Healthcare Delivery and Evidenced –Based Nursing Practice

QUESTION 1: Healthcare Delivery and Evidenced –Based Nursing Practice
The registered nurse working in the cardiac care clinic is tasked with implementing quality improvement measures. To educate the clinic staff, the nurse plans an in-service program to introduce concepts of quality improvement and evidence-based practice. Additionally, the role of the case manager will be included in the presentation. The nurse plans on using care of the patient with Congestive Heart Failure as a template, and prepares sample clinical pathways, care maps, and multidisciplinary action plans. (Learning Objective 3)

Describe how clinical pathways are used to coordinate care of caseloads of patients.
What is the role of the case manager in evaluating a patient’s progress?
What are examples of evidence-based practice tools used for planning patient care?
QUESTION 2: Community-Based Nursing Practice
Mrs. Johnson, a 67-year-old female patient, has recently been discharged from the hospital following an admission for COPD. She has a past medical history of a colon resection related to acute diverticulitis. She developed a surgical wound infection that requires daily wet to dry wound packing and IV Zosyn. Mrs. Johnson was discharged with home oxygen. To manage her care at home, home care visits were ordered. (Learning Objective 5).

What would be involved in setting up the first home care visit?

Describe the nursing assessments and management that would occur during the visit.

QUESTION 3: Case Study, Chapter 3, Critical Thinking, Ethical Decision Making, and the Nursing Process
1. Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of the small intestine. She is currently receiving comfort measures only in hospice. She has gangrene of her right foot and has a history of diabetes controlled with oral agents. She is confused and the physician has determined that she is unable to make her own informed decisions. The hospice nurse, not realizing that the weekly order for CBC and renal profile had been discontinued, obtained the labs and sent them to the nearby laboratory for processing. The abnormal lab results obtained later that day revealed that the patient needed a blood transfusion. The hospice nurse updated the patient’s medical power of attorney who was distressed at the report. The patient’s wishes were to die peacefully and to not have to undergo an amputation of her right foot. But if the patient receives the blood transfusion, she may live long enough to need the amputation. The patient’s physician had previously informed the medical power of attorney that the patient would most likely not be able to survive the amputation. The patient’s medical power of attorney had made the request to cease all labs so that the patient would receive comfort measures until she died. The patient has no complaint of shortness of breath or discomfort. (Learning Objective 4)

What ethical dilemma exists?

Who are the stakeholders and what gains or losses do each have?

What strategies should the hospice nurse take to resolve the ethical dilemma?

QUESTION 4:
Chapter 4, Health Education and Health Promotion
he community health nurse is planning a health promotion workshop for a high school PTSO (Parent-Teacher-Student Organization). The choice of topics was suggested by the high school’s registered nurse who has observed a gradual increase in student obesity. The two nurses have collaborated to develop this workshop to provide parents, students, and teachers with information about the importance of health promotion. (Learning Objectives 6, 8, and 9)

Describe the importance of a focus on health promotion.

According to the health promotion model developed by Becker (1993), what four variables influence the selection and use of health promotion behaviors?

c. Describe four components of health promotion.

QUESTION 5: Chapter 5, Adult Health and Nutritional Assessment
The registered nurse prepares to conduct a nutritional assessment on Mrs. Varner, a 52-year-old Caucasian female who describes herself as “overweight most of my adult life.” The client states that her health is good. She works part time as a receptionist and volunteers about 10 hours per week in her church. The nurse obtains Mrs. Varner’s height as 64 inches and her weight as 165 pounds. (Learning Objective 8)

What is the rationale for computing body mass index? What is Mrs. Varner’s BMI?

Calculate her ideal body weight. What is your assessment of her BMI and weight?

Based on Mrs. Varner’s BMI and weight, the nurse measures her waist circumference. Describe the proper procedure for this assessment.

Mrs. Varner’s waist circumference is 38 inches. What is your assessment?

What laboratory values would the nurse review to evaluate Mrs. Varner’s protein levels?

QUESTION 6: Chapter 6, Individual and Family Homeostasis, Stress, and Adaptation
Mary Turner stepped on a nail 5 days ago and sustained a puncture about 1 inch deep. She immediately cleaned the area with soap and water and hydrogen peroxide, and applied triple antibiotic ointment to the site. Today she comes to the clinic with complaints of increased pain and swelling in her foot. On assessment, the nurse notes that the puncture site is red and edematous, and has a moderate amount of yellowish drainage. (Learning Objective 9)

Describe the sequence of events that caused the local inflammation seen in Mary’s foot.

What is the role of histamine and kinins in the inflammatory process?

Which of the five cardinal signs of inflammation does Mary exhibit?

Because Mary’s injury occurred 5 days ago, the nurse should assess for what systemic effects?
QUESTION 7:
Chapter 7, Overview of Transcultural Nursing
The nurse manager of an ambulatory care clinic has noted an increased number of visits by patients from different countries and cultures, including patients from Mexico and other Latin American countries. Concerned about meeting the needs of this culturally diverse population, the nurse manager convenes a staff meeting to discuss this change in patient demographics, and to query the staff about any learning needs they have related to the care of these patients. (Learning Objective 3)

What strategy to avoid stereotyping clients from other cultures should the nurse include in this meeting?

Identify culturally sensitive issues to be discussed in the staff meeting.

One technician on the staff complains that some patients never make eye contact, and this makes it difficult for him to complete his work. How should the nurse respond?

QUESTION 8: Chapter 8, Overview of Genetics and Genomics in Nursing
Mr. Wayne is a 38-year-old man with a significant family history of elevated cholesterol levels. His father died at age 42 from a massive heart attack secondary to elevated cholesterol and triglycerides, and two of his older siblings are currently taking medications to lower their cholesterol levels. Mr. Wayne makes an appointment to discuss his risk for hypercholesterolemia. The nurse recognizes that Mr. Wayne is at risk for familial hypercholesterolemia because this is an autosomal dominant inherited condition. (Learning Objective 2)

Describe the pattern of autosomal dominant inheritance.

Mr. Wayne asks what chance his children have of developing familial hypercholesterolemia. How should the nurse respond?

Explain the phenomenon of penetrance observed in autosomal dominant inheritance.
QUESTION 9: Chapter 9, Chronic Illness and Disability
Mr. Edwards is 20-year-old male patient who is admitted for treatment of recurring pyelonephritis (kidney infection) and surgical treatment of a urinary stricture, which has decreased the urinary stream. Mr. Edwards has paraplegia; he is paralyzed from the waist down secondary to an automobile accident when he was 16. He came by ambulance to the hospital, leaving his wheelchair and wheelchair pressure-relieving cushion at home. According to the nursing history, the patient is a nonsmoker and he does not drink alcohol or take any illegal drugs. (Learning Objective 5)

What nursing considerations should be made for Mr. Edwards related to his disability?

What health promotion and prevention education does Mr. Edwards need?
QUESTION 10: Chapter 10, Principles and Practices of Rehabilitation
You are assigned to care for David Ramsey, a 22-year-old male patient who sustained a back injury secondary to being thrown from a motorcycle. He did not damage the spinal cord, but the computed tomography revealed a compression fracture at L-2 (lumbar area). David complains of severe lower back pain with numbness and tingling in the lower extremities. You identify the following nursing diagnosis: Impaired Physical Mobility.
(Learning Objective 4)