as grooming, edema to extremities, or gait. My co-workers always say, “Jen doesn’t miss anything!” My second professional strength is that I strive to be the best at what I am doing. I want to go the extra mile to do what is right for the patient and the people I work with. I do not want to be told twice or reminded on how to do something. When I work in the recovery room, I know what the doctor’s preferences are in caring for the patient.

My first weakness and biggest downfall is that I am critical. I put a lot of pressure on myself and other people to do things correctly. This is something that I continuously must check myself on. Just because it isn’t my way doesn’t mean that it isn’t being done correctly. I have found that through my work and personal experience that if you are constantly picking at someone, they may just give up! My second weakness is that I am not very confident. When I feel insecure and unsure about myself or my skills, I try to talk myself out of it. I clam up in uncomfortable situations.

Benner’s model of skill acquisition theory helps to improve my confidence and attention to detail. My base knowledge and experience help to provide me with the confidence boost that I need. According to McEwen and Wills (2014), expertise develops when the clinician tests and refines propositions, hypotheses, and principle-based expectations in actual practice situations.  I know that in my current position, I am an expert. This makes me feel comfortable that I am making the right decisions for my patients. This can also apply to my weakness of criticism. A novice nurse may not seek advice from me if I am constantly critical of them and their work.

Chin, P. & Kramer, M. (2014) Integrated Theory and Knowledge Development in Nursing: Theory and Process. (9th Ed.); Elsevier.

McEwen, M. & Wills, E. (2014). Theoretical Basis for Nursing (4th Ed.); Lipincott Williams and Wilkins ISBN 9781451190311

  In your reply posts, incorporate challenges you would anticipate for the proposals, as well as arguments to overcome those challenges. Each reply should be 200  :

 Today, I believe most of the money being spent on healthcare should be used on educating patients on possible lifestyle modifications that can be made for many different disease preventions. Diet is one of the most modifiable factors for numerous diseases that the majority of the population suffers from, such as diabetes and hypertension. “The Dietary Approach to Stop Hypertension (DASH) diet, a dietary pattern, currently receiving much attention, was originally designed to reduce blood pressure13; this diet emphasizes intakes of fruits, vegetables, whole grains, nuts, legumes, moderate amounts of low-fat dairy; and underscores reduced intakes of red or processed meats, sodium, and sweetened beverages( Hossein, 2019) ” Here the author stresses the importance of DASH diet and how it can manage hypertension apart from using prescription drugs. With the stress of education on patients, they would be able to manage hypertension and save money on costs such as insurance premiums, and copays. “and higher adherence to DASH diet score was related with lower odds of metabolically unhealthy normal weight phenotype in comparison to metabolically healthy normal weight younger adults ( Hossein, 2019) “ Here, the population can avoid metabolic syndrome by following the DASH diet, which is proven to be a modifying factor. The avoidance of liquor is also a large modifying risk factor in the role of hypertension.
Other modifying factors include exercise. It has been proven that 30 mins of exercise at least 3 times a week reduces blood pressure levels. Diet and exercise have great impact in the prevention of hypertension and diabetes ( type 2) “ brings attention to the importance of healthy aging. Adoption of healthy lifestyle activities such as participating in physical activity on a daily basis is key to maintaining physical and mental health. (Norma, 2020).” Here, we can even use education to involve the elderly population to prevent any extra complications of aging. “he results indicated that the exercise intervention contributed to significant improvements in the older adults’ health-related variables for the EG when contrasted with the control group ( Norma, 2020 )” So, you see the Dash diet, and even exercise is useful at any age so this would be a modifiable factor. This method has also proved to be effective in reducing diastolic, systolic blood pressures, cholesterol, blood lipids, and even depressive symptoms. Money that is given to insurance companies should be spread out to other healthcare branches in order to spread knowledge. Health companies would be putting money towards prevention. Money should also be going towards mandatory screening of preventable diseases. Offices need to be constantly reminded of annual blood work up, lung cancer screening, and even regular blood pressure work up. As far as end of life care goes, money would be spent naturally less on chronic treatments and even procedures because of better health maintenance and wellness which was added earlier in life. In regard to policy utilizing this information we can install schools to have only healthy food option in order to prevent diabetes. The cost of diabetes is a lifelong commitment to insulin, blood checks, and doctor visits if not controlled early on. There should be no sodas, fresh squeezed juices, and more gym time. I hope to see a future that focus more on wellness to eliminate the prognosis of diseases and money spent on these diseases. A lot of diseases can be prevented by exercise, proper eating, and being active with screening. We should educate regrading things like the DASH diet to promote wellness. There should be strict polices in regards to foods in children’s school’s, and free screenings.

1. Watch the patient documentation in EHR for Nurses webminar.
http://www.youtube.com/watch?v=TBs60F6WXpw

2. Watch the YouTube video; Nurse informatics take electronic medical records to the next level.
https://www.youtube.com/watch?v=Dq1Br5bE_y4

3. Watch the YouTube simulated Electronic Health Record DocuCare.
http://vimeo.com/65644695

—Turn in a two page summary of your findings, including any personal experience you have had or know of regarding this topic