NURS 8551 – Preparing for Dissertation Essay Paper

Patient care planning is the organised assessment and identification of patient problems, the setting of goals, and the establishment of methods and strategies based on best evidenced based practice for achieving them (Uhlrich, Canale & Wendell, 2005). The aim of this assignment is to analyse a case study and create a nursing care plan based on the patient’s issues. Initially background information regarding the patient’s medical diagnosis is provided and seven prioritised nursing problems have been identified. Focus is made on the key nursing problem-immobility, and discussion is made as to why this issue is important to address and what impact immobility has on other nursing issues. Subsequently collaborative health care roles related to the management of the patient are explored. Following this a nursing care plan has been developed. It includes the aims and goals of the care plan, planning and implementation of care, evaluation of the effectiveness of the treatment and rationale using best evidenced based reasons for the proposed plan. NURS 8551 – Preparing for Dissertation Essay Paper

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Body of Assignment

Mrs Winn is a 66 year old retiree and is currently travelling around Australia with her husband. Mrs Win has just undergone a Laparoscopic Cholecystectomy which involves removal of the gallbladder using laparoscopic guidance through several small incisions in the abdomen. The gallbladder is most commonly removed due to cholelithiasis or cholecystitis. “Cholelithiasis is caused by the precipitation of substances contained in bile, mainly cholesterol and bilirubin. Approximately 80% of gallstones are composed primarily of cholesterol; the other 20% are black or brown pigment stones consisting of calcium salts and bilirubin” (Porth & Matfin, 2009, p. 975). Acute cholecystitis is generally due to diffuse inflammation of the gallbladder, usually secondary to obstruction of the gallbladder by gallstones. It can also be associated with sepsis, severe trauma or infection of the gallbladder. Repeated episodes of acute cholecystitis or chronic irritation of the gallbladder by stones may also lead to chronic cholecystitis. Mrs Win also has a history of hypertension, which is defined as persistent blood pressure readings above the normal range (above 120mmHg systolic; 80mmHg diastolic) (Berman, et al., 2008). In addition to this, Mrs Win is suffering from osteoarthritis of the knees which is characterised by the degeneration of articular cartilage in joints (Porth & Matfin, 2009). Mrs Win’s hypertension and osteoarthritis are being managed by medication. NURS 8551 – Preparing for Dissertation Essay Paper

Crisp and Taylor (2005) state that the activities of daily living are the activities usually performed in the course of a day, necessary for adequate self-care. Postoperative clients may have problems affecting their ability to independently perform these tasks and it is the goal of health professionals that their patients achieve the same level of functioning or greater after any intervention. Seven of these potential issues relating to the case study are highlighted below.

Pain management is a high priority in managing the care of Mrs Win. She is complaining of abdominal pain 3/10 and shoulder tip pain 5/10. It is essential that pain is managed effectively as it can have a considerable influence on a patient’s physical and psychological state and significantly affect her ability to perform any activities of daily living. Informing the patient that shoulder tip pain is a common symptom post Laparoscopic Cholecystectomy will help to reassure the patient that it is not an adverse complication. It is due to air injected intraabdominally during the procedure causing irritation of the diaphragm. The pain is referred to the shoulder tip due to their common dermatome. Pain management following surgery includes drug therapy, positioning, massage, relaxation techniques and diversion (St. Marie, 2002). NURS 8551 – Preparing for Dissertation Essay Paper

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Wound care is also a crucial component in Mrs Win’s management. She has four abdominal wound sites with a Verivac drain insitu and appropriate care based on best evidenced-based nursing practice is required to encourage healing and prevent infection and further complications (Dealey, 2005).

Another issue to have a significant effect on a patient postoperatively is immobility. It has a substantial effect on all aspects of the patients’ life and will be discussed in more detail further on.

In addition, nutrition and hydration is a key element to the recovery of Mrs Win. She is complaining of nausea and only tolerating sips of water orally. Eating and drinking are essential constituents in maintaining body homeostasis and a well balanced diet is crucial to her recovery as it impacts on her ability to perform all activities of daily living. Inadequate nutrition also has a negative effect on the body’s capacity to fight infection and maintain good skin integrity. Good nutrition is too important to promote wound healing (Crisp & Taylor, 2005). NURS 8551 – Preparing for Dissertation Essay Paper

Respiratory complications are another potential problem for Mrs Win. She is receiving oxygen via nasal prongs at a rate of 3L per minute and her respiratory rate is 22, which is above the normal range of 10 to 20 breaths per minute (Berman, et al., 2010). She is at risk of developing atelectasis due to surgery, lack of nutritional intake and immobility (Hatfield & Tronson, 2009). Mrs Win is also being administered morphine which could also potentially cause respiratory depression (Porth & Matfin, 2009).

Mrs Win is also at risk of impaired skin integrity due to her age, inadequate diet and restricted mobility. Nursing interventions such as assessing and reporting signs and symptoms of impaired skin, repositioning every 2 hours, and pressure relieving devices need to be in place to reduce the risk of decubitus ulcers (Rosdahl, 2008).

Concern of Mrs Win’s psychological state must also be considered. She has a higher than normal respiratory rate and blood pressure which may be signs of anxiety. Appropriate care needs to be taken to reassure Mrs Win and deal with any psychological issues which may arise (Ignatavicius & Workman, 2010).

“Mobility, the ability to move freely, easily, rhythmically and purposefully in the environment is an essential part of living” (Berman, et al., 2008). It is vital to maintaining independence. Physical activity is often how people define their health because psychological wellbeing and the effectiveness of bodily function depend largely on their mobility status. As Mrs Win has just had a Laparoscopic Cholecystectomy her mobility would be significantly affected due to a number of reasons. She is experiencing pain and nausea which would discourage her from attempting to ambulate. Mrs Win is on oxygen therapy and also has drains and intravenous fluid insitu which would restrict her somewhat as to what she can do. She may also be drowsy and fatigued due to the anaesthetic given in surgery. Mrs Win also has a higher than normal respiratory rate which may indicate she is short of breath and this may also deter her from any physical activity. In addition, she may also be anxious about ambulating due to all of these reasons. Impaired mobility has a substantial affect on body functioning and the ability to perform acitivities of daily living. Firstly when a person is upright, the expansion of the lungs is improved and improves endobronchial mucous drainage, decreasing the possibility of chest infection. Intestinal activity is more effective, reducing the chance of constipation and the kidneys are able to drain more effectively lessening the likelihood of urinary retention. Lack of mobility may affect Mrs Win’s ability to maintain personal hygiene and therefore also affect her psychological wellbeing. Additionally, Mrs Win is at increased risk of developing pressure ulcers and/or deep vein thrombosis due to her immobility. As exercise increases skeletal muscle blood flow this would also affect Mrs Win as she is receiving intramuscular analgesia and this improves absorption of the drug after injection. Narcotics such as morphine can however cause serious adverse effects such as nausea, dizziness and hypotension which would also affect Mrs Win’s ability to ambulate (Bullock & Manias, 2011). NURS 8551 – Preparing for Dissertation Essay Paper

Collaborative roles of other health professionals would be beneficial in the holistic care of Mrs Win. Below are four roles essential to her care. A physiotherapist’s aim is to restore and improve functional ability of the client. They assess the individuals’ needs and using various treatment techniques promote the ability to move, reduce pain, restore function and prevent disability. Mrs Win would advantage from the care of a physiotherapist as she is in pain and has decreased mobility following surgery and may have difficulty performing regular tasks. A physiotherapist may also provide appropriate respiratory exercises to reduce the chance of atelectasis and improve pulmonary function. She may also benefit from care planning and exercises to assist in the management of her osteoarthritis (Herbert, Jamtvedt, Mead & Hagen, 2007). NURS 8551 – Preparing for Dissertation Essay Paper

A social worker may also be incorporated into Mrs Win’s care planning. Their role is to improve the quality of life by helping them cope with and solve issues in their everyday life. Mrs Win is travelling around Australia with her husband and assumingly away from the support of other family and friends. A social worker may assist in the organisation of any social or practical support needs (temporary accommodation, food, transport etc) (Payne, 2005).

Another health professional worth considering is an occupational therapist. Occupational therapy is designed to address issues relating to the skills required to perform activities of daily living. Their aim is to improve a patient’s ability to participate in these activities by modifying the environment to support participation. As Mrs Win has a history of osteoarthritis, recovering from surgery and travelling in a caravan, an assessment by an occupational therapist may be beneficial in her treatment. They may be able to modify her caravan to suit her needs (Crepeau, Cohn & Schell, 2009). NURS 8551 – Preparing for Dissertation Essay Paper

Dieticians have an important role in the management of patients which could be valuable to Mrs Win. They have extensive knowledge about food and nutrition and in order to promote good health they manage the preparation and service of food, design personalised diets and educate individuals on good nutritional practice. A dietician would have an important role in the postoperative care of Mrs Win as she has just had surgery and it is crucial that she consumes a diet suitable to her needs to facilitate a good recovery. A dietician may also assist in educating Mrs Win on the importance of a healthy diet once she leaves hospital (Mahan & Escott-Stump, 2008).

Conclusion

The aim of this assignment was to analyse a case study and create a care plan. Initially the patient’s medical diagnosis was explored, following by identification and examination of the top seven prioritised nursing issues. Subsequent to this the top nursing problem-mobility, was considered in more detail. Exploration of the importance of this issue was addressed along with what impact immobility has on other nursing issues. Also discussed is the other health professionals’ role in a collaborative health care approach. After this a care plan is developed focusing on the aims and goals, planning and implementation of care, evaluation of the effectiveness of the treatment and rationale using best evidenced based reasons for the proposed plan. NURS 8551 – Preparing for Dissertation Essay Paper

Job interviews can be one of the most stressful events in an individual’s life. There are many suggestions that will assure your interviewer will be successful. You need to make sure you role play, prepare and the interview itself. First ask help from professional people who are at a management level to role play an interview, which will help you relieve your anxiety. Ask them to go over general ways of an interview to get more of a feel for it. NURS 8551 – Preparing for Dissertation Essay Paper

This will ensure you wont make many mistakes.

Next comes preparing yourself for the interview. Make sure you have enough rest you do not want to arrive looking exhausted a good sleep will help clear your mind of negativity and look and feel rejuvenated. Another way of preparing for the interview is to have breakfast. It is a proven fact that our brains will work better if we have food in our stomach. Make sure the night before you have your necessary documents as far as a copy of a resume, references, and any certificates etc. , keep that in a nice folder folder or portfolio.

Finally its the interview itself, Arrive on time or be 15 minutes early for that shows responsibility on how you are as far as time management, which will give them a sample on how your attendance will be. The proper attire plays an important role a job interview, because if portrays a professional image on how you carry yourself. When you meet the interview shake their hand firmly for that signifies confidence as well as trust. Do not bring your cell phone put it on complete silence or turn it off, it would honestly kill your interview it would be the rudest thing if went off and there goes your interview. NURS 8551 – Preparing for Dissertation Essay Paper

The best thing to do and the right thing is to remain with eye contact with the interviewer. Whatever you do talk appropriately do not use slang just be confident keep things simple and be yourself, Remember your trying to present yourself. These are the tips I use for a job interview, using these steps will help your interview by a tremendous amount. This is because I have management skills and my parents are successful managers. These useful tips are all based on experience and common sense which will improve the outcome of the interview.

This is an interview of a Master’s- prepared nurse who has recently assumed an Assistant Director of Nursing position. The intend of the interview is to show how a graduate of a Master of Science in Nursing would adequately prepare a nurse to assume a higher role in the field of nursing practice, education or administration. This achievement offers the individual with many opportunities for growth and opens the door to different career possibilities. I chose to interview B. A. , a fellow instructor at the Anaheim nursing school where we teach.

Aside from knowing that she is optimally qualified to fill her post, I am also impressed by how she rose from the ranks, and how she values education as the tool to reach for her dreams. Overview of Career B. A. started her career after graduating as a Medical Assistant at Everest College (formerly Bryman College), La Palma in 1991. NURS 8551 – Preparing for Dissertation Essay PaperOnly  page

She worked from 1991 – 1993 at a surgical group practice clinic in Cypress, and was responsible for the back room. She gained clinical experience while assessing patients, taking vital signs, assisting doctors and performing venipunctures and injections.

Not content with her work, she continued with her studies and became a Certified Nursing Assistant from Long Beach City College in 1993. She worked at the Skylight Convalescent Home at Long Beach from 1993 – 1996. B. A. cared for and coordinated with nurses regarding her clients’ physical needs and these reinforced her desire to learn more so she could be of better service. And so, while working as a CAN, she pursued her Licensed Vocational Nurse program at Long Beach City College and graduated in 1996. She studied fulltime on weekdays and worked two jobs on weekends, to make both ends meet.

From 1996 – 2000, she worked as an LVN at the St. Mary’s Hospital in Long Beach, where she refined her technical skills on medication pass, intravenous therapy, irrigations and catheterizations, as well as patient support and safety implementations. B. A. was diligent and industrious, enough to be noticed by her charge nurses. One day, a supervisor approached and encouraged her to continue studying, and not to waste her talent. This prodded her to take an Associate Degree in Nursing, graduating from Long Beach City College in 2000, and subsequently passing her licensure examination.NURS 8551 – Preparing for Dissertation Essay Paper

From 2000 – 2004, she was promoted to Clinical Nurse II at St. Mary’s Hospital, Long Beach. She became a Nurse Supervisor at the Rehabilitation Unit, taking charge of LVNs and CNAs while coordinating with the interdisciplinary team regarding the clients’ therapies. By this time, her yearning for knowledge was insatiable, pushing her to finish the Bachelor of Science in Nursing degree at the University of Phoenix in 2008. This opened the door for more exciting opportunities and challenging roles. She was promoted to Clinical Nurse III at St. Mary’s Hospital, a position she held for seven years from 2004 – 2011.

1. A. became the Nurse Coordinator of the same unit, liaised residents’ activities with the team and acted as resource person for staff in- services. In 2008, she was also certified as a Public Health Nurse. Ever grateful for her blessings, B. A. sought to share and impart her knowledge and skills with budding student nurses. From 2004 till present, she has returned to her Alma Mater, Everest College, as an Instructor of the LVN program. She continues to teach and inspire students, telling them to study well and learn in order to become successful nurses of the next generation. Graduate Education

During the interview, I saw glimpses of why B. A. wanted to be a nurse and why she pursued higher education. She recalled getting Scarlet Fever when she was a schooler and remembered a nice lady visiting and taking care of her. There was also a time when she lost her second pregnancy from an abruption. She was in shock and denial, and a nurse assisted her in cleansing and preparing the remains. She also mentioned that among her mother’s clan, she is the only member who is a degree holder. She considers this a major personal accomplishment. Together with her passion her teaching, she obtained her graduate education. NURS 8551 – Preparing for Dissertation Essay Paper

2011. A. completed MSN/ Nursing/ Health Care Education at the University of Phoenix in 2011. This was an intense twenty month on- campus program, career- designed particularly for working professionals. The program prepared a baccalaureate degree nurse to function in leadership roles in clinical practice and educational settings. The curricula, centered on evidence- based practice, critical thinking and leadership development, helped to increase her knowledge and hone her skills. (Master of Science in Nursing, 2013)The nursing courses included advanced nursing content and process together with leadership skills.

(Master of Science in Nursing, 2013) The health care education program focused on faculty role, curriculum development, assessment and evaluation, and instructional strategies. (Master of Science in Nursing/ Nursing/ Health Care Education, 2013) The degree certified and qualified her for titles such as Nursing Instructor, Assistant Professor and Professor, and posts like Assistant Director of Nursing and Director of Nursing. (Summary Report for:Nursing Instructors and Teachers, Postsecondary, 2013) Present Position B. A. is a newly- appointed Assistant Director of Nursing at our school. She is also in training and is expected to assume the Director of Nursing post next year to fill a projected vacancy. The nursing faculty is enthralled at her meteoric ascent and pledges to support for her success. She stated that her graduate education properly prepared her for the present job. She also claims that, in teaching students, critical thinking must be stressed and information provided must be evidence- based so students will be better informed and will act responsibly. NURS 8551 – Preparing for Dissertation Essay Paper

She cited the importance of knowing the theoretical basis of nursing and the principles of health promotion and disease prevention so we can teach better primary, secondary and tertiary nursing care. (Master of Science in Nursing, 2013) Having gone through Ethics, Professional Role Development and Human Diversity and Social Issues helped improve her outlook in life and how she deals with people. (Master of Science in Nursing, 2013) Her leadership training proved valuable particularly in her new role fraught with challenging decision- makings. B.

1. is adept in curriculum design and development, especially when she spearheaded the updating of our LVN course syllabi. Lastly, she claims to be a good team player, collaborator and patient advocate. She is also a great resource person, lecturer- educator and always is a reliable shoulder to cry on. Pearls of Wisdom B. A. advises students and fellow instructors to develop discipline and perseverance. Her accomplishments are outstanding, to say the least, for someone who grew up in urban Chicago ( she quips) and being a single mother of two.

She stated that a person must always look for a purpose in life and that there is nothing one cannot do if you set your mind into it. Continuously studying and reaching for the highest goal is her motto, and rightly so for she is currently in the midst of her Doctorate in Nurse Practice degree too. “The more you know, the better you would interact with your students and your clients”, she would remark. And above all, “Always pray and seek guidance from the Lord”. Our Assistant Director would say who recently was also appointed a Religious Minister of their congregation. NURS 8551 – Preparing for Dissertation Essay Paper. Conclusion

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