A 32-year-old Native American/Indigenous female patient is admitted to the emergency room with the following symptoms: abdominal pain and tenderness, nausea/vomiting, and chills. Her vitals are 109/52, T: 101.9 oral, P: 98 and regular, R: 26.

Assignment:

Based on what you have learned so far in this course, create a PowerPoint presentation that addresses interventions.

Use clear headings that allow your professor to know which bullet you are addressing on the slides in your presentation. Support your content with at least 4 sources throughout your presentation.

Make sure to reference the citations using the APA writing style for the presentation. Include a slide for your reference at the end. Follow best practices for PowerPoint presentations related to text size, color, images, effects, wordiness, and multimedia enhancements.

This week covered the basics of an EHR, barriers to clinician adoption, and some dissatisfactions on the part of patients. Create a PowerPoint presentation with speaker notes providing the detail on a minimum of 3 and a maximum of 5 interventions nurses should implement that enforce best user practices with the EHR that help maintain patient-centered focus during care and interactions with patients and their families

Assignment Expectations   

Length: 10 (without counting title and reference slides)

Structure: Create a PowerPoint presentation with speaker notes (50 words speaker notes) that includes title and reference slides in APA style.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least 4 scholarly sources to support your claims.

Discussion Question:

A 32-year-old Native American/Indigenous female patient is admitted to the emergency room with the following symptoms: abdominal pain and tenderness, nausea/vomiting, and chills. Her vitals are 109/52, T: 101.9 oral, P: 98 and regular, R: 26.

 

The patient has a history of kidney failure and has been on peritoneal dialysis for the past 6 months. She is single, lives alone, and is on Medicaid.

• List the cues that are of immediate concern
• Explain why these cues are of concern.
• What do you think is occurring with this patient (may be more than 1)?
• What priority nursing interventions would you implement?
  • Discuss the appropriate members of the interdisciplinary team to include in this patient’s care and why.
  • Discuss any religious, cultural, or ethnic considerations.
• Explain how you would determine if these interventions were effective.

List the cues that are of immediate concern:
1. Abdominal pain and tenderness
2. Nausea/vomiting
3. Chills
4. Low blood pressure (109/52)
5. Elevated temperature (101.9 oral)
6. Increased respiratory rate (26)

Explain why these cues are of concern:
The cues listed above raise several concerns. Abdominal pain and tenderness, along with nausea/vomiting, could indicate a gastrointestinal issue, such as an infection or obstruction. Chills may suggest the presence of an infection. Low blood pressure could be a sign of hypovolemia or sepsis. An elevated temperature and increased respiratory rate may be indicative of an underlying infection or inflammation. Considering the patient’s history of kidney failure and peritoneal dialysis, there is a possibility of peritonitis, a serious infection of the peritoneum, which is a risk associated with dialysis.

What do you think is occurring with this patient (may be more than one)?
Based on the given information, it is possible that the patient is experiencing peritonitis, an infection of the peritoneum, which could be associated with her history of kidney failure and peritoneal dialysis. Additionally, the presence of chills, elevated temperature, and increased respiratory rate raises concerns about systemic infection or sepsis.

What priority nursing interventions would you implement?
1. Assess the patient’s vital signs frequently to monitor any changes or worsening of the condition.
2. Start intravenous (IV) access for fluid resuscitation if the patient’s blood pressure remains low or if signs of hypovolemia are present.
3. Administer prescribed analgesics to alleviate abdominal pain.
4. Collect blood and urine samples for laboratory analysis to identify the causative agent of infection, assess kidney function, and check for electrolyte imbalances.
5. Initiate appropriate antibiotic therapy as per the healthcare provider’s order.
6. Maintain strict aseptic technique during peritoneal dialysis to prevent further infection.
7. Collaborate with the interdisciplinary team, including nephrologists, infectious disease specialists, and the primary care provider, for comprehensive management of the patient’s condition.
8. Provide education to the patient regarding the signs and symptoms of infection, adherence to peritoneal dialysis guidelines, and the importance of medication compliance.

Discuss the appropriate members of the interdisciplinary team to include in this patient’s care and why.
The appropriate members of the interdisciplinary team for this patient’s care may include:
1. Nephrologist: They specialize in the management of kidney diseases and can provide expert guidance in the patient’s kidney failure and peritoneal dialysis treatment.
2. Infectious Disease Specialist: They can assist in the diagnosis and management of the underlying infection, such as peritonitis, and help determine the appropriate antibiotic therapy.
3. Primary Care Provider: They play a crucial role in coordinating the patient’s overall care and collaborating with other specialists involved in her treatment.
4. Registered Nurse: The bedside nurse is responsible for monitoring the patient’s condition, administering medications, providing comfort measures, and assessing the effectiveness of interventions.
5. Clinical Pharmacist: They can review the patient’s medication regimen, ensure appropriate dosing, monitor for drug interactions, and provide guidance on antibiotic therapy.
6. Social Worker: As the patient is single, lives alone, and is on Medicaid, a social worker can assess the patient’s social support, financial resources, and assist with coordinating any necessary social services or home care arrangements.

Discuss any religious, cultural, or ethnic considerations.
It is important to consider the patient’s Native American/Indigenous background in providing culturally sensitive care. Native American cultures often have specific beliefs, practices, and values that may influence their healthcare decisions.

Some possible religious, cultural, or ethnic considerations in providing care for a Native American/Indigenous patient include:

1. Traditional Healing Practices: Native American cultures often incorporate traditional healing practices alongside Western medicine. It is important to respect and acknowledge these practices, and if appropriate, integrate them into the patient’s care plan with their consent.

2. Sacred Objects and Rituals: Native American patients may have sacred objects or rituals that hold spiritual or cultural significance. Healthcare providers should be aware of these items and respect their importance to the patient. It is essential to communicate with the patient and their family to understand any specific rituals or objects that should be accommodated during their care.

3. Communication and Language: Native American communities may have unique languages or dialects. Efforts should be made to provide language interpretation services, if needed, to ensure effective communication between the healthcare team and the patient. Moreover, healthcare providers should be mindful of potential language barriers and employ culturally appropriate communication techniques to establish trust and understanding.

4. Cultural Traditions and Beliefs: Native American cultures often place importance on communal values, respect for elders, and the interconnectedness of individuals with nature and the community. Understanding and respecting these cultural values can help establish a therapeutic relationship with the patient and facilitate patient-centered care.

5. Family Involvement: Native American communities often have strong family ties and place importance on collective decision-making. Involving the patient’s family or trusted community members in care discussions, with the patient’s consent, can support the patient’s emotional well-being and facilitate shared decision-making.

6. Trauma-Informed Care: Historical traumas, such as forced assimilation, displacement, and discrimination, have affected Native American communities. Healthcare providers should be aware of the potential impact of these traumas on the patient’s health and well-being, and approach care with sensitivity and empathy.

Explain how you would determine if these interventions were effective.
To determine the effectiveness of the interventions implemented for the patient, several assessment measures can be taken:

1. Monitoring Vital Signs: Regular monitoring of vital signs, including blood pressure, temperature, heart rate, and respiratory rate, can help assess the patient’s physiological response to treatment. Stable or improving vital signs may indicate a positive response to interventions.

2. Symptom Assessment: Continuously assessing the patient’s symptoms, such as abdominal pain, tenderness, nausea/vomiting, and chills, can provide insight into the effectiveness of pain management, fluid resuscitation, and antibiotic therapy. Reduction in symptoms or their resolution indicates the interventions are having a positive effect.

3. Laboratory Analysis: Analyzing blood and urine samples collected for laboratory tests can provide objective data on the presence of infection, kidney function, and any changes in electrolyte levels. Improvement in laboratory values, such as reduced inflammatory markers or normalized kidney function, can indicate the effectiveness of interventions.

4. Patient Feedback: Regular communication and feedback from the patient regarding their comfort level, pain relief, and overall well-being can help assess the effectiveness of nursing interventions. Open dialogue with the patient can provide valuable information about their perception of the care received.

5. Collaborative Evaluation: Collaboration with the interdisciplinary team, including the nephrologist, infectious disease specialist, primary care provider, and clinical pharmacist, allows for ongoing evaluation of the patient’s progress and the effectiveness of interventions. Regular team meetings and discussions can help identify any necessary adjustments or modifications to the care plan.

By considering these assessment measures and actively involving the patient in their care, healthcare providers can evaluate the effectiveness of the interventions implemented and make informed decisions to optimize the patient’s outcomes.

Assignment

Using the Nelson Data to Wisdom continuum model as the framework for discussion, provide specific examples of how the typical functionality found in a clinical system such as an EHR meets these levels and explain how the levels and functionality apply to the professional practice of nursing.

Many software companies are proprietary regarding their coding, functionality, internal data parsing, and data storage methods which may make interoperability challenging. Based on your reading chapters and assigned article, explain two significant problems related to interoperability and create at least one solution to each. How do your solutions technically and financially impact healthcare on a global scale?

Two significant problems related to interoperability in healthcare are:

1. Lack of Standardized Data Formats: One problem is the lack of standardized data formats across different software systems and healthcare organizations. Each software company may use its own proprietary formats, making it difficult for different systems to exchange and interpret data accurately. This leads to data fragmentation and inefficiencies in sharing patient information.

Solution: The adoption and implementation of standardized data formats, such as HL7 FHIR (Fast Healthcare Interoperability Resources), can help address this problem. FHIR provides a standardized way of structuring and exchanging healthcare data, allowing systems to communicate and share information seamlessly. By implementing FHIR as a common standard, healthcare organizations can achieve greater interoperability and improve data exchange between different software systems.

Technical and Financial Impact: Implementing standardized data formats like FHIR can have significant technical and financial impacts on healthcare globally. Technically, it enables seamless integration and exchange of patient data across different systems, leading to improved care coordination, reduced errors, and enhanced decision-making. Financially, it can help healthcare organizations save costs by reducing the need for custom interfaces and complex data conversions between systems. It also promotes competition and innovation among software vendors, as they can focus on building solutions that adhere to the standardized format rather than investing resources in proprietary data formats.

2. Limited Data Sharing Due to Privacy and Security Concerns: Another challenge in interoperability is the concern over privacy and security of patient data. Healthcare organizations and software companies often have strict privacy policies and compliance requirements that limit the sharing of patient information to ensure data protection. This can impede interoperability efforts and hinder the seamless exchange of data between systems.

Solution: One solution to address this problem is the implementation of robust data security and privacy frameworks, such as encryption, access controls, and audit trails. Additionally, the use of patient consent management systems can empower individuals to control the sharing of their health information and give informed consent for data exchange. By adopting privacy-enhancing technologies and ensuring transparent data governance practices, healthcare organizations can strike a balance between data security and interoperability.

Technical and Financial Impact: Implementing robust privacy and security measures not only protects patient data but also builds trust among patients and healthcare stakeholders. It enhances data confidentiality, integrity, and availability, thereby reducing the risk of data breaches and unauthorized access. From a financial perspective, while there may be upfront costs associated with implementing these measures, they can help prevent costly data breaches and legal consequences. Moreover, improved interoperability resulting from enhanced privacy and security can streamline healthcare processes, reduce redundancies, and ultimately lead to more efficient and cost-effective care delivery on a global scale.

By addressing these two significant problems related to interoperability through standardized data formats and robust privacy and security measures, healthcare can experience improved data exchange, care coordination, and patient outcomes. The technical advancements and streamlined workflows resulting from these solutions contribute to the overall advancement and financial sustainability of healthcare systems globally.

You are the nurse on a renal unit. Consider following patients with renal issues. Provide at least a one-paragraph answer to each question.

1. The nurse notices the patient’s renal labs indicate the onset of kidney failure. What are the nurse’s top three priorities?

2. The nurse is reviewing a patient’s urinalysis report and finds many areas are positive. Identify and explain the significance of abnormal findings in each area of the urinalysis report (color, clarity, pH, specific gravity, glucose, blood, ketones, protein, bilirubin, leukocyte esterase, nitrite, white blood cells, red blood cells, epithelial cells, bacteria).

3. With any type of electrolyte replacement, such as potassium or magnesium, why is it important to know and understand what the patient’s renal status is before giving the supplements?

4. You are administering morning medications to a patient. The patient states that they are taking bumetanide not furosemide at home. What is your first action? What other actions will you take after the initial one?

5. The patient had their indwelling catheter removed 8hr ago and has not voided. What actions will you take? Prioritize your actions and provide a rationale for each action.

6. The patient had their indwelling catheter removed 8hr ago and has not voided. What possible complications can occur if the patient does not void soon?  How will you know complications are manifesting (what will you see)? What will you do to prevent possible complications?

Assignment Expectations
Length: 1200 words; answers must thoroughly address the questions in a clear, concise manner.

1. When the nurse notices the onset of kidney failure based on the patient’s renal labs, the top three priorities are:

a) Assessing the patient’s fluid and electrolyte balance: Kidney failure can disrupt the body’s fluid and electrolyte balance, leading to imbalances such as hyperkalemia or hypervolemia. The nurse should closely monitor the patient’s vital signs, assess for signs of fluid overload or dehydration, and collaborate with the healthcare team to adjust fluid and electrolyte replacement therapies as needed.

b) Managing symptoms and complications: Kidney failure can present with various symptoms such as fatigue, edema, and changes in urine output. The nurse should assess the patient’s symptoms, administer prescribed medications (e.g., diuretics or phosphate binders), and provide interventions to manage complications such as hyperkalemia (e.g., administering Kayexalate or initiating cardiac monitoring).

c) Educating the patient and family: Kidney failure is a serious condition that requires ongoing management and lifestyle adjustments. The nurse should provide education on dietary restrictions (e.g., low sodium and potassium), medication adherence, fluid intake monitoring, and signs and symptoms of complications. It is important to ensure the patient and family understand the importance of follow-up appointments and adherence to the treatment plan.

2. Abnormal findings in each area of the urinalysis report:

– Color: Abnormal colors (e.g., dark brown or red) may indicate the presence of blood, bilirubin, or certain medications in the urine, suggesting possible kidney or liver dysfunction.
– Clarity: Cloudy or turbid urine can indicate the presence of bacteria, white blood cells, or other particles, suggesting infection or inflammation in the urinary tract.
– pH: Abnormal pH levels can indicate acidosis or alkalosis, which may be associated with renal dysfunction or metabolic imbalances.
– Specific Gravity: Abnormal specific gravity values may indicate impaired kidney function, dehydration, or fluid overload.
– Glucose: Presence of glucose in the urine (glycosuria) may indicate uncontrolled diabetes or kidney tubular dysfunction.
– Blood: The presence of blood in the urine (hematuria) may indicate urinary tract infections, kidney stones, or kidney damage.
– Ketones: The presence of ketones in the urine may indicate diabetic ketoacidosis or inadequate carbohydrate metabolism.
– Protein: Proteinuria can be an early sign of kidney damage or a symptom of other underlying conditions such as diabetes or hypertension.
– Bilirubin: The presence of bilirubin in the urine may suggest liver dysfunction or obstruction of the bile ducts.
– Leukocyte Esterase: Positive leukocyte esterase indicates the presence of white blood cells, suggesting a urinary tract infection.
– Nitrite: The presence of nitrites in the urine can indicate a bacterial infection, such as a urinary tract infection.
– White Blood Cells: Increased white blood cells in the urine (pyuria) may suggest infection or inflammation in the urinary tract.
– Red Blood Cells: The presence of red blood cells in the urine (hematuria) may indicate kidney stones, urinary tract infections, or kidney damage.
– Epithelial Cells: Increased epithelial cells in the urine may indicate renal tubular injury or inflammation.
– Bacteria: The presence of bacteria in the urine may indicate a urinary tract infection.

Interpreting these abnormal findings requires further assessment, collaboration with the healthcare team, and appropriate interventions to address the underlying causes and manage associated conditions.

3. It is important to know and understand the patient’s renal status before administering electrolyte replacements such as potassium or magnesium supplements because impaired renal function can affect the body’s ability to excrete these electrolytes properly. If the patient’s kidneys are not functioning adequately, administering such supplements can lead to electrolyte imbalances and potential toxicity. Therefore, knowing the patient’s renal status helps determine whether the patient’s kidneys are capable of handling the additional electrolyte load.

Before giving electrolyte supplements, it is essential to assess the patient’s renal function through laboratory tests such as serum creatinine and estimated glomerular filtration rate (eGFR). These tests provide information about the kidneys’ ability to filter and excrete waste products, including electrolytes. If the patient’s renal function is compromised, the nurse may need to adjust the dosage or frequency of electrolyte supplements or consult with the healthcare provider to determine the appropriateness of administration.

By considering the patient’s renal status before giving electrolyte replacements, healthcare providers can prevent electrolyte imbalances, such as hyperkalemia or hypermagnesemia, which can have serious consequences, including cardiac arrhythmias or neuromuscular dysfunction. Avoiding these complications enhances patient safety and promotes better outcomes.

On a global scale, integrating knowledge of a patient’s renal status before administering electrolyte supplements can have both technical and financial impacts on healthcare. Technically, it ensures that interventions are tailored to each patient’s specific needs, minimizing the risk of adverse events and optimizing patient care. By preventing complications associated with electrolyte imbalances, healthcare systems can avoid the additional costs of managing these complications, including hospital admissions, specialized treatments, and extended hospital stays. Additionally, focusing on preventive measures reduces healthcare expenditure by promoting efficient resource utilization and improving patient outcomes, leading to better overall healthcare delivery and cost-effectiveness.