A 21-year old female (A.M) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhea, and a fever for 3 days. She states that she has Type I diabetes and has not been managing her blood sugars since she’s been ill and unable to keep any food down. She’s only tolerated sips of water and juices. Since she’s also been unable to eat, she hasn’t taken any insulin as directed. While helping A.M. from the lobby to the examining room you note that she’s unsteady, note that her skin in warm and flushed and that she’s drowsy. You also note that she’s breathing rapidly and smell a slight sweet/fruity odor. A.M. has a challenge answering questions but keeps asking for water to drink.

You get more information from A.M. and learn

• She had some readings on her glucometer which were reading ‘high’
• She vomits almost every time she takes in fluid
• She hasn’t voided for a day but voided a great deal the day before
• She’s been sleeping long hours and finally woke up this morning and decided to seek care

Current labs and vital signs: 

1. What is the pathophysiology for the condition you believe A.M. has?
2. Relate the etiology and clinical manifestations for the condition you identified for A.M.

The practitioner at the urgent care facility makes the decision that A.M. needs to go to the hospital by ambulance. Once at the Emergency Department (ED), the ED physician orders these items:

1. 1000 ml Lactated Ringer’s (LR) IV stat
2. 36 units NPH (Humulin N) and 20 units regular (Humulin R) insulin SQ now
3. CBC with differential; CMP: blood cultures X2 sites; clean-catch urine for UA and C&S; stool for ova and parasites; Clostridium difficile toxin, and C&S; serum lactate; ketone; osmolality; ABGs on room air
4. 1800 calorie, carbohydrate controlled diet
5. Bed rest
6. Acetaminophen (Tylenol) 650 mg orally Q4 hrs PRN
7. Furosemide (Lasix) 60 mg IV push now
8. Urinary output every hour
9. VS every shift

The orders above — which are questionable related to her condition and which are appropriate?

1. What are the expected treatments for this condition?

Instructions:

Summarize the questions above and formulate what may be happening with A.M. and how you would improve her condition.

Use two evidence-based articles from peer-reviewed journals or scholarly sources to support your findings. Be sure to cite your sources in-text and on a References page using APA format. http://rasmussen.libanswers.com/faq/208365

1. Your community is at risk for a specific type of natural disaster (e.g., tornado, flood, hurricane, earthquake). Use Nightingale’s principles and observations to develop an emergency plan for one of these events. Outline the items you would include in the plan.

2. Using Nightingale’s concepts of ventilation, light, noise, and cleanliness, analyze the setting in which you are practicing nursing as an employee or student.

3. You are participating in a quality improvement project in your work setting. Share how you would develop ideas to present to the group based on a Nightingale approach

This assignment will incorporate a common practical tool in helping clinicians begin to ethically analyze a case. Organizing the data in this way will help you apply the four principles and four boxes approach.

Based on the “Case Study: Healing and Autonomy” (attached) and other required topic study materials, you will complete the “Applying the Four Principles: Case Study” document that includes the following: (attached)

Part 1: Chart

This chart will formalize the four principles and four boxes approach and the four-boxes approach by organizing the data from the case study according to the relevant principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice.

Part 2: Evaluation

This part includes questions, to be answered in a total of 500 words, that describe how principalism would be applied according to the Christian worldview.

Remember to support your responses with the topic study materials.  

Read Chapters 3 from Practicing Dignity.

URL:https://www.gcumedia.com/digital-resources/grand-canyon-university/2020/practicing-dignity_an-introduction-to-christian-values-and-decision-making-in-health-care_1e.php 

APA style is not required, but solid academic writing is expected.

You are required to submit this assignment to LopesWrite. 

Section B: Literature Support

To begin, work through the reference list that was created in the Problem Description Assignment in Topic 2. Appraise each resource using the “Rapid Critical Appraisal Checklists” available in the textbook appendix. The specific checklist you use will be determined by the type of evidence within the resource.

Develop a research table to organize and summarize the research studies. Using a summary table allows you to be more concise in your narrative description. Only research studies used to support your intervention are summarized in this table. Refer to the “Evaluation Table Template” available in the textbook appendix or use the “Evaluation Table Template” resource as an adaptable template.

Write a narrative of 750-1,000 words (not including the title page and references) that presents the research support for the project’s problem and proposed solution. Make sure to include:

1. Description of the search method (i.e., databases, keywords, criteria for inclusion and exclusion, and number of studies that fit your criteria).
2. Summarization of all of the research studies used as evidence. The essential components of each study need to be described so that readers can evaluate its scientific merit, including study strengths and limitations.
3. Description of the validity of the internal and external research.

It is essential to make sure that the research support for the proposed solution is sufficient, compelling, relevant and from peer-reviewed professional journal articles.

Although you will not be submitting the checklist information or the evaluation table you design in Topic 3 with the narrative, the checklist information and evaluation table should be placed in the appendices for the final paper.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required for the individual sections, but is required for the final paper.

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. 

Upon receiving feedback from the instructor, refine Section B for your final submission.

AttachmentsHCA699.R.EvaluationTable_student.docx