It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. M., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.

Case Scenario

Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.

Objective Data

1. Temperature: 37.1 degrees C
2. BP 123/78 HR 93 RR 22 Pox 99%
3. Denies pain
4. Height: 69.5 inches; Weight 87 kg

Laboratory Results

1. WBC: 19.2 (1,000/uL)
2. Lymphocytes 6700 (cells/uL)
3. CT Head shows no changes since previous scan
4. Urinalysis positive for moderate amount of leukocytes and cloudy
5. Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. M.’s situation. Include the following:

1. Describe the clinical manifestations present in Mr. M.
2. Based on the information presented in the case scenario, discuss what primary and secondary medical diagnoses should be considered for Mr. M. Explain why these should be considered and what data is provided for support.
3. When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
4. Describe the physical, psychological, and emotional effects Mr. M.’s current health status may have on him. Discuss the impact it can have on his family.
5. Discuss what interventions can be put into place to support Mr. M. and his family.
6. Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 

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. 

 Unit 2 Discussion 

Sampling 

It is anticipated that the initial discussion response should be in the range of 250-300 words

How do the sampling methods and sample sizes vary for the different types of quantitative and qualitative research?

• Hypothetically, what sampling method would you use to conduct a study of your selected evidence-based practice problem/topic? Why?
• How would you determine the sample type and size?

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Please review the rubric to ensure that your response meets the criteria.

 

Emotional intelligence is a systematic and scientific way of measuring our people skills. It is those skills and competencies that measure how we express and perceive ourselves, the way we develop and maintain relationships with others (Chamberlain College of Nursing, 2021). This involves using emotions as data to measure the quality of our relationships. It has been said that the majority of the success in business today is about 85% due to emotional intelligence and about 15% technology or actual job skills. This means that our success as leaders is less dependent on our knowledge skills of the job but more on our emotional competence. If we can skillfully perform the duties of the job but do not possess the elements of emotional intelligence such as self-awareness, self-regulation, motivation, empathy, and social skills, we will not be effective leaders with high productivity, high job satisfaction, or great patient outcomes. Success in our work, therefore, requires us to work effectively, efficiently, and cohesively being mindful with other people be it as members of the same team, as leaders, or colleagues. According to   Krén & Séllei, 2021, emotional competencies like self-awareness, awareness of others, and self-management are positive predictable indicators of job performance. Emotional competence helps us to not only reduce friction in our relationships with others but also helps resolve conflicts as they arise and helps the organization thrive.

Identify three strategies to reduce friction and build unity between the parties using emotional competence as the framework?

            Every organizational leadership has to be able to adapt to changes, survive, and thrive in new environments (Sadeghi et al.,).  Emotional competence is one characteristic that can help leaders achieve that goal. Using emotional competence as the framework in order to reduce friction among my team members and build unity, I will exercise social awareness. This enables me to use effective communication to identify what exactly is the root cause of the conflict. As a leader, I’m fully aware that conflict is somewhat similar to an iceberg. What you see on the surface is typically not the cause or the only cause of the conflict but what’s beneath the surface. While exercising empathy, understanding, and being attentive to staff’s needs, I’ll speak to each staff to find out exactly what the conflict or the cause of the conflict is. Oftentimes, causes of conflicts are differences in opinions, perceptions, beliefs, values, needs, assumptions, knowledge, interests, roles and so much more. I will therefore do my best to identify what exactly is beneath the surface, what is the cause of the conflict, and provide my team with the support they so desperately need while helping resolve the conflict.

Through self-management, I’m able to be open-minded to the staff’s perceptions of the conflict, their criticism of my managerial style while gaining their trust. Identifying common grounds is a strategy for the beginning of a mutual relationship, a basis for building a relationship. As a leader, I’ll help the team focus on common grounds, our common interests instead of differences. Focusing on differences limits us but focusing on common grounds such as improved patient outcomes, job satisfaction, job retention helps us to move forward with reduced friction.

Another strategy is using social- awareness to set boundaries.  The team can collaboratively set boundaries on what each member will and will not tolerate and how conflicts can be resolved as they arise.

What outcomes would you identify to measure the effectiveness of each strategy?

Outcomes I’ll use to measure the effectiveness of the strategies will still revolve around communication. Within 3-6months of the conflict resolution, I’ll speak to each member of the team to find out their opinion about the conflict resolution. This I can achieve by either speaking to them directly, having an anonymous survey box where each staff can freely share their anonymous opinions without fear of retaliation. If cost-effective, I can also have an outside entity conduct an employee survey. I can also measure outcomes through employee job performance, productivity, time and attendance, employee attitude, and relationships with one another.

Consider an adversarial relationship that exists between leaders and departments in your organization. How does the culture of the organization affect the situation? What knowledge, skills, and attitudes do you bring to the organization? What would others say are your leadership strengths? How can these strengths be used to reduce the adversarial relationship?

            Interdepartmental or intra-team collaboration is essential for the successful functioning of every organization, especially in healthcare. Collaboration helps promote productivity, teamwork, job satisfaction, job retention, and improved patient outcome. An adversarial relationship that existed between leaders and departments in my organization was when the facility attempted to implement an electronic medical record system (EMR) for anesthesia documentation in the operating room.  Sadly, without consultation with anesthesia leadership, or anesthesia staff adequate training, the hospital not only purchased a system-wide EMR for the hospital but also decided to implement its usage same day throughout the hospital. This of course was not well received by anesthesia leadership, causing significant obvious conflict between the anesthesia department and the hospital administration. The culture of the organization that helped resolve the conflict was both parties owned up to their mistakes with each assuming that the other had good intentions for either implementing the hospital-wide EMR or with anesthesia not going “Live” the same day as the rest of the hospital did. Both parties understood that the EMR was a requirement for reimbursement by the federal government, it was a necessary requirement for promoting patient safety however both parties had different opinions on the timing and the type of EMR to use. With negotiations and discussions, both understood each other’s perspective and after extensive training of the anesthesia staff, the EMR was implemented on a later date by the anesthesia team.

            I bring to the organization not only my job and technical skills as a Certified Registered Nurse Anesthetist (CRNA), but my emotional intelligence as well. I understand that we can all teach and learn from each other therefore I’m always open and receptive to others’ opinions, suggestions and ideas. I believe as healthcare providers; we all inherently want what is best for our patients though we may differ on how to accomplish such goals. I am honest, trustworthy, empathetic, passionate, and relate well with others. Some of the leadership strengths others may say about me include, my ability to respond instead of reacting to situations. I like to acknowledge other people’s emotions and with empathy and mindfulness, I ask clarifying questions as conflicts arise instead of reacting to the actual situation. Another strength is my transparency. I believe that with honesty, truthfulness, and transparency, I’m able to gain trust from my team, therefore, giving me the ability to influence their opinions while allowing me to lead. I respect and value each member of the team understanding that though we have different roles, each role is vital for the success of the organization. These are some of the strengths that can help decrease adversarial relationships in a workplace and promote unity

References

Chamberlain College of Nursing. (2021). NR-703 Week 2: The Emotionally Intelligent Leader [Online lesson]. Adtalem Global Education

 Krén, H., & Séllei, B. (2021). The role of emotional intelligence in organizational performance. Periodica Polytechnica: Social & Management Sciences, 29(1), 1.

Sadeghi, T., Ali Kiani, M., Saeidi, M., Moghaddam, H. T., Ghodsi, M. J., & Hoseini, R. (2018). The relationship between emotional intelligence with administrators’ performance at mashhad university of medical sciences. Electronic Physician, 10(3), 6487-6493. doi:10.19082/6487

I NEED A COMMENT FOR THIS DISCUSSION BOARD WITH AT LEAST 2 PARAGRAPHS AND USE AT LEAST 2 SOURCES NO LATER 5 YEARS. 

Scenario

“Mary  is  a  health  information  management  (HIM)  student  completing  a  clinical  practice  rotation  in  an  acute  care  hospital  in  her  community.  This  week  she  is  learning  about the release-of-information process. At the breakfast table, Mary’s mother asks her to  find  out  what  is  wrong  with  Ruth,  their  next-door  neighbor.  Ruth  has  been  admit-ted  to  the  hospital  twice  in  the  past  three  months, and Mary’s mother wants to know why.  While  processing  the  requests  for  release of information that afternoon, Mary comes  across  one  from  Ruth’s  insurance  company.  Mary  learns  that  Ruth  was  hospitalized due to physical abuse by her husband.  Mary  has  been  in  trouble  with  her  mother  recently.  She  knows  that  if  she  tells “”her  mother  this  information,  she  will  score  “big points.” She is very tempted to tell her mother the information she has learned. Later  that  same  day,  while  responding  to  another  request  for  information,  Mary  realizes  that  the  medical  record  she  is  reviewing belongs to Ron, her best friend’s fiancé.  Mary  learns  that  Ron  has  a  drug  abuse  problem  and  was  recently  diagnosed with HIV. Mary will be the maid of honor at the wedding of Ron and Patricia two months from now, and she knows that Patricia  does  not  know  about  Ron’s  problems.  Mary  becomes  worried  and  wonders whether she should tell her best friend what she has learned, because Ron’s conditions  could  affect  Patricia’s  health  and  the quality of her married life”

Questions:

“What  should  HIM  professionals  do  when  family  or  friends  ask  them  for  information about others or when they discover  things  about  people  they  know during the process of doing their work?  Does  Mary  have  the  right  to  reveal this information to others?”

“In the situation regarding Mary’s friend Patricia  and  her  fiancé  Ron,  would  Mary  be  more  justified  in  revealing  patient  information  than  in  the  situation regarding the next-door neighbor? Why or why not?”

 

Write 2-3 pages, each question should have one full page only, be creative and use your critical thinking, refer to the ethical decision-making matrix which is provided at the end of the chapter.

It is required to follow the APA style format, include a cover page, an introduction, and a conclusion. Use at least three quality current resources within the last five years and from medical journals.

Please review the scoring rubric before you submit your assignment. 

JR is a 56 yo man with h/o asthma, HTN and hyperlipidemia. He presents to the ER today with h/o shortness of breath for 45 minutes at rest. He reports that he was feeling well and in his usual state of health until about an hour ago, when he smelled something burning. 20 minutes later, he began to feel short of breath and was wheezing. He tried using his albuterol inhaler without success, so he proceeded to the ER. Upon arrival, he was tachycardic, tachypneic, wheezing, using accessory muscles and hypertensive. His last admission for an asthma attack was 2 months ago. He denies a recent cold or URI and says the albuterol usually helps him when he feels an attack coming on and tends to use it on a daily basis. He generally has wheezing and shortness of breath on a daily basis. JR reports poor sleep due to waking about 2 times a week for shortness of breath. He has 2 cats, which sleep next to him on his pillow and he lives in an apartment complex. JR does not smoke, but his neighbor smokes. JR is a carpenter by occupation. He monitors his peak flow once a week at home. He reports that his peak flow generally runs about 325 L/min and his personal best is 480 L/min. His current peak flow is 175 L/min.

Medication Prior to Admission:

Albuterol MDI 2 puffs BID-QID PRN

Salmeterol Diskus 1 inhalation QID

Ipratropium bromide MDI 2 puffs QID

Lovastatin 20 mg po HS

Lisinopril 10 mg po QD

Questions:

1. Classify JR’s asthma severity and control based on signs and symptoms prior to this most recent exacerbation and visit to the ED.
2. Classify JR’s exacerbation severity based on PEF and symptoms.
3. Identify the various triggers in JR’s life that may exacerbate asthma and prevent control.
4. Which step should JR have been on prior to ER based on severity and current medications?
5. Which medications are dosed incorrectly and/or inappropriate for JR’s asthma severity?
6. Would a short-burst of oral corticosteroid be indicated at this time? If so, what dose and duration?
7. How would you assess that JR is well-controlled?
8. If JR is well-controlled, how would you step down in therapy?

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text).