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2023 Hello i need a Good and Positive Comment related with this argument

2023 Nursing p6

Hello i need a Good and Positive Comment related with this argument 2023

Hello i need a Good and Positive Comment related with this argument .A paragraph  with no more  100 words.

 

 

Ashley Pittman 

 

1 posts

 

Re:Topic 1 Mandatory Discussion Question

 

Ms G. presents to the ED with cellulitis of the LLL.  She reports no improvement since applying heat for several days.  Miss G. also reports increased pain and has developed chills suggesting that she has a fever.  Assessment findings show an open wound on her LLL with drainage present and swelling of >3 cm in comparison to her RLL.  She has a temperature of 102.2 F and wound cultures are positive for Staph aureus.  Lab values show an elevated WBC with > 10% bands and 80% L shift in neutrophils.

 

My recommendation would be IVF, Abx, A1C, CMP, complete set of VS, head to toe assessment, CBG ac/hs (insulin if needed).  Miss G. would also benefit from evaluation by OT and PT as well as meeting with a Diabetic Educator.  Social work would also be beneficial as she lives alone and may have greater needs than we are aware of.  Imaging of the LLL can tell us if she is experiencing DVT or if there is damage beyond what we can see. 

 

It is essential that we treat the existing infection so that she can return to baseline, and it is equally important that we assess her knowledge of Diabetes as uncontrolled diabetes can have a serious impact on wound healing. 

 

Muscle groups that are likely to be affected by Miss G.’s infection include gastrocnemius, soleus, extensor hallucis longus, extensor digitorum longus, fibularis longus, vastus medialis, rectus femoris, and extensor hallucis brevis (ARC Resource Center, nd).

 

The data presented paints a picture of where Miss G may need assistance and/or education.  She needs to be evaluated on her understanding of Diabetes and management of the disease.  Many complications come from diabetes including delayed wound healing.  She will need labs drawn over the course of her stay to evaluate the effectiveness of the abx.  An A1C will tell us if Miss G manages her Diabetes well over time.  Evaluation by PT and OT are important for safe discharge home as she lives alone and was not able to perform ADLs independently upon admission.  She will need to follow up with her PCP after discharge to have the wound on her leg looked at. 

 

As mentioned above, delayed wound healing can be caused by diabetes and also poor nutrition. Miss G may also suffer from depression as she is managing a chronic condition and living alone; depression has also been linked to delayed wound healing. 

 

“The moment a person with diabetes suffers a break in the skin of their foot, they become at danger for amputation. Most commonly, patients have neuropathy, which could be causative. When coupled with an impaired ability to fight infection, these patients become largely unable to mount an adequate inflammatory response. Thus, the DFU that may look like a healing wound becomes a portal for infection that can lead to sepsis and require limb amputation” (Journal of Investigation, 2007).

 

 

 

 

 

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2023 Hello i need a Good and Positive Comment related with this argument A paragraph with no more 100 words Ms

2023 Nursing p1

Hello i need a Good and Positive Comment related with this argument A paragraph with no more 100 words Ms 2023

Hello i need a Good and Positive Comment related with this argument .A paragraph  with no more  100 words.

 

 

  1. Ms. G. presents with cellulitis of the left leg – this is noted by lab results that indicate infection such as increased WBC, bands >10%, and an 80% left shift of her neutrophils. Ms. G. also has swelling and erythema of her left leg, is unable to bear weight, and is running a temperature. Ms. G. needs more lab work (CMP, ABG, Hgb A1C,CK,  lactic acid, procalcitonin, CRP, pan cultures, and an MRI or CT of left leg), as well as additional vital signs. When a patient is septic their HR is either increased or decreased, patient is generally hypotensive, and patient is tachypneic. Because Ms. G. is diabetic she needs an ABG and CMP to see if she has DKA due to the infection, and an A1C to see how well controlled her blood sugars are. CK should be checked to see if Ms. G. is in rhabdo due to muscle breakdown and possible DKA. Lactic acid and procalcitonin are indicators for sepsis and is something that should be done immediately upon suspecting sepsis. Patient should be pan cultured, however, or at the very least 2 sets of blood cultures should be done prior to starting antibiotics. CRP will be elevated due to the infection and is not a specific test but will show that she has inflammation. MRI or CT to evaluate if there are any other problems associated with her infection other than cellulitis.  Preferably an MRI as it will give better results. Surgery consult should be ordered also. Recommended treatments consist of: IV antibiotics, possible sepsis and dka protocols, as well as possible surgery. Ms. G. also needs to have a wound consult for the wound on her left ankle and an appropriate dressing applied. Marking the margin of the red area is recommended in order to determine if the site has expanded, as well as, measuring ble to see the extent of the swelling. Elevation of left leg above the level of the heart if possible.
  2. The muscle groups affected are: Lower leg: gastrocnemius, soleus, extensor digitorum, extensor hallucis longus, extensor hallucis brevis, tibialis posterior. Possible muscles affected in upper leg: gracilis, semimembranosus, bicep femoris, vastus lateralis, rectus femoris, Sartorius, tensor fasciae latae, and adductor longus. Listing muscle groups that are affected is challenging due to the seriousness of the infection. All of the muscle groups in the upper and lower leg could be affected.  While these are all skeletal muscles each of our organs are considered muscles also and when a patient is septic each one can be affected leading to multiorgan system failure.
  3. The significance of the data provided shows that Ms. G. has an infection, is likely septic r/t to cellulitis of the left leg, as well as dka, and will probably need to be admitted to the hospital for IV antibiotics, possible insulin infusion and to be stabilized. Follow up labs are listed above and patient should be having a regularly scheduled Hgb A1C with her primary care physician. Patient needs more education on managing her diabetes and proper skin care, especially foot care since she is diabetic. Patient should be seeing a wound nurse for the wound on her ankle, and a podiatrist to have her feet checked and nails cut. Patient also needs to see a diabetic educator and nutritionist to help her understand DM and to help her with a plan of care for weight loss and blood sugar control. Patient also needs homecare and a program such as Meals on Wheels that will deliver her meals for her, at least until she has recovered. If homecare is not an option and she is unable to care for herself at home then placement in a skilled nursing facility is recommended.  
  4. Ms. G. is diabetic and this will prevent wound healing. Ms. G. also has a wound on her left ankle that needs to be addressed. Ms. G. needs a significant amount of education and to be seeing specialists. If Ms. G. does not have a proper diet then her wound healing will be delayed also. While nutrition is important long term for her it is also important to help her heal from her current state. DM is a serious disease with debilitating side effects if not managed properly. Uncontrolled DM can lead to organ failure, blindness and loss of limbs.  

 


 

 

 

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2023 Ethical Issues With an Aging Population According to the CDC in the United States the proportion of the population

2023 Nursing See attached Question:

Ethical Issues With an Aging Population According to the CDC in the United States the proportion of the population 2023

 

 

Ethical Issues With an Aging Population

 

According to the CDC, “in the United States, the proportion of the population aged >65 years is projected to increase from 12.4% in 2000 to 19.6% in 2030,” (CDC, 2003, para. 2). Caring for this aging population is going to be one of the greatest challenges facing the health care industry. Not only will the number of individuals requiring care rise, but so will the cost. As poignantly stated by Crippen and Barnato, “unless we change the practice of medicine and reduce future costs, and explicitly address the ethical dilemmas we face, there may come a time when our kids simply cannot afford us” (2011, p. 128).

 

In this Discussion, you will examine the ethical issues that the United States and other nations must address when faced with the health care challenges of an aging population.

 

To prepare:

 

·         Consider the ethical aspects of health care and health policy for an aging population.

 

·          The question, “What are the economic consequences, now and for future generations of taxpayers if we fail to adapt our policies to the changing reality of an older population?” (p. 21). Consider how you would respond to this question. In addition, reflect on the ethical decisions that arise when dispersing limited funds.

 

·         Contemplate the impact of failing to adjust policy in accordance with the changing reality of an older population.

 

·         Reflect on the ethical dilemmas that arise when determining expenditures on end-of-life health care.

 

 

 

Post an explanation of the ethical standards you believe should be used in determining how resources should be allocated for an aging population and end-of-life care. Then, provide an analysis of the ethical challenges related to the preparation for the provision of such health care.

 

 

 

 

 

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2023 E Prescribing E prescribing is the transmission of prescription or prescription related information using electronic media

2023 Nursing E-Prescribing

E Prescribing E prescribing is the transmission of prescription or prescription related information using electronic media 2023

E-Prescribing

E-prescribing is the transmission of prescription or prescription-related information using electronic media between a prescriber, dispenser, pharmacy benefit manager, or health plan, either directly or through an intermediary, including an e-prescribing network.

In an effort to understand the benefits and cautions about e-prescribing, conduct thorough research. For your Dropbox assignment, create a 4- to 5-page report in Microsoft Word document consisting of your research findings covering your responses to the following questions:

  • Evaluate three pros and three cons of e-prescribing.
  • Summarize the e-prescription standards as described by the National Council for Prescription Drug Programs.
  • Evaluate the projected cost and time savings as estimated by the United States Department of Health and Human Services.
  • Comment on the controversy surrounding the 2013 e-prescribing penalty.

Support your responses with examples.

Cite any sources in APA format.

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