Topic: Hypermetabolic lymphadenopathy

Using the five evidence-based practice guidelines discussed below. Your topic will be related to nursing practice in some way. In other words, there needs to be nursing implications to addressing your question. Overall guidelines for each part of the project include:

***The Five Steps of Evidence Based Practice***

STEP ONE: Ask a clinical question which may interest you in PICO format relating to your topic. For example, are there pharmacologic interventions that have been effective in decreasing allergy symptoms in children? OR In children, what is the effect of pharmacologic interventions on allergy symptoms?

Define your question using PICO. Your question should be used to help establish your search strategy. Submit the following information for your clinical question. First provide the following (use the below format):

Patient/Problem: __________________________

Intervention: __________________________

Comparison: __________________________

Outcome: __________________________

Then write out your PICO question (IF relevant to your question, add “T” for time frame) Template for Asking PICOT Questions

INTERVENTION In ____________________

(P), how does ____________________

(I) compared to ____________________

(C) affect _____________________

(O) within ___________

(T)? DIAGNOSIS OR DIAGNOSTIC TEST

In ___________________

(P) are/is ____________________

(I) compared with _______________________

(C) more accurate in diagnosing _________________

(O)? PROGNOSIS/PREDICTION In ______________

(P), how does ___________________

(I) compared to _____________

(C) influence __________________

(O) over _______________

(T)? Short Definitions of Different Types of Questions: Intervention: Questions addressing the treatment of an illness or disability. Diagnosis: Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation. Prognosis/Prediction: Questions addressing the prediction of the course of a disease.

*Be sure you include “compared to” in your topic using PICO.

STEP TWO: Conduct a literature search. Be sure to include also systematic reviews (e.g., the Cochrane Database of Systematic Reviews) and evidence-based practice guidelines (www.guideline.gov) in your search strategy.

STEP THREE: Review and Critically Appraise the evidence. Describe the problem and purpose of each research study. Describe the research methods, including process of data collection, sampling, and data analysis, for each research study What were the results of the study? Summarize the major findings and conclusions of each research study Critique the strengths and weaknesses of the research methods. The expectation is that you also cite your textbook, when describing research methods or criteria for evaluating research. Are the results valid? To answer this question, you need to critique the studies for validity-based on your critical appraisal of the literature, are the results valid? Are the findings clinically relevant to patient(s) identified? Do you believe this will work in practice?

STEP FOUR: Integrate evidence to implement a decision.

STEP FIVE: Evaluate the outcome.

 

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Purpose three innovative, value-based healthcare changes that will affect patient outcomes for those on hospice? Two barriers for each change and two ways each purposed change could enhance value based care?

Please be specific as I’m a visual learner so the more detailed the information that better.

 

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Name three benefits of implementing a new fall prevention program.

please be specific, I’m a visual learner so the more detail the better.

 

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Name 2 ways you can you integrate technology into implementing a new fall prevention program?

please be specific as I’m a visual learner so the more detailed the better

 

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Your Shift

It is 8:00pm, and you go to assess your patient. She is alert and responding to questions appropriately.

Lungs have crackles in the right lower lung. Left lung is clear. O2 saturation is 94% on 2 liters nasal cannula. Her skin is warm and dry no cyanosis. Distal pulses are palpable. Abdomen is soft and bowel sounds are present. Her IV is running and no leaking or swelling.

Before you leave the room, you ask her if she needs anything and remind her to use her call bell for assistance to get out of bed. Call bell is within reach of the patient. Bed is locked and in the lowest position.

Later the patient care assistance (PCA) yells for help. You get to the room and your patient is laying in the floor, face down. “I was just tried to get to the toilet. I thought I was home and forgot I had these compression stockings on” She lifts her arm and you see blood coming from the IV site. It has come out of her arm.

Patient is alert and oriented to person, place, time and situation. She is able to move all of extremities without pain.  “I’m ok. My back is hurting some now. I’m so embarrassed. I forgot I was in the hospital and had the compression stockings on. I thought I could go to the bathroom by myself.” The healthcare provider (HCP) assesses the patient and the patient is assisted to bed.  An x-ray of the back is ordered.

You did a complete assessment and put a dressing on the bleeding IV site. You call the IV team and they place a new IV # 20 in the right hand. You restart the IV fluid Lactated Ringers at 125 mL/hr. You completed the incident report as per hospital policy and notify the nursing supervisor of the fall. The x-ray was completed and awaiting results.

It is 10pm and you are finishing up your work, when your patient’s call light goes off. She requests pain medication and rates her pain a “7” on the 0-10 numerical scale. You give the patient the pain medication as ordered. Her vital signs are T 98.8 orally, HR 76 and regular, R 22 and unlabored, SPO2 94% on 2 liters nasal cannula, BP 132/76.

The HCP calls to check on your patient and says the x-ray was negative for fractures or dislocations. HCP gives an order for out of bed as tolerated with assistance and also discontinues the compression stockings.

You discontinue the compression stockings at 10:30pm and explain to the patient to use her call light if she needs to use the restroom.

It is now the change of shift and you need to give a verbal report to the oncoming nurse/your instructor.

 

 

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