Nursing care reports writing assistance

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Samples of questions we can handle include;

• Discuss the differences and similarities between Managed Care Organizations (MCOs) vs. Accountable Care Organizations (ACOs).

Given the current health care environment, provide solid speculation as to how MCOs and ACOs may transform to meet the needs of their consumers. Be sure to support your thoughts and analysis with scholarly sources.

*Will also need to respond to 3 classmate’s posts, will send that after you turn in an assignment.

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• Personal Improvement Project Report

  For this week, you will begin work on your Module 1 Assignment, which will be due in Week 6.

  Suppose you wanted to improve something about yourself and your behaviors. Let’s take the example of lowering caffeine intake. How would you begin? According to the principles of CQI, you would approach it in an analytical manner. You would examine the reasons for your caffeine use and begin to track consumption, noting the amount you take in, the times of day, and the physical and mental effects. You would then attempt to reduce the intake and continue to track all the same points. Then you would consider the data you have gathered and whether you succeeded in your aim.

  For your Module 1 Assignment, you will go through these steps with a personal improvement topic of your choosing. You will then write a report summarizing the data and process you followed and applying what you’ve learned to a healthcare context.

  The Assignment (4–5 pages, not counting tables, graphs, diagrams, and charts):

  Part 1: Aim

  Clearly state the aim of your project.

  Part 2: Process Analysis

  Consider the process leading to the results that you aimed to improve. Create a process map to identify the steps in the process and identify the people (other than you) who were involved in the process.

  Part 3: Measurement

  Describe the data collection method used, including an explanation of what you measured and how. Be specific.

  Present the data in a table, graph, diagram, run chart, or XmR chart.

  Part 4: Changes

  There is a saying, “Not all change leads to improvement, but all improvement leads to change.” Explain the changes you made based on the data. What worked? What didn’t work?

  Part 5: Reflection and Application

  Reflect on your Personal Improvement Project and what you learned.

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• Foundations Care Plan Assignment

Instructions:

1. Read scenario; underline or highlight related data; develop lists of related data. (see #8 for the hint)
2. Identify 3 priority (most urgent) nursing issues and write a nanda nursing diagnosis label for each; can be “at-risk” or “actual” diagnosis

• hint: use the nanda list in your book

3. Number 3 nanda diagnostic labels you identified in order of priority.

• hint: consider maslow’s hierarchy of need; think about what needs to be addressed immediately

4. Pick the nanda diagnostic label that is the highest priority and develop the nanda diagnostic label into a complete nursing diagnosis, correctly incorporating all components

• hint:
• if you use an “at risk” diagnostic label, the nursing diagnosis will have 2 parts: nanda label and related factor
• if you use an “actual” diagnostic label, the nursing diagnosis will have 3 parts: nanda label, related factor and defining characteristics.

5. Using the nursing diagnosis completed,

Develop one (1) goal statement and a supporting objective.

The goal is a general statement, but the objectives must include all of the following components:

• smart (learn this acronym and how to use it!)
• s: specific
• must be patient-centered; start with “the client will…”
• m: measurable
• a: attainable
• r: realistic
• t: timed
• hint: your goal and objectives must be based on the priority nursing diagnosis you completed in # 4.
• do not write goals and objectives based on a different diagnostic label. When you write complete care plans for future clients, each diagnostic label will be developed into a nursing diagnosis and have its own goals, objectives and interventions. For this assignment, use your 1st priority diagnosis

6. Based on your nursing diagnosis and goal, write appropriate nursing interventions.

How about writing a nursing care plan?

• hint: the interventions must directly relate to the nursing diagnosis, goal and objective you have developed. Do not list interventions for other diagnoses. Note that sometimes the same intervention may apply to more than one diagnosis, but do not include unrelated interventions.
• when identifying interventions, use your text to locate appropriate interventions. You may also use the internet as a resource for interventions; many examples of care plans are available, but do not copy a care plan directly from the internet; your care plan must be specific to this scenario and this patient.

7. Grading

• using the care plan completed in class as an example, complete the care plan assignment as above and submit.
• a “rough draft” of your care plan must be submitted in week 9; this counts as a quiz grade
• final grading based on the rubric provided
• care plan assignment is due week 10 and is 4% of your grade. (nonobjective)

8. Developing your critical thinking skills:

• hints for grouping like data and developing “issues”

1. A) are any of the vital signs abnormal? Are there other factors in the scenario that could have caused the abnormal vital signs?
2. B) g. C. Has fallen 3 times. Is there any other data that makes her at risk for falling again?
3. C) based on the scenario, what else is g.c. at risk for?
4. D) why has her pain increased today? What data supports this?
5. E) why was she admitted to a rehab facility instead of going directly home when discharged from the hospital?
6. F) why do her orders include a high protein drink supplement?
7. Developing nursing interventions

• should be based on the 1st priority, fully developed nursing diagnosis, goal and outcome statement
• should be a nursing action; use action verbs such as assess, administer, monitor, teach, assist, instruct etc.
• ask yourself: “does this intervention help to meet the goal and objective statement?” Will these interventions accomplish the desired outcome?

Assignment: Nursing care reports writing assistance

Scenario

Gillian chickory is a 72-year-old retired bus driver admitted yesterday from fortis hospital to fortis rehab and care manor. Prior to admission, she lived alone in her own home. She has a daughter who lives out of state. She does not have any advance directives.

She has fallen three times in the past month; and has large bruises in various stages of healing on her right hip, shoulder and cheek. Her most recent fall, 3 days ago, resulted in a 2 inch laceration below the right eye. She has 6 sutures in place and the eye socket is a deep purple color.

She is oriented x 4; her vital signs are: t 99.9, p88, r16, bp 106/54; pain 7/10, right cheek.

During the initial assessment in the morning, ms. Chickory tells the nurse she is having much more pain in the right cheek today. The nurse notes a small gap opening between 2 of the sutures, and a small amount of yellow pus oozing from the wound. The surrounding area is red, hot to the touch and edematous.

Ms. Chickory has lost 15 pounds over the past month. She is 5’ 6” and now weighs 118 pounds. Her appetite is poor, and she states she “has not felt much like eating.”

Although her orders are for ambulation, she is fearful of falling again and seldom gets out of bed. Her right side is painful; it is difficult for her to turn and prefers to lie on her left side. She often refuses assistance to reposition.

Ms. Chickory was diagnosed with hypertension 2 months ago and started on both an antihypertensive and a diuretic. Since starting these medications, she is often incontinent of urine. She is very embarrassed about this and does not call for help to “clean up” when she is wet. She states she “pees on the floor a little” on the way to the bathroom.

Orders

Allergies: nka

Medical admitting diagnoses:

• physical decline; hypertension; unexplained weight loss; congestive heart failure

Medications:

• labetalol 100 mg by mouth twice a day. Hold for systolic bp <100; diastolic <60
• bumex (bumetanide) 1 mg by mouth once a day
• klor-con® m20 extended-release (potassium chloride) take 1 tablet daily by mouth
• milk of magnesia 30 ml once day as needed for constipation
• boost high protein dietary supplement, 8 ounces 3 times a day between meals
• acetaminophen 325 mg, tabs 2 every 4-6 hours as needed for mild to moderate pain

Diet: regular diet; calorie count for 3 days; dietary referral for weight loss

Activity: following pt consult, assist out of bed daily; may ambulate as tolerated

Physical therapy: pt consult for evaluation of gait; evaluate activity tolerance