Mr. Nguyen is a 58-year-old patient that had septic shock and developed Acute Respiratory Distress Syndrome. He is orally intubated and on a mechanical ventilator. He is paralyzed and sedated.

• What manifestations might you observe for a patient with ARDS?
• What complications can Mr. Nguyen develop from being mechanically ventilated?
• List priority nursing interventions to prevent complications associated with ventilatory support.
• What interventions can be implemented specifically to prevent the development of Ventilator Acquired Pneumonia (VAP)?
• You are orienting in the ICU, the nurse you are working with is not implementing the VAP interventions. What would you do?

Initial Post 1:(A.T)

 Severe respiratory distress and low oxygenation are characterizations of ARDS. Manifestations of ARDS include severe dyspnea (difficulty breathing), shallow, rapid breathing, Low oxygen concentrations or hypoxemia, cyanosis (bluish lips or skin as a result of low oxygen levels), reduced lung compliance, increased effort of breathing, bilateral infiltrates seen on the X-ray of the chest, altered mental state as a result of hypoxia. A number of complications can develop for Mr. Nguyen from being on mechanical ventilation, such as ventilator-associated pneumonia (VAP), oxygen toxicity, ventilator-induced lung injury (VILI), barotrauma (high airway pressure-induced lung damage), and ventilator-associated events (VAEs). Priority nursing interventions to prevent complications with ventilatory support include regular evaluation of Mr. Nguyen’s respiratory condition, to avoid self-extubation and lessen agitation continue to administer appropriate sedation and analgesics, keep an eye on and maintain the proper ventilator alarm settings, changing positions frequently to avoid pressure sores and atelectasis, oral hygiene to stop VAP, ensure appropriate ventilation circuit and endotracheal tube hygiene, trials of weaning to evaluate preparedness for extraction. The following are some interventions to avoid ventilator-associated pneumonia (VAP): To lessen the chance of aspiration, raise the bed’s head to a position between 30 and 45 degrees. using chlorhexidine for oral hygiene to stop the growth of microorganisms, routine evaluation of endotracheal tube (ETT) suctioning requirements, To reduce contamination, use a closed suctioning system. To avoid microaspiration, the ETT cuff pressure should be regularly assessed. Reduce the amount of time that patients need mechanical ventilation by using a sedative strategy. Sedation vacations are interrupted every day to evaluate preparation for extubation. It would be imperative to take immediate action if I saw an ICU nurse failing to apply VAP preventative treatments. I would document the circumstance and your activities for my charge nurse or unit manager and If the problem persists, I would talk to my nurse manager or supervisor to make sure that best practices and procedures are followed and maybe consider reeducation for the nurse. In the ICU, patient safety is the top priority. 

Initial Post 2:(B.M.)

Acute Respiratory Distress Syndrome, or ARDS, is a dangerous lung condition that can develop in people who are critically ill and necessitates frequent mechanical ventilation to maintain breathing. One of the symptoms of ARDS identified in Mr. Nguyen was a cluster of respiratory and systemic symptoms. The underlying lung tissue injury and inflammation that obstruct the lungs’ ability to exchange oxygen and carbon dioxide are reflected in these signs and symptoms. Extreme shortness of breath, rapid breathing (tachypnea), cyanosis (bluish skin color), restlessness, fatigue, decreased urine output, tachycardia, low blood pressure (hypotension), and altered mental status are a few of the main symptoms.

When caring for critically ill patients, nurses must consider the potential difficulties of mechanical ventilation, as in Mr. Nguyen’s case. The process of mechanical ventilation requires placing a tube in the patient’s airway in order to deliver oxygen and remove carbon dioxide. Even while treatment can save lives, there are risks and a chance of problems. Ventilator-associated pneumonia (VAP), barotrauma (high air pressure lung damage), ventilator-associated lung injury (VALI), ventilator-associated events (VAE), pressure ulcers, cuff-related tracheal injury, sedation-related complications (such as excessive sedation or inadequate pain management), and infection at the site of the endotracheal tube insertion are a few potential side effects of mechanical ventilation.

Priority nursing interventions include regular evaluations of the patient’s vital signs, oxygen saturation, and respiratory status to gauge how they are responding to mechanical ventilation. Maintaining proper ventilation settings and keeping an eye out for signs of high or low airway pressures are necessary to prevent lung injury and maximize respiratory assistance. The patient must be moved frequently to lessen the chance of pressure sores and to improve lung expansion, which may be compromised in ARDS patients. Regular sedation intervals and assessments of extubating readiness are necessary to avoid prolonged artificial breathing and reduce the risk of sedation-related issues.

In order to prevent the emergence of Ventilator-associated Pneumonia (VAP), nurses should implement specific measures. Among them are regular suctioning of the endotracheal tube to remove secretions and reduce the risk of aspiration, maintaining proper positioning of the endotracheal tube to prevent micro aspiration of gastric contents, and routine oral hygiene using antiseptics to lessen bacterial colonization in the oropharynx. Raising the head of the bed by at least 30 degrees can prevent aspiration, and closely following infection control protocols such hand hygiene and sterile procedures lowers the risk of infection.

While orienting in the ICU, if I see a nurse not using VAP treatments, I would do the following:

I would speak to the nurse politely and respectfully to express my worries on the lack of VAP interventions. I want to underline how important VAP prevention is for patient safety and outcomes, and how it is our responsibility to adhere to best practices in the ICU.I would share my knowledge and understanding of the importance of VAP prevention, emphasizing how it may significantly impact patient recovery and minimize the likelihood of issues. I would give the nurse the tools and knowledge she needs to carry out the VAP interventions, or I would volunteer to help her. Accurate documentation is essential for maintaining a culture of cooperation and stability in our healthcare system and delivering high-quality care to our patients.

Please see attachment for instructions

A 40 year old female presents with complaint of a headache for one week. Reports a “head cold” 3 weeks ago.  Thought it was getting better, but sinus symptoms are back and even worse.

Describes the headache is located across her forehead; feels like pressure behind my eyes and unable to breathe out of nose. Also feels mucus running down the back of throat.  Pain sometimes severe (8/10) but with acetaminophen reduces to moderate (4/10) and occasionally mild (2/10).  Occasional nonproductive cough.  Feels feverish at times; noted frequent sneezing and no appetite. Bending over seems to make the headache worse.  “Acetaminophen improves my headache, but doesn’t take it away.” Taking Sudafed HCL 120 mg every 12 hours, with some relief. Symptoms are worse in the morning – awakes with a headache. Ranges from 2/10 at its best to 8/10. Difficulty with concentrating at job and feels very tired.

PLEASE RESPOND TO THE FOLLOWING IN 50 WORDS OR MORE:

• The Nursing Legislation and Advocacy page on the FNA website identifies 4-different ways for you to get involved with advocacy.  Discuss which way(s) you would most likely get involved with and why?

One way I would get involved with is by participating in the FNA advocacy days. Each Advocacy Days, nurses from across the state gather in Tallahassee during legislative sessions to learn about current legislative issues and specific bills that may affect their practice or the overall healthcare environment in Florida. This allows nurses to meet with legislators face to face. Nurses are able to voice their concerns and take part in helping shape the life of nurses. 

• Find and peruse the Barbara Lumpkin Toolkit (BLT).  What are your thoughts about the information provided in the toolkit and what did you learn that you didn’t know before?

The Barbara Lumpkin Toolkit is a resource that can be used by nurses to speak to legislators. The toolkit discusses ways for nurses to get in contact with legislators as well as offering tips on how to do so. The BLT also details the correct way to communicate nursing concerns to legislators. Something I didn’t know is that it would be more helpful to communicate with new legislators than legislators who have a lot of experience. As new legislators could be more sympathetic to our concerns then experienced ones would. 

• The Florida Keys community experiences unique healthcare needs.  Identify 1-healthcare issues or trends you would consider advocating for that would have an impact on nursing in the Florida Keys.  Based on the BLT how would you go about advocating for the healthcare issue?

In the Florida Keys there is a critical nursing shortage. Leading to higher nurse-patient ratios that are unsafe. Per BLT to advocate for safe nurse-patient ratios I would make a list of the media in the Florida Keys. In the Keys news travels very quickly. An advantage we have is that Key West is a fairly small town and alot of people know each other. If we use the correct media tools we can recruit nurses while also providing benefits, higher pay, and different incentives to retain our staff. If this does not work, writing letters and using other ways of getting in contact with legislators to decrease the turnover and patient-nurse ratios can be also helpful. As well as joining the Advocacy Days to advocate for a safe work environment.

Florida Nurses Association. Barbara Lumpkin Institute. (n.d.). https://www.floridanurse.org/Links to an external site.  

 Scenario:  

Your organization is planning to purchase a tool for data analytics. You have been asked to make a recommendation for two tools. 

Your organization is also researching the application of data warehousing, big data, and data mining. You have also been asked to make an evaluation of how data warehousing, big data, and data mining can be beneficial to a healthcare system. Some members of your audience may be unfamiliar with these concepts, so part of your goal is to provide background information.

• Research two data analytics tools that you would recommend in response to the scenario above.  
• Thoroughly investigate the specifications of each tool and consider the pros, cons, and hardware requirements of each tool. 
• Using supporting evidence from the articles you researched, create a PowerPoint presentation with the following information:
  • Recommend two tools for data analytics and explain why they would be beneficial to your organization.
  • Provide a description of big data, data mining, and data warehousing.
  • Provide an analysis of how data mining can be beneficial to a healthcare system.
  • Explain the purpose, characteristics, and components of a data warehouse.
  • Explain how the type of data warehousing used can impact the ability to mine data.
  • Describe examples of the successful use of guided data mining and automated data mining within healthcare.
  • Support your work with references from this week’s Learning Resources and the three articles you found in the Walden Library.
• Provide references in APA style at the end of your presentation—the reference slide or slides do not count toward your assignment total.