What other members of the interdisciplinary team would you want to contact to assist with the family?

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Directions:
Read through the following case study. In this case study you are the primary care nurse on a busy medical surgical floor. Answer the questions utilizing the sections power point presentation and readings. Submit your assignment in a Word document using proper APA formatting. Please refer to the Grading Rubric for Discussions.

Mrs. Paul is a 48-year old woman dying of end-stage liver disease and chronic renal failure. She is fatigued and has experienced significant weight loss, despite significant edema. She was diagnosed with colon cancer three years ago.
Mrs. Pauls family is very upset and wants aggressive interventions done to help improve her appetite, curb her weight loss (she has lost 18 pounds in the last 4 weeks) and prevent nausea/vomiting. Her physician believes that one of the contributing factors to her fatigue is that her hemoglobin and hematocrit are low. She has receive 4 units of packed red blood cells over the past 2 weeks. The patient stats that the fatigue continues, despite the blood transfusions. She has intractable nausea and vomiting and, as a result, she is frequently admitted to the hospital. As the nurse on the medicine unit you are admitting and assessing Mrs. Paul during her most recent admission. The medical unit staff is very upset with Mrs. Pauls family. The patients primary doctor and oncologist have not taken an active role in discussing palliative care with the patient or the family. One of your peers that has been caring for Mrs. Paul during frequent her frequent admissions states: this family and patient deserve better-someone needs to be truthful with them so they know that their loved one is dying.
Questions to answer:

Discuss your evaluation process in this case regarding: fatigue, weight loss, nausea, and vomiting.
Based on you assessments identify what management strategies you would use. What issues would you want to discuss with the interdisciplinary team?
Considering Mrs. Pauls and her familys needs and concerns, what strategies and interventions might you consider in her nursing plan of care?
How would you approach the physician about entertaining the possibility of palliative care for the patient and her family?
Case Continued
Ms. Paul has four children (ages 15, 17, 21, 25). You happen to have a conversation with the two youngest children, as they have come to the hospital after school to visit their mother. Their mother has gone to radiology for a CT-scan and you (the bedside nurse) decide that this would be a good time to talk with her children. The youngest confides in you that she knows her mother is dying. I saw her vomit blood before we brought her to the hospital.We used to put puzzles together, but she is too tired anymore.Is my mother going to die?
Questions to answer:

How would you respond to the 15-year old daughter?
What other members of the interdisciplinary team would you want to contact to assist with the family?

NO MORE THAN 400 WORDS

Acute coronary syndrome, chest pain, cardiac enzymes

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INTERESTS: Acute coronary syndrome, chest pain, cardiac enzymes

Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.

In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICOT modelpatient/population, intervention/issue, comparison, and outcome

outlined in the Learning Resources to design your questions.
To prepare:

� Review the article,

Formulating the Evidence Based Practice Question: A Review of the Frameworks,found in the Learning Resources for this week. Focus on the PICOT model for guiding the development of research questions.
� Review the section beginning on page 71 of the course text, titled, �Developing and Refining Research Problems in the course text, which focuses on analyzing the feasibility of a research problem.
� Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.
� Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.
� Formulate a preliminary PICO questionone that is answerable based on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question?
Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.
� Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.

To complete:
Write a 3 page paper that includes the following:
A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice
The 5 questions you have generated and a description of how you analyzed them for feasibility
Your preliminary PICOT question and a description of each PICOT variable relevant to your question
� At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections
INTERESTS: Acute coronary syndrome, chest pain, cardiac enzymes

What does the course instructor mean by integrative abilities?

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The following response on the discussion board was posted by the course instructor:
The advanced practice role of Certified Nurse Midwife (CNM), Certified nurse practitioner (CNP), Certified nurse specialist (CNS), and certified nurse anesthetics (CRNA) required an intensive set of clinical skills, understanding, and integrative abilities that synthesize advanced practice nursing knowledge.
Discussion Question:
What does the course instructor mean by integrative abilities? Provide evidence to support your response.

This part of the assessment task requires you to develop a nursing care plan for the patient in the provided case study.

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This part of the assessment task requires you to develop a nursing care plan for the patient in the provided case study. In order to do this, you will need to consider the role of the interdisciplinary team and registered nurse in the management of this patient.

In addition to a brief introduction and conclusion, Part B of your report should include:
A discussion of the importance of the guiding principles of self-management, empowerment and advocacy in the collaborative management of the patient and his family.
A discussion of the role of the registered nurse in the acute medical ward in the management of this patient and his family including an analysis of the ways in which the registered nurse could collaborate with other members of the interdisciplinary team to co-ordinate the provision of comprehensive nursing care to the patient and his/her family. This may include care that may be required when patient returns home.
A nursing care plan that contains five (5) nursing interventions that would be appropriate for the patient at this stage of his presentation.
Each intervention must be supported by a rationale that explains at least one or all of the following: how it will address the underlying pathophysiology, how it is keeping with the guiding principles discussed in your report and/or how it is consistent with current best practice.
Your report must adhere to academic writing conventions. Sub-headings may be used, but dot points and tables should not be included in your report.
You should support your discussion with a MINIMUM 12 recent (less than 7 years old) and credible sources. Credible sources include, peer reviewed journal articles, text-books, evidence summaries, best practice guidelines, government documents, health facility clinical guidelines and policies/procedures and websites containing content aimed at health professionals. Please note that lecture slides will not be considered to be appropriate sources for this assessment task.
Please note that you can and should refer to any relevant information from Part A of your report without needing to repeat it in this assessment item. For example, “as discussed previously in Part A of this report….”

Case Study for Part B

Luigi develops an ulcer on his right leg that will not heal despite oral antibiotics and becomes infected, causing cellulitis to develop over his lower right leg. He is unable to walk unaided. His diabetes remains poorly controlled due to poor understanding and compliance with his diabetic diet as his wife does all the cooking. As a result his renal function is deteriorating. He is admitted to hospital for IV antibiotics, stabilisation of his diabetes and care of his worsening leg ulcer. He is commenced on sliding scale insulin titrated to his BGLs whilst in hospital and IV Ceftriaxone. He is extremely upset that he has to remain in hospital as his son is away and his wife is home alone.