HEENT Article (Carotid Artery Stenting)

Attached Files:

•  carotid_stent_technique_article.pdf (581.732 KB)

Please answer the following questions after reading the article:

1. What are the parameters for considering whether to perform carotid surgery? (two conditions)

2. Reduction in the stroke risk in patients with atherosclerotic disease has been attributed to the use of what or which intervention? (three of them)

3. Experts feel which is a safer means of treating carotid stenosis? Medical Management or surgery?

4. What is a carotid endartarectomy? Explain..

5. Name three contraindications to carotid stenting?

6. What is the one most critical factor from studies that increase peri-procedural complications?

The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Colleges of Nursing (AACN), using nontraditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, specific care discipline, and local communities.

This assignment consists of both an interview and a PowerPoint (PPT) presentation.

Assessment/Interview

Select a community of interest in your region. Perform a physical assessment of the community.

1. Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.”
2. Interview a community health and public health provider regarding that person’s role and experiences within the community.

Interview Guidelines

Interviews can take place in-person, by phone, or by Skype.

Develop interview questions to gather information about the role of the provider in the community and the health issues faced by the chosen community.

Complete the “Provider Interview Acknowledgement Form” prior to conducting the interview. Submit this document separately in its respective drop box.

Compile key findings from the interview, including the interview questions used, and submit these with the presentation.

PowerPoint Presentation

Create a PowerPoint presentation of 15-20 slides (slide count does not include title and references slide) describing the chosen community interest.

Include the following in your presentation:

1. Description of community and community boundaries: the people and the geographic, geopolitical, financial, educational level; ethnic and phenomenological features of the community, as well as types of social interactions; common goals and interests; and barriers, and challenges, including any identified social determinates of health.
2. Summary of community assessment: (a) funding sources and (b) partnerships.
3. Summary of interview with community health/public health provider.
4. Identification of an issue that is lacking or an opportunity for health promotion.
5. A conclusion summarizing your key findings and a discussion of your impressions of the general health of the community.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA format ting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

AttachmentsNRS-428VN-RS4-FunctionalHealthPatternsCommAssessment.doc
NRS-428VN-RS4-ProviderInterviewAcknowledgementForm.doc

3-One area of nursing that seems to be an ongoing problem is nurse to patient ratio. I feel like when this subject is brought up to those in charge of staffing, they want to roll their eyes at me or whoever is asking about it. I understand that nurses have been wanting less patients for as long as I can recall. The problem is more than just floor nurses complaining. With the advancements in technology and medicine, patients are able to have their cares at home or surgeries on an outpatient basis. Those “walkie talkie” patients are becoming fewer and fewer in the hospital. The patients that we take care of on a daily basis are sick. And I mean they are sick. These patients that may have been ICU patients in the past are now on acute care floors and are being cared for by a nurse that has four other very sick patients. If they had been admitted to the ICU, their nurse may have only one more patient. Floor nurses are being pulled very thin which also leads to nurses feeling burnt out and can have those nurses looking for a different job, which leads to the nursing shortage (Garretson, 2004). We have continued to have the same nurse to patient ratio for years now even though the patients being seen are getting sicker. If nurses had less patients to care for, closer attention can be given to their patients and the risk of mortality can be decreased (Shekelle, 2013)

Garretson, S. (2004). Nurse to patient ratios in American health care. Nursing Standard, 19(14), 33-37. Retrieved 8 29,

 2018, from 

      https://ncbi.nlm.nih.gov/pubmed/15633873

Shekelle, P. G. (2013). Nurse–Patient Ratios as a Patient Safety Strategy: A Systematic Review. Annals of Internal

5-I like your post. Of course Nurses play an important customer service role for hospitals, doctors offices and other medical facilities. Nurses are the ones with the most frequent, direct patient interaction. I just want to share  the best way to provide excellent customer services .

Be personable and connect with patients:

• Listen
• Use      touch when appropriate
• Make      eye contact
• Do      not rush interactions with patients
• Acknowledge      that you are understanding the patients desires and concerns by      summarizing and stating them back to the patient and verifying that you      both are on the same page.

Use appropriate language:

• Discuss      medical information in language that patients can understand

For example: If a patient has a fourth grade reading level do not use every big word and medical term possible when discussing medical information

Show that you care:

• Ask      patients if they have any questions or concerns
• Take      the time to listen to any questions or concerns that the patient may have
• Show      empathy and acknowledge their issues
• Address      their issues and keep them informed on actions being taken

Involve patients in their care:

• Give      patients choices whenever possible
• Take      their preferences into consideration and formulate a plan together
• Be      knowledgable and considerate of the cultural, social or economic factors      that influence their care, decision making, and interation with the      healthcare team

6-Medication errors are one of the most common causes of unintended harm to patients. Med errors can lead to patient disability or even death. The problem is many nurses are in a hurry or don’t even realize they have administered the wrong medication. This can not only lead to possible further harm but does nothing to correct the error as it goes unnoticed. A patient returns from surgery, anxious and in pain, with several I.V. lines and intracranial pressure (ICP), monitor in place. The I.V. tubing used in the operating room differs from the tubing used in the intensive care unit (ICU). In her haste, the ICU nurse prepares to inject morphine into the patient’s ICP drain, which she has mistaken for the central line. She stops just in time when she realizes she is about to make a severe mistake.  The nurse did not complete her five rights before administration leading to a med error. With the new mandated law of electronic charting, we are required to scan our meds which may cut back on the number of errors, but I do not believe it will eliminate them. Technology is growing in hospitals and helping nurses to go right path and prevent medication errors, but unfortunately, med error still exists. Nurses can help further eliminate medication errors by following five rights and completing the appropriate checks before administering any medications. A possible benefit to help reduce medication errors may be to extend new grads internships as well. Education is the key to prevent the medication error. Medication administration is a complicated multistep process that encompasses prescribing, transcribing, dispensing, and administering drugs and monitoring patient response. An error can happen at any step. Although many errors arise at the prescribing stage, some are intercepted by pharmacists, nurses, or other staff.

References

American Nurses today-ANA:https://www.americannursetoday.com/medication-errors-best-practices/

Nurse Perceptions of Medication Errors: What We Need to Know for Patient Safety: https://www.nursingcenter.com/journalarticle?Article_ID=514523

Please, post a response to the following discussion in APA format without cover page, one paragraph, using one reference from peer-reviewed Nursing Journal not older than 5 years.

     Abdominal Assessment

Performing a thorough assessment is an essential skill. The treatment for any client is based on the diagnosis, and that diagnosis relies entirely on the assessment. To assess a 78-year-old male with a chief complaint of abdominal pain, bloody diarrhea, fever, and weight loss; there are many important factors to take into consideration. First, it is crucial to assess more in-depth the chief complaint, known as a history of current illness. These will include an assessment of the abdominal pain following the pqrst. Also, an assessment of his bowel movement (diarrhea), when did it started, what causes it, what makes it subsides; did he took anything to stop it, did he had any changes in his eating habits, ask him to describe his bowel movements, and did any nausea or vomiting accompany it. Next, an assessment of the fever to find out when did start it, what was his highest temperature reading, what causes the fever to subside, was he exposed to any diseases like Clostridium difficile or food poisoning and is it accompanied by chills. Additionally, an assessment of his weight loss to see how much weight did he lost and in how long, was the weight loss intentionally, what type of diet does he follows, is there any cultural or belief factors that affect his diet.  

After the history of the current illness is obtained, the assessment continues into the risk factors. These will include a list of medications, and if the client is taking any NSAIDs or blood thinners; food, drugs, and environmental allergies; use of tobacco, alcohol and recreational drugs; history of vaccinations and traveling out of the country; past medical history (PMH), past surgical history (PSH), family history, previous hospitalizations, history of previous gastrointestinal (GI) problems like GERD, peptic ulcers, inflammatory bowel disease (IBD), anemia, and celiac disease, history of previous diagnostics GI tests and results like endoscopies and lab work. Also, assessment of living conditions, whom does he lives with, who prepares his meals, does he has access to drinking water and electricity. Even though certain diseases are not common in the US, the healthcare provider should never exclude them from the assessment. Assessing for parasitic diseases is a critical component for patients with GI symptoms and fever. Even though is more common in developing countries, it should not be ignored in the US. Commonly caused by ingestion of contaminated food or water, parasitic diseases are often misdiagnosed for tumors. The common symptoms are abdominal pain, diarrhea, bloody stool, fever, and weight loss (Çiftci, Bulut, Özdaş & Yıldırım. 2018). Amebomas are variable in sizes and on assessment are found as a palpable mass that causes obstructive symptoms and mimics many other diseases.

The next step is the physical examination. These start with the inspection, looking for the color, contour, size, shape,  pulsations, and lessions (Jensen, 2015). Then, the assessment continues with the auscultation of the bowel sounds over the four quadrants and the vascular sounds. The next step is percussion of the four abdominal quadrants assessing for the size of the organs and looking for tympanic sounds over the hollow areas and dullness over the organs, masses, fluids or obstructions (Jensen, 2015). The palpation is performed at the end, beginning with light palpation and assessing for pain, then follow by deep palpation to check for organs, masses, or tenderness (Jensen, 2015).

The documentation of the assessment findings is done using the SOAP format. All subjective data is documented under S, and all objective data is documented under O.  The assessment or diagnosis is written under A., And the plan of treatment is documented under P.