hydration station

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you talk about that at your place of work; beverages are not allowed at the nurses’ station only in the break room. That too was true at my place of work, however we recently implemented a hydration station at the nurses’ station, which gives us a place to contain our beverages. There are however specific rules, for example they have to be in a proper beverage container, containing a lid, they have to have the name of the nurse and current date, or else it will get thrown out. According to United States Department of Labor and OSHA (n.d.), they do not have a prohibition against having beverages at the nurses’ station, all they require is that it is not near blood or infectious material and because of that we do have a weekly audit of the hydration station, which verifies that we are in compliance with OSHA. Just a thought. Thank you for sharing.

Reference

Occupational Safety and Health Administration [OSHA]. (n.d.). Requirements for Covered Beverages at the Nurses’ Station. Retrieved from

manager

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Professor, I honestly think my manager is original in the sense that she is both professional and business like, yet human and compassionate. I am referring to the fact that she is not afraid to “jump in” and provide nursing care when the unit in need of an extra hand. I have not heard of another unit in “my” hospital where managers are like my manager. When it comes to listening to nurses and their suggestions, I know of at least one other unit that is managed in a similar way. I feel lucky. 

Are Leadership and Management Different?

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Although often used interchangeably leadership and management are very different. “management and leadership do share many similar duties which consist of working with people and influencing others to achieve goals. Management skills are used to plan, build, and direct organizational systems to accomplish missions and goals, while leadership skills are used to focus on a potential change by establishing direction, aligning people, and motivating and inspiring.”(Algahtani, 2014). As a nurse leader you can expand your influence to create change and accomplish goals by overlapping your leadership and management skills. By using your leadership skills you can motivate other nurses to go above & beyond when caring for patients and encourage them to come up with solutions to our everyday problems. Leadership skills will also help you when developing your nurses to become future leaders or to meet their personal goals, doing so will in turn provide them with a sense of fulfillment. By using your management skills you can also ensure that your nurses have the adequate staffing and supplies needed to get perform their duties. A managers main function is “to provide services to the community in an efficient and sustainable manner”(Algahtani, 2014).

Algahtani, D. A. (2014). Are Leadership and Management Different? A Review. Journal of Management Policies and Practices,2(3). doi:10.15640/jmpp.v2n3a4

functions of management

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The functions of management include planning, organizing, staffing, directing, and controlling. Within each of these functions, decisions must be made to optimize the care provided while remaining fiscally responsible.

Leadership is a more challenging role to define. At times, leaders may not have formal authority, but they may have power through their ability to influence others. A leader’s emphasis is on interpersonal relationships; they may be known as mentors, coaches, advocates, or role model. (Lecture 1)

Management and leadership may coexist in one, though they may not at all. Some managers are leaders as well, and some are not. You may think they would go together, but we have all had experience with a manager that is NOT a leader. You know the one. The one who is the boss, and handles business, but not one that inspires, advocates or mentors staff.

One the other side of the coin, you may have had the pleasure of experiencing a manager that is a leader as well, someone who is part of the team and inspires, mentors, and coaches staff. The inspiration and the management. The boss who rally’s the troops and makes you WANT to be there and WANT to work for them. The two overlap in multiple areas.

As a nurse leader, I do believe I can expand my influence to create change by taking advantage of this overlap. I feel that I am inspiring and able to mentor and encourage and advocate for not only my patients, but my coworkers, company, and my profession. I would take advantage of the overlap by using my leadership abilities to continue to mentor, inspire, and encourage others in doing their best and being team players. A huge part of this is leading by example, which I strive for daily.

Resources

Lecture 1. (2018). NRS-451V. Theories and Concepts in Leadership and Management. Phoenix, AZ: Grand Canyon University.

mandated reporter scenario

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Review your state’s mandated reporter statute. Provide details about this in your post. If faced with a mandated reporter issue, what are the steps in reporting the issue? Create a mandated reporter scenario and post it. Respond to one of your peer’s scenarios using the guidelines for submission/reporting in your state. Be sure to include a reference to your state’s website related to mandated reporting. 

Cultural competencies for nurses

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Dyer-Berenson, Ch. 1 & 2

1.In reference to Dyer-Barenson, describe the process to obtain cultural competency. Has this course helped you begin this process? What else do you need to do?

2. What is the difference between ethnicity and race,? What are primary and secondary characteristics of a culture?

Summary: The purpose of the weekly reflective journal exercises is to allow for analysis, synthesis and evaluation of nursing theory using guided questions. Reflection has been referred to as a process that happens internally, privately or in isolation (Hill & Watson, 2011).  Also a useful definition of reflection has been referred to as the examination of an issue of concern, as a consequence of experience, creating clarity and meaning in terms of self, and which results in a change of perspective ( Boyd & Fales, 1983).

book :

Dayer-Berenson, L. (2014). Cultural competencies for nurses: Impact on health and illness, 2nd edition. Sudbury, MA: Jones and Bartlett. ISBN: 1-978-1-4496-8807-3

Leadership Health Care

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When we consider the word love as a verb instead of a feeling, the biblical worldview would state that this loving relationship is related to two principles: honor and protection. Explain how these two principles guide servant leadership in the workplace.

LYMPHATICS

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ROS:

GENERAL:  No weight loss, fever, chills, weakness or fatigue. 

Head: Symmetrical, no swollen lymph nodes, no signs of sinus infection

Eyes:  Does wear glasses due to myopia, no blurred vision, double vision or yellow sclerae.

Ear: No hearing loss.

Nose: Cough present, no congestion, runny nose.

Throat: No sore throat or difficulty swallowing.

SKIN:  No rash or itching. Some redness and swelling to right leg.

CARDIOVASCULAR:  Right side chest pain, chest pressure, and chest discomfort. Racing heart palpitations.

RESPIRATORY:  shortness of breath, chest tightening, increased pain when inhaling, labored breathing.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Some frequency in urination, wakes twice at night to urinate.

NEUROLOGICAL: headaches and numbness and tingling of fingers. MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes. No known history of splenectomy.

PSYCHIATRIC:  Endorse feeling anxious

ENDOCRINOLOGIC:  reports cold sweat

ALLERGIES:  latex and mold

O.

General: steady gait. Flushed face with a facial grimace. Appears anxious

Vital signs:

Temperature: 97.9 oral

Respiratory rate: 32, labored

Heart rate: 112, tachycardic

BP right arm: 148/88

Oxygen saturation: 90% on room air

Weight: 210 lbs., stable

Height: 5’8”

Skin: Cool, diaphoretic

Thorax and lungs: Thorax symmetrical; diminished breath sounds right middle and lower lobes; no rales, rhonchi, or wheezes; breath sounds vesicular with no adventitious sounds to the left lung

Cardiovascular: Heart rate is irregular with good S1, S2; no S3 or S4; no murmur or jugular vein distention.

Abdomen: Protuberant with normoactive bowel sounds auscultated x4 quadrants

Peripheral vascular: Right calf with 2+ edema, erythema; warmth and tenderness

on palpation noted; left lower extremity without edema or erythema; 2+ dorsalis pedis pulses bilaterally

Neurologic: Anxious; awake, alert, and oriented to person, place, and time

Diagnostic results: EKG shows Atrial fibrillation. He is waiting to do an angiography, chest x-ray and a ventilation/perfusion scan (V/Q) to examine blood flow in the lungs. Labs for collection are complete blood count, complete metabolic panel, lipid panel, troponin, creatinine kinase, creatine phosphokinase.  D-dimer test to check for DVT and pulmonary embolism are needed, and a cardiac MRI to fully view the heart. (Dains, et al., loc 3494. 2016)

A.

The provider states that the patient may have a pulmonary embolism. While this may be accurate, it is good to rule out other illnesses before giving a definitive diagnosis without proper analysis as misdiagnosis can cause a delay in treatment leading to great consequences. There are other possible differential diagnoses such as GERD, anxiety, and angina; 

Respiratory

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APA format 3 peer review references 

Patient Initials: __JH_____                Age: __60_____                                 Gender: ____M___

Subjective Data:

Chief Complaint: Case #3 “I have a cough that’s getting worse.” (Laureate Education, 2012).

HPI: Mr. Hendricks is a 60 year-year old Caucasian male who presents today complaining of a cough that is progressively getting worse; more frequent over the past three days. He states that his cough is accompanied by expectoration of thick green secretions accompanied by some blood at times. He has associated symptoms of shortness of breath that is aggravated when walking and nothing seems to help. Patient also states that he had difficulty trying to fall asleep last night because he felt like he was getting a fever and had intermittent chills and sweats and took Tylenol. He states “I have never felt like this before and would like to know what’s going.”

Medications: over the counter Tylenol 650mg po at nights.

Allergies: No known drug or food allergies. No seasonal allergies.

Past Medical History: No medical history provided.

Past Surgical History: No surgical history provided.

Immunization history: Up to date with immunizations. Influenza shot received September 2018. Pneumococcal vaccine received October 2018.

Personal/Social History: Patient denies smoking, drinks wine socially, exercise with brisk walking three times weekly and tries to eat a balanced diet. He has a master’s degree in finance and works as an accountant at an accounting firm. He is a safe driver who drives to work daily and always wears seatbelt. He lives with his wife who is a homemaker who helps baby sit twin granddaughters. Patient denies history of recent travel to foreign country within the three months.

Review of Systems

General: productive cough with green phlegm and blood at times; shortness of breath, chills, night sweats, fever and restlessness.

HEENT: Patient denies head or nasal congestion, headache, nasal discharge, dizziness, vertigo. Patient states productive cough with green-colored sometimes bloody phlegm.

Cardiovascular: Patient denies palpations. Has some chest tightness.

Respiratory: Patient states that he has SOB that worsens with walking. Has productive cough with green-colored sputum and occasional hemoptysis. Patient states that he hears whistling noises when he breathes.

Objective Data:

Physical exam:

General: Mr. Hendricks is a 60 year old Caucasian male and a good historian who is relatively healthy and has good hygiene. Alert and oriented x 3, looks age appropriate with normal facial expression and appropriate behavior. He coughed a few times during exam and appears to be in some respiratory distress with shortness of breath.

Vital signs: Ht. 5’9”, Wt. 210 lbs; BMI= 30, blood pressure 128/70, pulse of 82, respirations of 20 and labored, temperature of 100.9 and O2 saturation on room air of 89%.

HEENT: No headache or head masses. No lesions. Wears glasses. Pupils equal and reactive to light; ears symmetrical, no tenderness or discharge. No frontal or maxillary sinus tenderness. No discharge from nose and mucosa pink and moist. Wears partial upper dentures. Throat appears red. Good hygiene.

Neck: No masses, full range of motion. Thyroid size normal.

Integumentary: Warm and most

Respiratory: Thorax symmetrical with diminished breath sounds. B/L rales and expiratory wheezes throughout. Wet productive cough.

Cardiovascular: regular heart rate with good S1 and S2 heart sounds. No S3, S4 or murmur.

Gastrointestinal: abdomen protuberant. Normoactive bowel sounds in all four quadrants.

Peripheral vascular: No peripheral edema. 2+ dorsalis pedis pulses palpated bilaterally.

ASSESSMENT:

Lab Tests and Results:

  1. CBC: Blood tests are used to confirm an infection and to try to identify the type of organism causing the infection (Mayo Clinic, 2018.)
  2. Sputum culture: is taken after a deep cough and analyzed to help pinpoint the cause of the infection (Mayo Clinic, 2018).
  3. O2 saturation: decreased oxygen saturation indications indicates hypoxemia. Normal range should be 95-100% on RA (Mayo Clinic. 2018).

Diagnostics:

  1. Chest X-ray: helps your doctor diagnose pneumonia and determine the extent and location of the infection (Mayo Clinic, 2018).

allergies

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APA format 3 peer review references due 10/13/18 at 2pm EST 

Patient Initials: __JH_____                Age: __60_____                                 Gender: ____M___

Subjective Data:

Chief Complaint: Case #3 “I have a cough that’s getting worse.” (Laureate Education, 2012).

HPI: Mr. Hendricks is a 60 year-year old Caucasian male who presents today complaining of a cough that is progressively getting worse; more frequent over the past three days. He states that his cough is accompanied by expectoration of thick green secretions accompanied by some blood at times. He has associated symptoms of shortness of breath that is aggravated when walking and nothing seems to help. Patient also states that he had difficulty trying to fall asleep last night because he felt like he was getting a fever and had intermittent chills and sweats and took Tylenol. He states “I have never felt like this before and would like to know what’s going.”

Medications: over the counter Tylenol 650mg po at nights.

Allergies: No known drug or food allergies. No seasonal allergies.

Past Medical History: No medical history provided.

Past Surgical History: No surgical history provided.

Immunization history: Up to date with immunizations. Influenza shot received September 2018. Pneumococcal vaccine received October 2018.

Personal/Social History: Patient denies smoking, drinks wine socially, exercise with brisk walking three times weekly and tries to eat a balanced diet. He has a master’s degree in finance and works as an accountant at an accounting firm. He is a safe driver who drives to work daily and always wears seatbelt. He lives with his wife who is a homemaker who helps baby sit twin granddaughters. Patient denies history of recent travel to foreign country within the three months.

Review of Systems

General: productive cough with green phlegm and blood at times; shortness of breath, chills, night sweats, fever and restlessness.

HEENT: Patient denies head or nasal congestion, headache, nasal discharge, dizziness, vertigo. Patient states productive cough with green-colored sometimes bloody phlegm.

Cardiovascular: Patient denies palpations. Has some chest tightness.

Respiratory: Patient states that he has SOB that worsens with walking. Has productive cough with green-colored sputum and occasional hemoptysis. Patient states that he hears whistling noises when he breathes.

Objective Data:

Physical exam:

General: Mr. Hendricks is a 60 year old Caucasian male and a good historian who is relatively healthy and has good hygiene. Alert and oriented x 3, looks age appropriate with normal facial expression and appropriate behavior. He coughed a few times during exam and appears to be in some respiratory distress with shortness of breath.

Vital signs: Ht. 5’9”, Wt. 210 lbs; BMI= 30, blood pressure 128/70, pulse of 82, respirations of 20 and labored, temperature of 100.9 and O2 saturation on room air of 89%.

HEENT: No headache or head masses. No lesions. Wears glasses. Pupils equal and reactive to light; ears symmetrical, no tenderness or discharge. No frontal or maxillary sinus tenderness. No discharge from nose and mucosa pink and moist. Wears partial upper dentures. Throat appears red. Good hygiene.

Neck: No masses, full range of motion. Thyroid size normal.

Integumentary: Warm and most

Respiratory: Thorax symmetrical with diminished breath sounds. B/L rales and expiratory wheezes throughout. Wet productive cough.

Cardiovascular: regular heart rate with good S1 and S2 heart sounds. No S3, S4 or murmur.

Gastrointestinal: abdomen protuberant. Normoactive bowel sounds in all four quadrants.

Peripheral vascular: No peripheral edema. 2+ dorsalis pedis pulses palpated bilaterally.

ASSESSMENT:

Lab Tests and Results:

  1. CBC: Blood tests are used to confirm an infection and to try to identify the type of organism causing the infection (Mayo Clinic, 2018.)
  2. Sputum culture: is taken after a deep cough and analyzed to help pinpoint the cause of the infection (Mayo Clinic, 2018).
  3. O2 saturation: decreased oxygen saturation indications indicates hypoxemia. Normal range should be 95-100% on RA (Mayo Clinic. 2018).

Diagnostics:

  1. Chest X-ray: helps your doctor diagnose pneumonia and determine the extent and location of the infection (Mayo Clinic, 2018).

 Differential Diagnoses:

  1. Bacterial pneumonia: is an infection of the air sacs in one or both lungs which may fill with fluid or pus, causing cough with phlegm or pus, fever, chills, and difficulty breathing, dullness to percussion, decreased breath sound, fatigue. It is most commonly caused by Streptococcus pneumoniae(Mayo Clinic, 2018). Since the patient appears to have most of these symptoms, this is a great possibility.
  2. Acute bronchitis: Acute bronchitis, often called a “chest cold,” is the most common type of bronchitis. It occurs when the airways of the lungs swell and produce mucus which makes one cough. It is caused by a virus and often occurs after an upper respiratory infection. Symptoms include sore throat, soreness in the chest, fever, coughing with or without mucus production, fatigue, mild headaches and watery eyes (CDC, 2017b). This can also be a possibility based on the patient’s symptoms.
  3. Asthma exacerbation: Asthma is a disease that affects your lungs. It causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Asthma can be controlled by taking medicine and avoiding the triggers that can cause an attack (CDC, 2017a). This can also be a possibility based on the patient’s symptoms.
  4. Bronchiectasis exacerbation: Bronchiectasis is a condition in which the airways (called bronchial tubes) that branch from the trachea into each lung become widened and inflamed. Such damage limits the ability of the airways to clear bacteria and mucus from the lungs, resulting in sputum production, cough, and shortness of breath. Bronchiectasis can be congenital or acquired as a result of an infection. Symptoms include cough, shortness of breath, wheezing, weight loss, fatigue and chronic sinusitis (Mount Sinai, 2018). Based on these symptoms, this can be a possibility for patient diagnosis.
  5. COPD exacerbation: chronic obstructive pulmonary disease (COPD) experiences long-term and progressive damage to their lungs. This affects air flow to the lungs. Symptoms include rapid shallow breathing, increasing amounts of mucus, which is often yellow, green, tan, or even blood-tinged, experiencing shortness of breath at rest or with minimal activity, such as walking from one room to another and wheezing more than usual (Healthline.com, 2018). Based on patient symptoms, this can also be a possibility for the patient condition.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to

physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Centers for Disease Control and Prevention (2017a). Asthma. Retrieved October 9, 2018 from:

Centers for Disease Control and Prevention (2017b). Bronchitis. Retrieved October 9, 2018

from: https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/bronchitis.html

Healthline.com (2018). COPD Exacerbation. Retrieved October 9, 2018 from:

Laureate Education. (Producer). (2012). Advanced health assessment and diagnostic reasoning.

Baltimore, MD: Author.

Mayo Clinic (2018). Pneumonia. Retrieved October 9, 2018 from:

Mount Sinai (2018). What is Bronchiectasis? Retrieved October 9, 2018 from: