Pneumonia is a lung infection caused by bacteria, virus, or fungus. The most direct endogenous sources of any of these microorganisms include infected nasal carriers, sinusitis, oropharynx, gastric, or tracheal colonization, and hematogenous spread (Alcon Fabregas & Torres, 2005). Although much is known about pneumonia, it remains the leading infectious cause of hospitalization and death in the United States ("Pneumonia," n.d.). One of the reasons why pneumonia is common is that the lungs are exposed to some ten thousand liters of air each day, as well as small amounts of saliva and even occasionally aspirated regurgitation, all of which can contain bacteria, viral and fungal agents, and other pathogens ("Pneumonia," n.d.).
Although pneumonia is contagious via airborne particles shared by infected persons, self-infection is far more common. This is why oral hygiene, nutrition, and other lifestyle issues are central to reducing disease prevalence. When the immune system has been compromised…… [Read More]
Pneumonia and Timely Antibiotic Therapy
The purpose of this project to educate hospital staff concerning the fact that research supports a best practice protocol that pneumonia patients should be provided with antibiotics within 4 hours of being admitted to the hospital. Pneumonia is defined by Evans and Tippins (2007) as being "an acute inflammation of the lower respiratory tract most commonly due to viral and bacterial infection. Areas or lobes of the lungs become consolidated resulting in an impairment of gas exchange" (p. 224). The environment of the project is a tertiary hospital facility that provides surgical, medical and rehabilitation services. The question is whether pneumonia patients should be given antibiotics within a certain time frame, such as 4 hours after being admitted to the hospital. At present, pneumonia remains the leading cause of death attributable to infection in patients aged 65 years and older and accounts for 13% to…… [Read More]
Pneumonia Case Study
The general statistics and facts about the patient are as follows. The patient is a Caucasian whit e email that is 52 years old. She was admitted to St. Mary's hospital on 12/12/2012. She stood a bit over five feet tall and weighed around 128 pounds. She was married with two grown children and lives in a small camping trailer as opposed to a conventional home or apartment/room.
Both the patient herself and the spouse of the patient are of disabled status. Advanced directives for the patient were in force as of the date of admission of the patient, again that being 12/12/2012. The purpose of the admission on 12/12/2012 was for a pneumonectomy. The patient was prior-diagnosed with necrotizing pneumonia in August 2012 and she hoad a lobectomy in Sepbemter. However, the necrotizing pneumonia destroyed the rest of the patient's lung.
The patient in question had…… [Read More]
The best nursing practice in the specific case would be not only the direct care of the young patient, but also the inclusion of the family in the in house hospital care as to provide an example of what is to be done at home in order to prevent relapse. Many family members might mistakenly believe that their own form of care will be sufficient in the case of a child's illness. However, it is the nurse's duty in such cases to prove to those family members that they need to follow specific and professionally proven methodologies in order to succeed in the recovery process, "Proponents of professionally-centered models view professionals as experts who determine child and family needs from their own as opposed to a family's perspective," (Trivette, Carl J.; Dunst, Carl; Boyd, Kimberly; Hamby, Debra W., 1995). By involving the family in the necessary care practices in house,…… [Read More]
These factors were examined in the work of Tolentino-DelosReyes, et al. (2007) who report themselves having conducted a study and in the form of the administration of a test containing ten items which was developed for the purpose of scoring the nurse on knowledge related to VAP. These questions were comprised by a Powerpoint presentation utilized by the project director in the education sessions in the CCU and SICU. The test specifically were related to "best-practice guidelines, microorganisms that cause VAP, hand washing, supine positioning, enteral feeding, factors related to VAP, definition of VAP, and diagnosis of pneumonia." (Tolentino-DelosReyes, et al., 2007) Stated as participants in the reported study were 14 nurses on day shift and another 14 night shift nurses along with 15 day shift and 18 night shift nurses from the CCU comprising a stated "65% to 70% of all the nurses in each unit." (Tolentino-DelosReyes, et al.,…… [Read More]
Topic: Pneumonia readmissions among nursing home residents 65 years and older in the United States of America.
Backdrop of the dilemma
Pneumonia remains an extreme health condition in America. It accounts for roughly 1 million medical-center admissions and over 50,000 fatalities yearly. Roughly ten to twenty percent of pneumonia occurrences need admittance to the Intensive Care Unit or ICU. Moreover, pneumonia accounts for near to 140,000 medical-center readmissions each year, pricing in excess of 10 billion dollars in medical expenses. Unsurprisingly, in the age of reputation and expense awareness, pneumonia re-admission levels for older people over Sixty-five years have grown to be a topic of greater attention and quality enhancement endeavors. Together with the Affordable Care Federal act enactment, the Centers for Medicare And Medicaid Solutions (CMS) keeps medical-centers responsible for extra re-hospitalizations by connecting readmission levels to compensation. In 2013, CMS recognized 2,225 medical-centers for compensation decrease in keeping…… [Read More]
Ventilator Associated Pneumonia reflects the most common healthcare related infection in the process of providing intensive care within the context of the hospital. The condition enhances the morbidity, mortality, length of stay, and costs increments. Ventilator Associated Pneumonia possesses significant threat to the development of human beings because of the costs and complexion of the condition. The condition occurs under the watch of the nurses who have the responsibility of providing extensive care to patients. Since the condition is complex, it is essential to focus on its prevention rather than treatment thus reduction in the total costs and adverse effects in association with Ventilator Associate Pneumonia (Zilberberg et al., 2011). This calls for the development of the implementation plan (K-1) to enable the prevention and reduction of the Ventilator Associated Pneumonia.
The population in which the solution is intended, the staff that will participate, and the key contributors that must…… [Read More]
Ventilator Associated Pneumonia: eview and Critique of a Quantitative esearch Article
Ventilator associated pneumonia is a significant problem affecting many patients that are intubated during hospital stays (NIH, 2012). Understanding and addressing this problem requires careful attention to the latest research, and this research must be approached from a critical perspective. Quantitative research, or research that directly and concretely measures certain phenomenon and describes relationships in numerical terms, has yielded no small amount of useful information on this topic, and critically examining a current article that outlines the knowledge regarding ventilator associated pneumonia is an excellent way to determine if there are any knowledge gaps or inconsistencies that require attention (Burns & Grove, 2011). The following paragraphs present just such an examination.
A substantial portion of patients intubated for ventilator-assisted breathing during hospital stays develop pneumonia as a result of infection spread or allowed to flourish at…… [Read More]
A study conducted by Ledgerwood et al. (2013) on the effects of tracheotomy tubes that have suction above the cuff established that the tubes have the capability to reduce VAP incidents. The amount of time spent in ICU and on the ventilator was also reduced. This does demonstrate that the patient was accorded the best treatment available to drain pleural effusion. The development of haemothorax/pneumothorax is anticipated in most patients who are intubated, but the risk is normally reduced. According to the different studies conducted, the likelihood of a patient suffering from VAP is decreased slightly when using SSD. The patient would still have contracted VAP if they were not intubated with the endotracheal tube. Therefore, the patient ended up incurring higher medical costs as they had to pay for the tube, and haemothorax/pneumothorax treatment. If they had not been intubated the patient would have only paid for the sickness.…… [Read More]
Ventilator associated pneumonia (VAP) accounts for the majority of nosocomial pneumonia which may lead to more extensive hospital stay and increased intensive care. Endrotachael tubes that provide continuous subglotic suctioning (abbreviated: C-ETT) may reduce VAP, but they are more expensive than the standard endrotacheal tubes (abbreviated: -ETT) that do not have the characteristic of continuous suctioning. The objective of this study (peronni et al., 2011), therefore, was to measure the comparative costs of C-ETT against -ETT among intubated people and see whether indeed the more costly C_ETT do show a difference that makes their expense worthwhile.
The issue that was discussed were the comparative merits of C-ETT compared with -ETT and to assess whether the merits of one are more significant than the merits of another and significant to the point that their added cost is worth the hospital's investment in the resource.
2/2: Correct critique of sampling design. Cite…… [Read More]
Chlorhexidine Gluconate Use in Ventilator Assisted Patients Prevent Ventilator Associated Pneumonia
Ventilator associated pneumonia is a common and fatal complicated issue for patients in ventilator care within the intensive care unit. Ventilated and incubated patients are a challenging threat for registered nurses to deliver high quality of care. It has been observed that incubation impedes the natural defense of the body against respiratory infections. The placement of an endotracheal tube enforces negative effect on the cough reflexes, which aims to protect the airway from invasive pathogens. The endotracheal tube prevents mucocoliary clearance of secretions and depresses epiglottic reflexes (ello, Lode, Cornaglia, & Masterton, 2010; Labeau, Vyver, Brusselaers, Vogelaers, & Blot, 2009). It causes the virulent bacteria to enter and it leaks around the inflated cuff of the endotracheal tube. Consequently, the lungs of patient infiltrate due to which pneumonia is caused. The ventilator associated pneumonia possibly occurs early…… [Read More]
In critically ill adults (p), how does the daily use of chlorohexidine (I) compared to sterile water reduce VAP (ventilator-associated pneumonia) (O) during hospitalized stay (T).
Part 2 Identifying a Problem
Of the infections acquired by patients who've used mechanical ventilation in hospitals, ventilator-associated pneumonia is the most common. It causes several deaths, prolongs hospital stay and adds to the cost of medical care. Ventilator-associated pneumonia is commonly developed when pathogenic bacteria colonize the aero digestive tract. Given this reality, prevention of the infection has always involved preventing bacteria colonization and the following aspiration of the contaminated secretions to the lower airways. (Babcock et al., 2004).
It is necessary that a reappraisal be carried out because of the limitations that the evidence base has. First, the current meta analyses are influenced heavily by three significant studies in patients undergoing cardiac surgery and they accounted for between forty to sixty…… [Read More]
Pneumonia, as Calkins and Palamountain (2017) point out in their article, Fighting Childhood Pneumonia in Uganda, remains one of the leading causes of death for children under the age of five across the world. As a matter of fact, more children have died from pneumonia related complications in recent times than from measles, malaria and HIV combined. This, in essence, is an indication to the seriousness of the issue – particularly in developing countries. In Uganda, for instance, “approximately 20,000 children under five died from the illness” in 2012; with the said figure being representative of “15 percent of under-five deaths in Uganda” (Calkins and Palamountain, 2017, p. 10). Various initiatives have been undertaken by both the government and INGOs in an attempt to arrest the situation. However, no single approach has yielded significant benefits. Therefore, taking the context of this discussion into consideration, the all-important question remains: what would…… [Read More]
suffered from its quasi-experimental approach, as several participants left the study since they left the facility or otherwise were not permitted to participate -- for example, those patients who recovered sufficiently to conduct their own oral care no longer engaged in the experimental protocol and condition. The results were positive and significant, however, the severity of the patients' conditions and the small sample size challenged the researchers, as discussed below.
The title of the article, Oral Intensity: educing Non-Ventilator-Associated Hospital-Acquired Pneumonia In Care-Dependent, Neurologically Impaired Patients, is absolutely clear, unambiguous, and accurate. The abstract offers a clear overview of the study, particularly as it is divided into sections that enable readers to quickly learn about the methodology, results, discussion, and implications of the study. The purpose of the research study is clearly defined: The purpose of the study is to determine if an enhanced oral care protocol would decrease the…… [Read More]
Nurses Knowledge on Ventilated Associated Pneumonia Prevention
Synthesizing & Describing: Differences & Similarities of Various esearch Components
The study provides the similarities and differences of the three studies (Al-Sayaghi, 2014, Bagheri-Nesami, & Amiri, 2014, Labeau, Vandijck, Claes, B. et al. 2007) by comparing their statement of problems and significant of the studies.
The three studies identify the VAP (Ventilator-associated pneumonia) as the most common HAIs (hospital-acquired infections) among patients in the intensive care unit. (Al-Sayaghi, 2014, Bagheri-Nesami, & Amiri, 2014, Labeau, Vandijck, Claes, B. et al. 2007). All the studies believe that the VAP can lead to high rates of mortality, and morbidity leading to an increase duration of hospitalization. (Al-Sayaghi, 2014, Bagheri-Nesami, & Amiri, 2014, Labeau, Vandijck, Claes, B. et al. 2007). They identify associated problems of VAP as longer stay in hospitals, and increased use of resources. However, Al-Sayaghi, (2014) provide detailed statistics related to VAP problems by…… [Read More]
Aspiration Pneumonia Prevention through in-Service Training for Nurses
N451 N Capstone Course
Design for Change Proposal: Aspiration Pneumonia Prevention through in-Service Training for Nurses
This is a position paper recommending the implementation of an in-service training among nurses in the hospital and skills nursing facilities on the prevention of aspiration pneumonia, of which a large segment of the sufferers are elderly patients. Especially in the case of elderly patients with nasogastric or under peg tube feeding, the need for nurses taking care of these patients is essential to ensure correct and proper care and safety for the patient. In this paper, the proponent of this paper will discuss relevant literature on the effectiveness of in-service nurse training in preventing aspiration pneumonia. Further, after this review of relevant literature, the proponent will present an action plan that the hospital management can review and take into consideration.
Change Model Overview
In developing…… [Read More]
Preventing Ventilator Associated Pneumonia
One of the most commonly occurring infections among patients hospitalized in intensive care units is ventilator-associated pneumonia, which is associated with several negative outcomes. This infection has generated considerable concerns among healthcare providers because it leads to protracted hospital stay, increased costs of healthcare services, and high mortality rate of between 15 and 45%. The infection also generates numerous complications for these patients, particularly those undergoing a major heart surgery that needs mechanical ventilation in the treatment process. Given these negative outcomes and increased concerns, prevention of ventilator-associated pneumonia is increasingly important in intensive care units. While several methods have been suggested to help prevent this infection, the use of endotracheal tube with subglottic suction line would help prevent VAP.
Using Endotracheal Tube with Subglottic Suction Line to Prevent VAP
As previously indicated, the use of endotracheal tube with subglottic suction line seems to be the…… [Read More]
Compliance to Ventilator Care Bundles on educing Ventilator-Associated Pneumonia
Ventilator-Associated Pneumonia (VAP) is a common infection that is acquired by patients who have used mechanical ventilation in health care facilities. This infection has generated numerous concerns in public health because of its negative impacts on health care. Some of these negative health effects include extended hospital stays, increased costs of health care services, and deaths. Consequently, there have been numerous initiatives in healthcare to address this problem including ventilator care bundles. Existing literature on evidence-based practice for dealing with VAP has shown that compliance with ventilator care bundles is the most suitable clinical intervention (Al-Thaqafy, 2014). For this study, the John Hopkins Nursing Evidence Practice Process will be utilized to facilitate compliance to these bundles in order to reduce VAP. John Hopkins developed an equation that helps administrators quantify probable savings through lessening hospital-acquired infections like VAP (Guterl, 2013). This…… [Read More]
Elevating heads of beds for patients on mechanical ventilation
Along with the recommendations for removal of plaque, there is also a guideline made by CDC that for proper treatment to "elevate at an angle of 30 to 45 degrees the head of the bed of a patient at high risk for aspiration." The benefits elevation of the head of the bed is on the theory that then gravity will reduce the possibilities of regurgitation that exists in an overly distended stomach. The recommendation by CDC also clearly states that the patients should not be lying flat unless there is some clinical need for that. At the same time, some medical authorities feel that this is likely to make the patients uncomfortable, though the recommendation is from CDC. This makes them reduce the angle of laying the patients bed at a lower angle than the angle specified by CDC.…… [Read More]
Some of the symptoms of ventilator assisted pneumonia may be the onset of fever, a higher white blood cell count, and a new or changing lung infiltrate that may be visible on a normal chest x-ray. Cultures taken as samples from the patient's airways may show the presence of microorganisms or bacteria and fungi that would eventually cause the dreaded ventilator assisted pneumonia in the patient. JAMA states that these risk factors may be eliminated to a large extent if the nurses and medical practitioners were to follow certain simple but essential steps in preventing the onset of the symptoms of pneumonia. First and foremost, the nurse must maintain a high degree of hygiene; he must wash his hands both before and after coming into contact with any patient, and second, he must try to keep the bed elevated to a 30 degree head up position, so that…… [Read More]
Furthermore, one of the pillars of collaborative care that will need to be firmly established is the fostering of clear dialogue and a means for strong communication within the care management planning. For instance, there needs to be a clear decision and communication of all tests ordered and when the test results will be available. One of the most important aspects of this collaborative care will be the nursing interventions which can have significant impact on the patient's health and stabilization (Allen, 2010). In fact, strategic nursing care can even minimize readmission rates of Margaret and other patients with comparable conditions (Chen et al., 2012).
Prioritize the Nursing Care Needs of Margaret
The prioritization of nursing interventions is essential, and the way in which a nurse determines this priority is going to be something unique and distinct. "Trials reviewed demonstrated a beneficial impact of nursing interventions for secondary prevention in…… [Read More]
Baker, 2000).The measurement of project effectiveness, an element of project impact evaluation, is crucial for the success of every proposed project. In this section, we present the method/mechanism for evaluating the effectiveness of the proposed solution. The process starts with the identification of the project users (Ventilation associated pneumonia patients), gathering data to be used in determining if the user received output, identification of process of transmission and ends up with the change process. This is indicated in the flowchart model (see figure 1.) which provides for an elaborate systematic way of examining the process within the proposed project and the outcome of the proposed project. The evaluation of the outcomes is the major purpose of the framework even though the outcomes can never be seen in total isolation of the proposed project "mechanics" (including transmission, project reception as well as use).At certain points in the project evaluation framework, it…… [Read More]
patients undergoing mechanical ventilation contract Ventilator Associated Pneumonia (VAP). This acute medical condition always results in increased death rates and associated medical costs among patients. This article reviews several literatures that try to enlighten masses on the diagnosis, medical treatments and VAP prevention methods. In addition, this article outlines recommendations medical practitioners can implement in their daily practices to curb VAP and offers an insight on controversies that usually arise during VAP diagnoses, treatment plans and prevention methodologies. This article defines VAP to be the causative agent of approximately 25 to 54% mortality rates among patients undergoing mechanical ventilation in ICUs. Factors responsible for VAP among patients include patients' population in ICUs, hospital stay durations and antimicrobial treatments. Even though antimicrobial medications are confirmed to reduce VAP casualties, further studies should be undertaken such as the ones outlined in the literatures below to help in early identification and treatment of…… [Read More]
Treatment to Patients
The main objective of providing treatment to patients is to relieve symptoms along with decreasing the progression of the disease as well as the mortality or morbidity. However, in some cases, this objective is not fully achieved, especially in the case of the patients who are admitted to the ICU with some serious and almost always a terminal stage of the disease. For example, when old patients are admitted in the ICU, their immunity is extremely low and this is the perfect time for the opportunistic infections to make matters worse for these patients. There are many infections that are specifically associated with patients admitted in the hospitals. Pseudomonas Aurigeonosa is a micro-organism that is well documented to cause bacterial pneumonia and bacteremia in the patients who are terminally ill and are receiving treatment in the hospital setting. Since most of the patients in the ICU are…… [Read More]
Prevention and Management of Ventilator-Associated Pneumonia in the Hospitals
Ventilator-associated pneumonia is an infection in the airways that develops more than 48 hours after a patient is intubated. While the prevention and management of pneumonia of any kind is considered as a commendable objective, it is characterized with several concerns given the significant effect of pneumonia linked to ventilator use. Ventilator-associated pneumonia has attracted considerable concern in the recent past because it has become the leading cause of death among infections acquired in the hospital. Actually, the rates of deaths from ventilator-associated pneumonia have exceeded those associated with central line infections, respiratory tract infections, and serious sepsis in the non-intubated patient ("Preventing Healthcare and Community Associated Infections," n.d.). It is increasingly likely that the most concerning aspect of ventilator-associated pneumonia is the high associated mortality (Kalanuria, Zai & Mirski, 2014). Consequently, several peer reviewed studies have been carried out to…… [Read More]
McClure Case Study
Patient Overview -- Patient, Mr. M., is 49 years old and has smoked for 25 years, quit three years ago when diagnosed with emphysema. He indicates he as shortness of breath for the past 48 hours, with sputum so thick he has difficulty coughing it out. Skin is warm and dry with slight clubbing of fingers noted. Lung sounds diminished with crackles and expiratory wheezes and barrel chest. Vitals are 101.8 Temp, pule 110, respiratory 32, BP 150/82. Blood gases show decreased O2 and increased C02 with an increase in red blood cells and twice the normal white cells.
M's risk factors for emphysema are high. Smoking for so long contributed to decrease of long function and is an abnormal dilation and destruction of the alveolar ducts and air spaces in the lungs. It usually occurs in people over 50, so Mr. M is at the lower…… [Read More]
woman entered the National Institutes of Health esearch Hospital in Bethesda Maryland with a serious, but fairly routine infection; however the subsequent events were to prove anything but routine. The article titled "Tracking a Hospital Outbreak of Carbapenem-esistant Klebsiella pneumoniae with Whole-Genome Sequencing," traced the effort to discover the cause of the woman's illness, as well how the staff at one of America's most advanced hospitals dealt with the subsequent outbreak of disease. (Starr, 2012) This article interested me because it focused on an outbreak of illness, something which anyone could have been affected, but also because it discussed two aspects of the course and it's text: single-celled life forms and genetics.
The woman brought to the NIH research hospital was suffering from an infection caused by an antibiotic-resistant organism, but it was a new strain, never before encountered. About a month after she was treated and discharged, another patient…… [Read More]
Oral Hygiene Methodology
There is a significant amount of research that shows statistical correlation between oropharyngeal bacterial colonization and the presence bacteria responsible for ventilator associated pneumonia (VAP). Several interventions have been shown as effective in reducing the incidence of VAP, but many have not gained widespread clinical use in a majority of hospitals. esearch does show that the amount of oropharyngeal bacteria present in the mouth and oral cavity has a relationship to the propensity of developing VAP. This is likely due to the lack of appropriate levels of oral hygiene combined with the bacterial colonization of ventilator equipment. We expect that oral and mouth washes regularly administrated that include chlorohexedine will kill bacteria and reduce incidence of VAP infections on ICU patients. The aim of this study will be to survey the efficacy of chlorohexdedine mouth washes in a randomized group of patients who were placed in an…… [Read More]
Management of Immunocompromised Patients
In beginning I writer specific nursing assignment. The Question: 2000 Words While clinical placement asked prepare a single room an admission. The patient requiring admission isolation room immunocompromised.
Immunocompromised patients usually require isolation in order to prevent them from becoming infected with infections from other patients which is known as protective isolation. For the immunocompromised patients, their immune system is unable to fight the infectious diseases. There are many diseases or conditions that lead to immunodeficiency in patients.
One is AIDS (acquired immunodeficiency syndrome). The pathophysiology of AIDS starts when the person's CD4+ T cell count begins to decrease as the disease kills these cells. This is HIV-induced cell lysis where the virus enters the CD4+ cells where it inserts its genetic information to the cell nucleus thus taking over the cell and replicating itself. The virus then mutates extremely rapidly thus making it more and…… [Read More]
Social Ecology of Health Promotion
Module 05 Question 01: explain the rationale behind the federal government's approach to regulatory containments in food.
The federal government's approach in relation to the regulation of the containments in food, aims at protecting the consumers on food insecurity through elimination of food pathogens. It is the role of the government to enhance the health system and conditions of its citizens through adoption and implementation of various rules and regulations in relation to the containments in food. The food supply of the United States integrates multi-faceted production system and delivery components. Some of the critical or essential components of this system include production, processing, preparing, packaging, labelling, distribution, and consumption of the food components (Fortin, 2011).
There is a risk in relation to the concept of each stage of the food supply system in the context of the United States. This makes it ideal for…… [Read More]
Six days after his initial complaint, the patient returned with worsening symptoms and was admitted to the hospital. No bacterial or viral infections could be found, but the patient was treated with antibiotics anyway as his symptoms suggested that his respiratory distress and other symptoms were due to some sort of infection. The fact that his condition continued to worsen without any notable effect from broad-spectrum antibiotics suggests that perhaps the physicians erred in this assessment, and that the negative results of the many tests for infectious agents administered to the patient were more accurate than the physicians thought. Focusing attentions more immediately on other potential causes and more direct methods of symptom relief, either in addition to or instead of the antibiotic treatment and observation that constituted the primary means of treatment at this stage, might have prevented or at least postponed the need for intubation and the mechanical…… [Read More]
I know whatever major I choose, my first priority is to help others and make a difference in their lives.
I feel I have a lot to offer to your university in my attitude, involvement, and dedication. I am a very sensitive person because of my sister and her condition. She has had many medical problems (including open-heart surgery, heart failure, and several battles with pneumonia). She is an inspiration to me, and my family rejoices in all of her successes. This has made me more open to others, and to understand those who are different, as well as those who fit in. I feel this will make me a better, more compassionate student and peer.
My sister has taught me more than compassion and sensitivity. Despite her health problems and situation, she still holds down a part time job at McDonald's, and is always positive and upbeat. As my…… [Read More]
Leadership and Management in Healthcare
Effective Leadership and Management
Leadership is much like communications in regards to the complexity inherent in these concepts. There are many different perspectives that are used to examine these issues and researchers study leadership and management from such disciplines includes Industrial and Organizational Psychology, Social Psychology, Business, and Sociology. There have been somewhere in the neighborhood of six to eight major approaches, depending on the vantage point, to leadership theory produced in the scientific literature over the last sixty years and even more have emerged from outside academia (Kilburg & Donohue, 2011). Competing theories include such perspectives as trait theory, situational theory, behavioral theory, competencies theory, network theory of leadership and many more.
Much of the work that a nurse-leader engages in on a daily basis rests in their ability to communicate with others; including clients, colleagues, superiors, and subordinates. Therefore, since this…… [Read More]
Omit itles and Degrees]
Klompas M., Speck, K., Howell M.D., Greene, L.R., & Berenholtz, S.M. (2014). Reappraisal of routine oral care with chlorohexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA internal medicine, 174 (5), 751-761.
his article deals with the routine oral care of patients using chlorhexidine gluconate as standard care when they receive mechanical ventilation during their hospital stay. heir aim is to assess the overall impact routine oral care has in conjunction with chlorhexidine in regards to patient-centered outcomes for patients receiving the aforementioned mechanical ventilation. hey chose randomized clinical trials that compared a placebo to chlorhexidine and chose only sixteen studies out of the 171 citations they explored because the 3,630 patients observed in the selected studies met criteria.
he results showed chlorhexidine provide patients with a lesser occurrence of infection than with placebo, although pneumonia risk was around the same for both.…… [Read More]
Chlorhexidine to Prevent Ventilator-Associated Pneumonia
Ventilator-associated Pneumonia (VAP) is one of the most common infections acquired by patients who've utilized mechanical ventilation in health care facilities. This infection is a major concern because it leads to several deaths, extends hospital stay, and increases the costs of medical care services. The infections are commonly developed when pathogenic bacteria colonize the aero digestive tract. According to Babcock et al. (2004), the prevention of these infections has usually entailed preventing bacteria colonization and the subsequent aspiration of the contaminated secretions to the lower airways. Given the increased incidents of ventilator-association pneumonia, this paper proposes the use of chlorhexidine in preventing it. Chlorhexidine has proven effective in prevention of VAP as shown in baseline data. The implementation of this proposed procedure in patient care will entail various logistics based on approval from organizational leadership.
Methods for Obtaining Necessary Approval and Support
One of the…… [Read More]
Quality and Accessibility of Information
Quantitative or qualitative data used in the report on how many patients have been admitted for pneumonia over the past several months would need to be complete in that it shows evidence of each of the following characteristics: accuracy, accessibility, comprehensiveness, completeness, consistency, currency, definition, granularity, precision, lineage, relevancy, and timeliness. The same holds true for a scenario in which a drug has been recalled and patients need to be contacted. Data should be quality in both cases, as it informs the reader of pertinent stats and needed facts (Lin, 2013).
In the case of providing a report on the number of patients admitted for pneumonia, an example of accuracy of data would be that the report truly represents the actuality or the reality of the situation. Names, for example, are not misspelled and indicate actually persons in both qualitative and quantitative data and for…… [Read More]
The hospital used for the study already had protocols in place to prevent patients from getting pneumonia. Published data was provided and posters were placed in all units. However, the nurses chose not to follow the protocols set forth. This is the reason the study was conducted. The nurses confessed that they felt oral care was more of a comfort to the patients than a preventative measure to pneumonia. The really did not take the time to learn that improper oral care in these patients lead to the excessive growth of bacteria which eventually found its way down the respirator tube and into the patient's lungs causing pneumonia. Once the nurses went through formal evidence-based program and followed the proper protocol, the rate of ventilator pneumonia decreased by 50%.
Providing proper training in addition to the posters displayed helped to reinforce the significance of proper oral care for their patients.…… [Read More]
" (Stone, 2006) Treatment is stated by Stone (2006) to be "diagnosis dependent and may be medical or surgical." Practical modifications include simple steps such as crushing of pills or opening of capsules to ease and facilitate swallowing.
The work of Leibovitz, et al. (2007) entitled: 'Dehydration Among Long-Term Care Elderly Patients with Oropharyngeal Dysphagia" states that long-term care (LTC) residents in the nursing home "especially the orally fed with dysphagia are prone to dehydration. The clinical consequences of dehydration are critical. The validity of the common laboratory parameters of hydration status is far from being absolute, especially so in the elderly." (Leibovitz, et al., 2007) it is related however that "combinations of these indices are more reliable." (Leibovitz, et al., 2007) the study reported by Leibovitz et al. is one that assessed hydration status among elderly LTC residents with oropharyngeal dysphagia and in which a total of 28 orally…… [Read More]
Evidence-Based Practice Project
A literature review conducted by abie and Curtis (2006) aimed at establishing the effects of washing hands in reducing respiratory infections. The literature was obtained by searching CAB Abstracts, PubMed, Embase, Cochrane, and Web of Science library. The inclusion strategy for the review were any studies that reported having an impact of hand washing to reduce respiratory infections. All articles included in the review were published before June 2004. This was a quantitative systematic review, which made it an effective method of analyzing and evaluating the selected studies. After searching for the relevant articles, the researchers found 395 articles, but only 61 articles were selected after the researchers reviewed their abstracts (abie & Curtis, 2006). The review and selection process continued and the final review included only eight articles, which the researchers established were more relevant to their study. Having eliminated the articles that focused on children…… [Read More]
prokaryotes consist of millions of genetically distinct unicellular organisms. A procaryotic cell has five essential structural components: a genome (DNA), ribosomes, cell membrane, cell wall, and some sort of surface layer which may or may not be an inherent part of the wall (1). Functional aspects of procaryotic cells are related directly to the structure and organization of the macromolecules in their cell make-up, i.e., DNA, RNA, phospholipids, proteins and polysaccharides. Diversity within the primary structure of these molecules accounts for the diversity that exists among procaryotes (1). Identifiable groups of prokaryotes are assembled based on easily observed phenotypic characteristics such as Gram stain, morphology (rods, cocci, etc.), motility, structural features (e.g. spores, filaments, sheaths, appendages, etc.), and on distinguishing physiological features (e.g. anoxygenic photosynthesis, anaerobiasis, methanogenesis, lithotrophy, etc.). Prokaryotes are commonly known as bacteria, and it is estimated that bacteria have been around for at least 3.5 billion years…… [Read More]
One of the key reasons that was found to be a factor in readmissions is that insurance companies continue to push for shorter hospital stays. They have reduced the number of days that they will pay for certain conditions. This was found to be a key factor in releasing patients early, when they might have benefited from a longer hospital stay (Bueno, oss, & Wang et al., 2010; Capelastegui, A,, Espana, P., & Quintana, J. et al., 2008), This factor will have to be considered as a potential barrier to the study. It may be that insurance companies and Medicaid/Medicare reimbursements are a factor in early release of patients rather than hospital practices.
Factors that were identified in other studies of hospital 30-day readmissions included the presence of deep vein thrombosis and pulmonary embolism (Spencer, Gore, & Lessard et al., 2008). Severity scores such as those for community-acquired pneumonia were…… [Read More]
Long-Term Nursing Facility Management Risks
Long-Term Nursing Family Management Risks
The major risk management issue of our hospital is the spread of nosocomial infections, more popularly known in the medical circle as hospital-acquired infections. This infection is something that a patient can contract or develop besides the condition for which he is admitted (Duel et al. eds, 2004). The include infections, which surface after discharge and occupational types among the workforce of the facility. These are widespread globally and assert strong impact among patients and facility workforce. The most common sites, according to a recent survey, are the urinary tract, the catether site, respiratory tract, bacteremia, skin and soft tissue, lower respiratory, surgical and the eyes (Duel et al., eds).
In our 150-bed facility in Chicago, pneumonia is a critical respiratory nosocomial infection concern. Our facility is a component of one of the biggest network of medical care…… [Read More]
Partial vaccination was not effective on children 6-23 months. This meant that full vaccination is necessary to optimally protect children of this age group from Influenza (Shueler et al.).
The results are consistent with those of other evaluative studies on children through randomized, controlled trials for efficacy and observational studies for effectiveness (Shueler et al., 2007). Vaccine effectiveness depends on the characteristics of the study population, specificity of the outcome, and the Influenza season. It was dissimilar to the findings of Ritzwoller and his team in that Shueler and team's subjects had more exposure to Influenza. The more specific outcome of laboratory-confirmed Influenza made the detection possible. And Shueler and his team's findings were similar to Ritzwoller and his team's in that the findings of both teams offered assurance that vaccination of young children would be beneficial, even in a year with sub-optimal match (Shueler et al.).
Vaccination Efficacy not…… [Read More]
The quality of life was another issue addressed in research of the use of feeding tubes with patients who have dementia (Finucane, 2001).
obert MCCann, MD reports that the everyday imagery of food and its pleasant addition to life cannot be ignored in the discussion of removing natural nutrition and using a feeding tube.
McCann reminds the medical community that the image of a family gathered around the Thanksgiving table, interacting and nurturing each other through the meal presents an entirely different image than an elderly person suffering from dementia alone in a bed in a nursing home with a tube inserted into their stomach. The imagery of food and its measurable impact on a person's life must be accurately envisioned for the decision to be made according to McCann (Finucane, 2001).
McCann studied Hospice cancer patients who were in the end stage of life. According to his research it…… [Read More]
Pleural Effusion in Children -- An Overview
Pleural Effusion is a disease resulting from excess production of fluids or a decrease in absorption or in some instances both thereby leading to an abnormal collection of fluids in the pleural space. It is the commonest pleural disease and has etiologies that include symptomatic inflammatory, cardiopulmonary disorders and malignant diseases that require speedy evaluation as well as treatment (Jeffery ubins 2016).
Disorders like an infection are some of the primary afflictions that could lead to the collection of fluids in the pleural space leading to pediatrics pleural effusion. The fluid accumulation can result from poor absorption or an increase in filtration. While mild effusion is asymptomatic, complications like septicemia, pneumothorax, pleural thickening, bronchopleural fistula, and respiratory failure might accompany it (Shahla Afsharpaiman, et al. 2016). a chest ultrasound or lateral decubitus indicates the probability of the existence of a large pleural effusion.…… [Read More]
Nurse burnout is a common occurrence. This can exacerbate an ongoing problem that is seen in hospitals, nosocomial infections. Nosocomial infections remain prevalent for patients with extended hospital stays like those in intensive care units. An infection that starts roughly 48 hours after admission, those in intensive care units (ICUs) experience a continued rate of infection leading to increase length of stay, mortality, and morbidity. The number of patients that develop a nosocomial infection are from 7 to 10% internationally (Dasgupta, Das, Hazra, & Chawan, 2015). As such, hospitals have decided to classify nosocomial infection sites based on clinical and biological criteria.
esearch has led to the discovery of several bacterial strains that involve the formation of nosocomial or hospital acquired infections. "The agents that are usually involved in hospital-acquired infections include Streptococcus spp., Acinetobacter spp., enterococci, Pseudomonas aeruginosa, coagulase-negative staphylococci, Staphylococcus aureus, Bacillus cereus, Legionella and Enterobacteriaceae family members,…… [Read More]
Elderly in Monrovia, CA
The population of people aged 65 years or greater is steadily escalating, as baby boomers come of age. It is estimated that this age bracket accounts for 10% of the total world population, and is statistically increasing. As this sector of the population steadily increases, there are of course, accompanying health care issues: osteoarthritis, cardiac and kidney issues, Alzheimer's or dementia, and an ever-growing problem with depression. For this essay, we will concentrate on several health issues that plague seniors nationally, but will specifically focus on the aging population over 65 in Monrovia, California.
Monrovia is a smallish city located at the foothills of the San Gabriel Mountains in the San Gabriel Valley, Los Angeles County. Monrovia was settled in the late 1800s as a central hub for the growing orange grove industry, but has now become more of a bedroom community that supports the urban…… [Read More]
Prior to the study, the researcher consulted pertinent literature on both the head-of-bed elevation standard and the Clinical Decision Support System. The sources used were authoritative and relevant. The information presented by the author is in agreement with other research in this clinical area of study (Frederich, Sud, & Sud et al. (2008); Williams, Chan & Kelly (2008).
The author placed considerable emphasis on nurse characteristics, which were not even mentioned as an objective of the study. They seem to have been added into the methodology without justification. The objective of the study addressed patient characteristics, but not nurse characteristics. This added in another variable that was not part of the original research study. Patient characteristics and the affect of the CDSS were discussed sufficiently, as were the limitations of the study. The authors provided enough details of the study to be replicated by other researchers. The authors were careful…… [Read More]
"Elimination of these and other pathogens from the lower respiratory tract is made possible by an effective innate immune response, which is necessary yet potentially dangerous to the infected host."
E. coli Outbreak:
There have been numerous E.coli outbreaks over the years. Pakalniskiene, Falkenhorst, Lisby, and Madsen (2009) studied one of the larger single source outbreaks. On November 11th, 2006, there was an outbreak in Greater Copenhagen, Denmark. The director of a high school had contacted the regional health authority to report an outbreak of diarrhea and vomiting among guests of a school dinner party. A total of 750 people, nearly all of the teachers and students at the school, had attended the dinner. The evening, the first people became sick. Three days later, when the director made the report, approximately 200 to 300 teachers and students had reported gastroenteritis. It was found that the fresh basil used in the…… [Read More]
Empyema Clinical Manifestation
Empyema: Lung Sounds and other Clinical Manifestations
Over the past decade, empyema has consistently been recognized as an acute, potentially life-threatening respiratory disease. A large number of studies have been conducted over the last years that address the unique symptomatology of empyema and the clinical implications of these symptoms.
The biggest diagnostic challenge of empyema is that patient often present with symptoms very similar and difficult to distinguish from an uncomplicated pneumonia. A patient typically shows symptoms such as fever and chills, excessive sweating, malaise, cough, dyspnea, pleuritic chest pain and unintentional weight loss (Sahn, 2007). These symptoms individually do not warrant a diagnosis of empyema. They do, however, require precautionary follow-up testing that should include a pleural fluid aspiration. The presence of pus -- an opaque, whitish-yellow viscous fluid consisting of serum coagulation proteins, cellular debris and fibrin deposition -- aspirated from the pleural space is…… [Read More]
Vitamin C for Common Cold
What is Vitamin C?
Vitamin C, also known as ascorbic acid, is a water-soluble ingredient that is essential for the health of human beings. It is essential for normal growth and development and it has consumed regularly. Since Vitamin C dissolves in water, the excess amounts leave the human body through urine and this means the body needs a constant supply of this vitamin everyday. The body cannot store vitamin C in any form.
One of the primary role of vitamin C is to repair the body cells and tissues and to prevent free radicals and toxins from getting accumulated in the body. It repairs wounds and makes them heal faster. The free radicals are known to play a role in cancer and heart diseases and good amount of vitamin C everyday helps to prevent any damage.
Sources of vitamin C
Most fruits and vegetables…… [Read More]
Karl Marlantes' Matterhorn
Karl Marlantes' novel of the Vietnam War, Matterhorn, seems to want to offer the reader an immersive approach towards the experience of Vietnam. If we can say of earlier Vietnam narratives -- whether in film, such as Oliver Stone's Platoon or Stanley Kubrick's Full Metal Jacket, or in fiction, such as Tim O'Brien's novels Going After Cacciato and The Things They Carried or Gustav Hasford's The Short-Timers (a cult classic of Vietnam fiction and the basis for Kubrick's film) -- that they have a sort of expressionistic technique, seeking to capture the experience of the war in a series of vignettes, we can see the originality of Marlantes' approach in greater relief to what has come before: his approach is not so much expressionistic as it is encyclopedic, an attempt to catalogue (in fiction) every single aspect of the one small event, the movement of a Marine…… [Read More]
, 2010). egardless of the cause, infant SV is linked to "significantly more symptoms of wheezing disorder and clinical allergy than controls and were more likely to be sensitized to common inhaled allergens" (Todd et al., 2010). The number of studies and the number of subjects is still small, but the correlations have been consistently large enough to suggest that a serious bout of SV-bronchiolitis in infancy is linked to later lung problems such as asthma, wheezing, and atopy. Therefore, M.C.'s parents should be educated about the possibility that M.C. may experience breathing problems in later life, and told to advise her primary care physician of her SV diagnosis and hospitalization.
Caiulo, V.A., Gargani, L., Caiulo, S., Fisicaro, A., Moramarco, F., Latini, G., & Picano, E.
(2011). Lung ultrasound in bronchiolitis: Comparison with chest x-ray. Eur J. Pediatr, 170, 1427-1433.
Healthwise. (2012). Bronchiolitis- topic overview. etrieved March 9, 2013…… [Read More]
Antibiotic Resistant Streptococci
There are more than thirty different species of streptococcal bacteria. The infections that strep causes in humans range from "strep throat," which is caused by Group A strep and relatively easily treatable, to diseases such as pneumonia and serious wound infections, both of which can prove deadly.(1)
Antibiotics were first developed during World War II, and have saved many millions of human lives since then that would have been lost to streptococci infections and diseases. Penicillin alone was solely responsible for dramatically decreasing mortality rates of soldiers wounded on the battlefields of World War II compared to corresponding rates of World War I casualties.
The widespread use of penicillin and more modern antibiotics that have been developed since World War II has been accompanied by the natural evolution of some bacterial strains that are resistant to antibiotics. In many respects, the natural ability of bacteria to develop…… [Read More]
oral chlorhexidine as preventative agent in of ventilator-associated pneumonia (VAP) in adults who are critically ill and mechanically ventilated in intensive care units (ICUs). The process of critiquing published studies leads to higher level of comprehension of empirical and evidence-based research. The discussion devotes some consideration to the way the authors addressed the protection of human participants, the research methodology -- including data collection, data management and analysis -- the research findings, and the conclusions drawn from the study outcomes.
Protection of Human Participants
isks to human participants in this research were minimal since the study is retrospective review of research. The original research studies protected the identity of the research participants, and data was presented in the aggregate form. The current research article is yet another layer away from the original studies and further still from the original information about the participants, none of which was presented in disaggregate…… [Read More]
In critically ill adults (p), how does the daily use of chlorohexidine (I) compared to sterile water reduce VAP (ventilator-associated pneumonia) (O) during hospitalized stay (T)?
oy's Adaptation Model (AM) states that the "nursing process is a problem solving approach for gathering data, identifying the capacities and needs of the human adaptive system, selecting and implementing approaches for nursing care, and evaluation the outcome of care provided" ("Application of oy's Adaptation Model," 2012). This approach seems uniquely well-suited to the question of how to reduce ventilator-associated pneumonia, a common complaint of patients during hospital stays. AM focuses on objective analysis of the problem and attempting to provide solutions which address human needs through a scientific approach to care. The first step of the nursing process is gathering data, in this case determining why pneumonia is so common amongst patients. Next identifying "internal and external stimuli" that give rise to…… [Read More]
The risk to humans is generally low, however during any outbreak of Avian Flu among poultry, there is always a possible risk to humans who have contact with the infected birds and surfaces contaminated with excretions from the infected fowl (Avian1). The current outbreak of H5N1 among poultry in Asia and Europe is an example of a bird flu outbreak that has caused human infections and death (Avian1). In rare instances, limited human-to-human spread of H5N1 virus has occurred, however transmission has not been observed to continue beyond one person (Avian1). Because all influenza viruses have the ability to change, scientists are concerned that the H5N1 virus could mutate and infect humans with a strain that could easily spread from one person to another (Avian1).
Furthermore, according to the CDC, because these viruses do not commonly infect humans, there is little or no immune protection against them in the human…… [Read More]
Because some children have developed brain damage after the immunizations, some parents are concerned that the vaccine is responsible for neurologic impairment, however research does not indicate a definitive link between the pertussis vaccine and brain damage, although research is still ongoing (hooping 2005). Yet, as a precaution, children with a history of seizures or brain disorders may not be proper candidates for the DTaP vaccine (hooping 2005).
2001 study revealed that pertussis was the cause of chronic cough in 19.9% of the patients studied. Once a disease that ravaged children worldwide, whooping cough is once again on the rise (Green 2002). Today, approximately 300,000 children worldwide die every year from whooping cough, usually in areas where immunization rates are low (Green 2002). Nonetheless, even in the United States, where immunization rates are high, roughly 1 out of every 200 babies who get whooping cough will die from it, another…… [Read More]
Sampling Data Analyses the single-study critique paper 2 individual assignment. Develop individual response Single-Study Paper 2 IOM topic area. Use article Single Study Critiques 1-2. It a requirement a quantitative study paper.
Quantitative article analysis
The Nursing esearch article "Effectiveness of an Aspiration isk-eduction Protocol" addresses a proposed method to reduce the risk of aspiration in critically ill patients through a three-pronged intervention strategy. The intervention strategy components include "maintaining head-of-bed elevation at 30 degrees or higher, unless contraindicated; inserting feeding tubes into distal small bowel, when indicated; and using an algorithmic approach for high gastric residual volumes" (Metheny, Davis-Jackson & Stewart 2010: 1). It used a two-group quasi-experimental design of critically ill, mechanically ventilated adult patients receiving tube feedings. 329 were in the control population, 145 in the experimental group (Metheny, Davis-Jackson & Stewart 2010: 1). The patients were all drawn from the same five ICUs at a Level…… [Read More]
Progressive Mobility Protocol
This paper is a project based on PICO. The clinical question that serves as the foundation for this data-based design is; for immobile critical care patients, does the use of a nurse driven progressive mobility protocol reduce ICU LOS compared to every hour of repositioning? In this paper, the adult patients admitted to an ICU represent the population (P) of interest. The nurse driven progressive mobility represents the intervention (I), the comparison (C) is the critical care patients repositioned every two hours, and the reduction in LOS represents the result.
Most hospitals place critically ill patients on bed rest and reposition them every two hours in the intensive care unit. Some literature reviews provide evidence in favor of progressive mobility protocols. In addition, the paper also reviews the safety of mobilization of the critical patients and the negative effects bed rest may have on…… [Read More]