Abstract This case study describes and analyzes nursing case in an acute care setting. The case concentrates on the patient's demographic data relevant to the illness, medical diagnosis and contributory factors leading to admission, pathophysiology of the primary illness, hospital course summary and nursing issues significant to the patient's subsequent recovery.
From the Paper "Mrs Tran (she prefers to be called "Grace") is a 47-year-old Vietnamese woman. She speaks little English and is traveling with her husband "John" from Vietnam. Although not mentioned, language barriers with the husband should be anticipated in order to ensure clear two-way understanding of the situation at hand. The couple were visiting their son, who is currently studying international business at La Trobe University. Medical diagnosis Mrs Tran presented 12 days ago with a sudden-onset headache and subsequent loss of consciousness. There were presumably no other extenuating factors surrounding her sudden illness. She has a significant past history of hypertension but was otherwise well. Compliance issues may have to be ruled and anticipated against when she recovers. A head CT scan revealed a 5cm x 4cm left frontal intracerebal hemorrhage."
Abstract This paper presents a colorful and detailed explanation of the function of the kidneys. The paper offers many diagrams to illustrate the material discussed. The paper also includes extensive research on acute and chronic renal failure. The paper examines acute renal failure by providing a case study on the subject.
Outline
Introduction
Mechanisms of Fluid Regulation
Acute Renal Failure Pathophysiology
Clinical Manifestations
Treatment
Diet
Drug Treatment
Case Study
References
From the Paper "The adrenal medulla functions as part of the autonomic nervous system. Stimulation of preganglionic sympathetic nerve fibers causes release of epinephrine and noreepinephrine. These regulate metabolic pathways to promote catabolism of stored fuels to meet caloric needs from endogenous sources. Epinephrine is the key player in the 'fight or flight' response. The adrenal cortex produces three steroid hormones. Glucocorticoids affect blood glucose levels using the negative feedback system. Mineralcorticoids exert their major efforts on electrolyte balance. Androgens effects are similar to male sex hormones."
Abstract This paper discusses how dealing with a life-threatening illness is a complex and an emotional process, often considered the most challenging and stressful event in an individual's life. By understanding how other people cope with life-threatening illnesses may help patients and their families prepare for or cope with illness. This essay reviews the phases an individual progresses through when facing illness and will present an overview of an acute health care setting for the terminal phases of illness. A review of the literature about dying in an acute setting helps delineate the limits of such a setting. The paper further discusses the role of the nursing profession and provides recommendations to improve the delivery of health care in an acute setting. Lastly, the paper presents the author's personal reason for exploring the topic.
Abstract This paper explains that acute lymphoblastic leukemia (ALL) is a leukemia in which the lymphoblast cells proliferate abnormally, resulting in the rapid progression of the disease with the abnormal cells easily infiltrating any organ in the body. The author points out that Jimmy has a favorable prognosis because his WBC count of 3,600/uL is within the range that suggests a favorable prognosis. The paper relates that two chronic complications of ALL are infection and bleeding.
Table of Contents
Introduction
Discussion of Jimmy's Case
Risk Factors for Cancer and Characteristics for a Favorable Prognosis
Pathophysiology ( White Blood Cell Lymphoblast)
Clinical Manifestations and Pathology
Chronic Complications and Pathophysiology
Laboratory Tests: CBC and Uric Acid
Bone Marrow Aspiration Test
Intravenous Fluids and Allopurinol to Prevent Renal Failure
Medications: Allopurinol, Vincristine, Dexamethasone and Asparaginase
Conclusion
From the Paper "In ALL, a white blood cell lymphoblast becomes genetically altered and begins to clone itself and proliferate. This cloning begins in the bone marrow, where white blood cell production occurs. In healthy individuals, white blood cells are produced in the bone marrow and transferred to the blood on a continuous basis. In individuals with ALL, the same process occurs, except that white blood cell production proceeds at an excessive and uncontrollable rate. The normal blood cell production in the bone marrow provides the blood with the white blood cells. This means that when proliferation occurs, the cells produced naturally are transferred to the blood. These cells are then transported throughout the body. The proliferating cells can also be transported to the thymus, liver, lymph nodes, testes, and the CNS, and can continue to proliferate from those locations. ALL also results in reduced levels of the other components of blood including platelets and red blood cells because the proliferating white blood cells crowd them out."
This paper is a dissertation proposal to examine what ethical standards are necessary in acute care settings within the private health care industry in the U.K.
Abstract This paper explains that, in the U.K., private health care providers are consistently seeking to expand their business and influence in the face of a declining National Healthcare System; and thus, in order for private health care providers to successfully market their services to the public, they must first prove that what they have to offer is worthwhile and ethical. The author states that the primary goal of this dissertation is to develop a theory-building process that will result in a strategic marketing plan for acute health care in the UK that will (1) build on best practices based on current medical ethics standards, (2) support the private health care industry's goals, and (3) provide guidance for private healthcare industry participants in the strategic marketing development process. The paper relates that the data will be collected via questionnaire utilizing Likert-type scales distributed to health care providers, marketing agents, and consumers.
Table of Contents
Introduction
Research Rational
Goals/Objectives of Study
Literature Review
Methodology
Approach/Research Design
Methods for Data Collection
Methods for Data Analysis
Discussion
Purpose/Relevance of Study
From the Paper "The private healthcare sector within the UK accounts for 25.3% of the UK healthcare market as of 2000. The private industry is divided among the following sectors: primary care services, acute care, psychiatric care, long term care and private medical insurance. Within the private healthcare sector, acute care accounts for a very small portion of services offered, and therefore will likely require the most aggressive marketing stratagems. Long term care accounts for the largest sector. The National Health Care Service in the UK has been suffering from a variety of problems affecting the infrastructure, including staff shortages. This leaves opportunity for growth in the private industry. This paper will focus on the acute care sector, which is currently expanding gradually in part as a result of the development of specialist facilities."
This paper discusses the Severe Acute Respiratory Syndrome (SARS) epidemic, a worldwide health care crisis with a sudden onset caused by a hitherto unknown agent, which took a heavy toll on human life over a short period.
Abstract The paper explains that the SARS crisis was successfully managed through an international cooperative effort, and the genetic sequence of the Coronavirus was finally mapped out, paving way for creating more specific assays for detection and for developing effective counter drugs. The author points out that the typical symptoms for the SARS disease include a rise in temperature (above 38 degrees); sore throat; breathing difficulty, which becomes progressively acute; myalgia or muscle pain; sputum formation; a considerable drop in blood platelets; and lymphopenia; all are symptoms that manifest within the first two weeks of the onset of the infection. The paper relates that treatment methods continue to be refined, specific pharmacological agents are being developed, and a quest for a SARS vaccine continues.
Table of Contents
Thesis
Introduction
The SARS Virus
Clinical Course of SARS
Symptoms and Diagnostics
Transmission of SARS
Epidemiology of SARS
China and Hong Kong
Toronto, Vietnam and Singapore
Treatment For SARS
Ribavirin
Lopinavir-ritonavir
Immunomodulatory Treatment
Interferons
Critical Care
SARS Vaccine [Latest Researches]
Conclusion
From the Paper "SARS is an acute infectious respiratory disease with all the symptoms of atypical pneumonia like fever, breathlessness that caused severe casualties in a short period of time. The first instance of SARS infection was reported in November 2002 in the Guangdong province of china. The SARS epidemic created a panic worldover and the World Health Organization issued a global alert on March 12th 2003 about the rapid spread of symptoms of atypical pneumonia. Symptoms of atypical pneumonia were reported in China and Hong Kong in February and March of 2003 and SARS created panic at the global level with 774 deaths and more than 8000 infected people. China, Taipei, Canada and Hong Kong suffered the most from the epidemic while sporadic SARS infections were found in many European nations and North America. Hundreds of people exhibiting symptoms were quarantined and treated for the complications until the SARS outbreak was fully contained. In July 2003 China officially announced the successful treatment of the last 12 cases of SARS."
Abstract In this article, the writer notes that acute care nurse practitioners (ACNPs) have a growing value within society because of the increasing retirement of the baby boomer population, the advances in disease research that have occurred over the past decade, and the decline in the physician population in the United States. The writer points out that the scope of practice for ACNPs has become broader, therefore, states continue to create laws that support the capabilities of these professionals. The writer maintains that new methods of training and acceptance of the capabilities of ACNPs by legislators and the public have allowed ACNPs to practice in a variety of settings and successfully meet the needs of the populations they serve. The writer also notes that it is evident that the acceptance of ACNPs is not universal and that there are still issues that pertain to prescriptive authority in some states. Finally, the writer concludes that because this field of nursing has been capable of advancing greatly over the past few decades, it is also evident that these concerns will be overcome and that ACNPs will eventually be the primary choice for quality health care in the United States.
Outline:
Introduction
History
Licensure vs. Certification
Scope of Practice
Challenges of the ACNP Role
Relevance of State Practice Acts
Conclusion
From the Paper "Licensure refers to the nurse's ability to pass professional exams that indicate his or her knowledge in the basic areas applied to the profession. The purpose of licensing by all states is to ensure that the individual's knowledge and skills can be minimally trusted and that the person has the ability to assist the public with their health care needs. Licensing is required of all nurses in each state."
"Certification can be accomplished by the nurse practitioner in a specific field related to the occupation. Certification is awarded through the passage of tests, but only tests the knowledge of the individual as it pertains to a specific field of medicine, rather than the entire scope of nursing. Most nurse practitioners are certified in some specialty field."
Abstract In this article the writer explains that the legal definition of a nurse practitioner differs between states and that the scope of practice of a nurse practitioner also varies considerably from one state to another. The writer also points out that as all nurse practitioners in every state perform physician services in critical care, they must conform to their particular state's requirements. The writer then points out that while Medicare requires that a nurse practitioner be authorized, under state law, to perform any service that is billed, state laws governing nurse practitioners' scope of practice differ to a significant degree. The writer maintains that numerous hospitals and other facilities are uninformed about the rules and procedures related to billing for nurse practitioners' services. The writer concludes that while research has indicated that nurse practitioners provide the same quality of care in acute care settings as do physicians, the same demands are made on them with the potential for legal problems.
From the Paper "The nurse practitioner's services are reimbursed through the facility fee or Diagnostic Related Group payment to the hospital. The main opportunities for billing nurse practitioner services are located in evaluation and management procedure codes. While the patient pays 20 percent of the physician fee schedule rate, Medicare pays 85 percent of 80 percent of the Physician Fee Schedule rate for physician services billed under a nurse practitioner's provider number. The American College of Nurse Practitioners maintains that this problem is the result of a problematic annual update formula so that Medicare payments to all providers of services are threatened with reductions each year. Since nurse practitioners receive just 85 percent of the reimbursement that physicians obtain, the reductions are substantial. Within the current system, payment updates for providers are linked with the U.S. Gross Domestic Product (GDP) growth."
Abstract The paper supports the modified philosophical approach to nursing championed by Chinn and Kramer and shows how their contribution to Dorothy Orem's theories improve the process of thought. The paper further shows how Chinn and Kramer codify, in a stepwise function, how to improve practice and apply conscious theory development to the profession. The paper discusses their "third-level" philosophical approach and relates that although this approach may seem distant to nurses involved in the day-to-day chaos of the acute care wards, they provide a useful conceptual framework for an improvement of the profession.
Outline:
Introduction
Implementation of Orem as Interpreted by Chinn and Kramer
Discussion
Conclusion
From the Paper "Nursing has progressed from a 'helping,' or 'mothering' profession in the mid-1900's to a profession which incorporates the same basic human emotions, but also combines with empirical evidence to help improve the patient's quality of life. Applying a concrete definition to the concept of nursing was a pioneering effort from Orem in the 1980's. Subsequent work by Fawcett, Chinn, Kramer and others in the 1990's added a more philosophical level to the practice of nursing."
Abstract Acute myleocytic leukemia is a cancer of the blood which is heterogenous in nature, making it rather difficult to consistently treat. A rare subtype of acute myelocytic leukemia, acute myelocyticleukemia is characterized by a differentiation block at the myelocyticstage and by a reciprocal translocation affecting chromosomes 15 and 17 (Fielding, et al. 1994). As such, acute myelocytic leukemia has not received as much attention as acute myelocytic leukemia, and had not, until relatively recently, received the kind of research necessary to find effective treatments. This rare blood cancer had been universally fatal until 1985. Since that point, this rare form of cancer has experienced a significant boost in research and treatment. This paper will examine the chromosomal abnormalities which make up acute myelocyticleukemia, current treatments, and current research into acute myelocyticleukemia. The point of the examination is to provide a greater level of understanding into this form of cancer.
Abstract This paper explains that the acute care nurse practitioner (APN) performs four roles: educator, researcher, clinician, and consultant/manager. The APN's role as consultant/manager is perhaps one of the most important of the four because this role helps to improve the use of existing scarce resources. The author points out that, in the acute care setting, the APN management role includes taking histories, conducting physical examinations, ordering, performing and interpreting appropriate diagnostic and laboratory tests, prescribing pharmacological agents, treatments, and non-pharmacological therapies for the management of the conditions, which they diagnose. The paper stresses that the structure of the acute care APN's role will depend upon the collaborative agreement with physicians and other members of the acute care team and organizational setting.
Table of Contents
Introduction
The Role as Consultant/Manager in an Acute Care Setting Implementation of APNs in Acute Care Settings
Summary and Conclusion
From the Paper "The research also shows that once an APN has started the implementation process, it is vitally important to continue to solicit timely feedback from other staff members, patients and management. This feedback will help solidify productive interpersonal relationships and the overall health of the acute care operation. The experts on organizational change say that staff members must feel comfortable in providing feedback to their managers, and likewise, supervisors must learn how to share their perceptions of individual job performance in an accurate, clear and honest manner. Managers at all levels can facilitate the communication process in their organizations by ensuring that the process is one in which people are able to provide and receive feedback in an open, honest and constructive manner."
Abstract In this article, the writer addresses three important themes for the acute care nurse practitioner (ACNP) and the clinical nurse specialist (CNS): ethical principles and ethical issues in patient care, professional resources available to help the ACNP, research highlighting the effectiveness of the ACNP and CNS in acute care. The writer also covers five ethical principles that guide the ACNP/CNS in their practice and notes that the move to procedure-based medicine requires the nurse to make more serious life-or-death decisions for the patient than in the past. The writer concludes that whereas the primary burden of patient care decision-making was placed on the physician in the past, the nurse must now weigh various ethical imperatives in order to make the right decision for the patient at the time.
Outline:
Introduction
Ethical Principles for the ACNP and CNS
Nonmaleficence
Utilitarianism
Justice
Fidelity
Veracity
Autonomy
Ethical Issues in Patient Care: Advance Directives
Ethical Issue in Patient Care: Clashing Ethical Requirements
Professional Resources
ACNP/CNS Effectiveness in Acute Care
Patients Spend Less Time in the Hospital
ACPN/CNS' Have Been Given Greater Responsibility
Increasing Cost Pressures Require Greater Nurse Participation
Conclusion
From the Paper "The legal aspects of patient treatment have come to the fore, but should not be regarded as equivalent to ethics issues. Much of what happens in the privacy of the intensive-care suite, the hospice or the general floors happens outside the purview of the medico-legal profession.
"Nurses make decisions today about patient care that they have not had to make in the past. Part of the reason for this is that hospitalized patients, on average, are sicker than they were in the past (mainly due to the shortened stay periods) and the need of physicians to leverage their care decisions with better-educated specialist nurses."
Abstract This paper examines the standards set by the National Service Framework for coronary heart disease regarding emergency cardiac care for patients presenting to the accident and emergency system at a hospital. The paper explains that these standards place a priority on aggressive management and providing early thrombolysis and that this type of treatment is controversial because it is questionable whether, given the suggested timeline and the need to differentiate from non-cardiac causes of chest pain, an adequate history and physical can be performed to prevent the administration of thrombolytics in patients where they are contraindicated. To further examine this topic, the paper gives a clear definition of acute myocardial infarction, looks at how to diagnose a patient with acute chest pain, explores the history, indications, and contraindications of thrombolysis, and reviews a multidisciplinary approach to thrombolytic administration.
From the Paper "The definitive diagnosis of AMI is best obtained by following a standard chest pain protocol. Most accident and emergency wards have these in place. It is standard to initially obtain a 12 lead electrocardiogram (ECG) and begin cardiac monitoring. Patient's routine laboratory studies include electrolytes, blood urea nitrogen (BUN), complete blood count (CBC) and markers for myocardial injury (Creatinine Kinase isoenzyme-myocardial (CK-MB) or troponin). Normal serial CK values rule out an acute infarction but are negative in the setting of acute unstable angina. A slight rise in CK-MB or troponin indicates myocardial injury but is not specific for ischemic syndromes. Troponin assay is highly sensitive for identifying acute coronary syndromes. Troponin has longer half life in the system than CK-MB but is less specific for the identification of infarction as opposed to repeated episodes of myocardial ischemia. As the total CK greater than two times the upper ranges of normal is indicative of infarction it can be used as an adjunct in diagnosis ischemia versus infarction and also in determining the relative efficacy of reperfusion. Serum troponin may take up to six hours to become diagnostically sensitive enough (Dougan, 2001)."
Abstract The paper offers the psychological and neurological definitions of stress and memory and explains how men and women handle stress in different ways. The paper looks at how teenagers of both genders may be especially vulnerable to stress. The paper studies the effect acute stress has on the short term memory and how chronic stress can negatively impact both short and long term memory of a sufferer in a permanent fashion. The paper provides suggestions on how to reduce stress and considers areas of future research.
Outline:
Abstract
Introduction
What is Memory?
What is Stress?
Gender, Age and Various Stressors
Acute Stress and Memory
Chronic Stress and Memory
How to Reduce Stress?
Conclusion
From the Paper "A memory is a kind of neurological activity of imprinting or retrieval. Different areas of the brain coordinate different areas of memory, such as phonological, or acoustic and linguistic memory, as opposed to visual and spatial memory. These different types of memory stimulate different areas of the brain. Intense personal memories appear to affect a particular structure of the limbic system of the brain, in addition to the hippocampus. This structure is called the amygdala and regulates human reactions to fearful situations."
Abstract This paper outlines a family's experience with pediatric episodic illness. It includes objective and subjective impressions on hospitalization, context of the situation as well as transition back to their home after the acute hospitalization of their children.
From the Paper "Episodic illness is also known as acute illness. Du Gas defines acute illness as " pertaining to a condition with a sudden, severe onset and a relatively short course ". Episodic illnesses with the younger pediatric population tend to evoke more concern with parents and health care professionals because of their still developing immune systems and susceptibility to complications. The family used for this assignment is considered to be nuclear, and is made up of Mr. and Mrs. "L", and their daughter "M". "M" is a two-year-old who was admitted to Mount Saint Joseph's Children's ward with an upper respiratory infection. Mr. and Mrs. "L" are in their generative or child rearing stage, and according to Erikson's developmental theory, "M" is in her autonomy vs. shame and doubt stage (Wong, D., 1999). Throughout her hospital stay, "M" was playful, happy and very cooperative. She has an astonishing vocabulary for her age, and is capable of doing much for herself. This may be due in part to her authoritative parents. According to Donna Wong, authoritative parents "combine practices from both of the foregoing extremes (passive and authoritarian). They direct their children's behavior and attitudes by emphasizing the reason for rules and negatively reinforcing deviations." (p.95)."
