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.

Apply the differences between negligence and malpractice to the practice of nursing. Provide examples to illustrate your points.

Write a grant proposal requesting funding to conduct research for the research question of “Is there a significant difference in the clinical outcomes, including mortality rates, reinfarction rates, and long-term quality of life, between patients treated with fibrinolytic therapy and those treated with percutaneous coronary intervention for acute myocardial infarction?”

Please use the template below to organize the grant proposal

· Executive Summary

· Statement of Need

· Project Description

· Conclusion 

· References  (6 references, I have provided some below)

Armstrong, P. W., Gershlick, A. H., Goldstein, P., Wilcox, R., Danays, T., Lambert, Y., Sulimov, V., Rosell Ortiz, F., Ostojic, M., Welsh, R. C., Carvalho, A. C., Nanas, J., Arntz, H. R., Halvorsen, S., Huber, K., Grajek, S., Fresco, C., Bluhmki, E., Regelin, A., Vandenberghe, K., … STREAM Investigative Team (2013). Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. The New England journal of medicine, 368(15), 1379–1387.
https://doi.org/10.1056/NEJMoa1301092

Joy, E. R., Kurian, J., & Gale, C. P. (2016). Comparative effectiveness of primary PCI versus fibrinolytic therapy for ST-elevation myocardial infarction: a review of the literature.
Journal of comparative effectiveness research,
5(2), 217–226. https://doi.org/10.2217/cer-2015-0011

Karha, J., & Topol, E. J. (2006). Primary percutaneous coronary intervention vs. fibrinolytic therapy for acute ST-elevation myocardial infarction in the elderly.
The American journal of geriatric cardiology,
15(1), 19–21. https://doi.org/10.1111/j.1076-7460.2006.05290.x

Krittanawong, C., Hahn, J., Kayani, W., & Jneid, H. (2021). Fibrinolytic Therapy in Patients with Acute ST-elevation Myocardial Infarction.
Interventional cardiology clinics,
10(3), 381–390.
https://doi.org/10.1016/j.iccl.2021.03.011

McClelland, A. J., Owens, C. G., Walsh, S. J., McCarty, D., Mathew, T., Stevenson, M., Gracey, H., Khan, M. M., & Adgey, A. A. (2005). Percutaneous coronary intervention and 1 year survival in patients treated with fibrinolytic therapy for acute ST-elevation myocardial infarction. European heart journal, 26(6), 544–548.
https://doi.org/10.1093/eurheartj/ehi149

Note: You do not need to provide research budgets/financials and organizational information which is covered in the tutorial.

Standardized Terminology and Language in Informatics

Discussion

Purpose

This week's graded discussion topic relates to the following Course Outcomes (COs).

Preparing the Discussion

· Discussions are designed to promote dialogue between faculty and students, and students and their peers. In discussions students:

· Demonstrate understanding of concepts for the week

· Integrate outside scholarly sources when required

· Engage in meaningful dialogue with classmates and/or instructor

· Express opinions clearly and logically, in a professional manner

· Use the rubric on this page as you compose your answers.

· Best Practices include:

· Participation early in the week is encouraged to stimulate meaningful discussion among classmates and instructor.

· Enter the discussion often during the week to read and learn from posts.

· Select different classmates for your reply each week.

Discussion Question

Standardized Terminology and Language in Informatics is an important part of healthcare. Nurses and healthcare workers need to understand and be able to communicate clearly.

Please select

one
of the following options and discuss your understanding of the role in healthcare and its potential impact on your practice.

· Usability

· Integration

· Interface

· Interoperability

· Meaningful Use (Meaningful Use terminology has largely been replaced by the phrase ‘Promoting Interoperability’ or ‘PI’)

· Reimbursement from Centers for Medicare and Medicaid Services (CMS) payment

· NANDA

· NIC/NOC

EBOOK to use for one citation:

https://bookshelf.vitalsource.com/reader/books/9781323903148/epubcfi/6/492%5B%3Bvnd.vst.idref%3DP7001015544000000000000000002CB2%5D!/4/2%5BP7001015544000000000000000002CB2%5D/2/2%5BP7001015544000000000000000002CB3%5D/7:6%5B%20In%2Cter%5D

email:
[email protected]

Pwd: Leroyismyhero1#

let me know if you cannot have access to the ebook

Prof needs one citation from the ebook and one external citation

 Please include a 200 words in two answers to peers 

 

1.The economic and human costs associated with Alzheimer’s disease have prompted various research studies into the matter. A key topic of research and evaluation is the family’s role or obligation in caring for Alzheimer’s patients, especially parents. Such studies need to incorporate ethical considerations as they involve human beings, sensitive and vulnerable medical and care information, and contribute to knowledge development of the matter; thus, they should be done in the right way to improve the credibility and reliability of the information in the research. Ethical considerations are guidelines and principles that guide research and ensure the research process does not violate any human rights or academic regulations.

Martinez et al. (2022) conducted a qualitative study to understand the dynamics of caregiving of patients with Alzheimer’s within the Latino community because of their emphasis on familism. The study conducted interviews as its primary data collection method, which mandated various ethical considerations. Therefore, Martinez et al. obtained approval from their university’s Institutional Review Board, and informed consent was obtained before the interview. In another study to understand the caregiver’s perception of the unmet palliative care needs in Iranian Alzheimer’s patients, Ashrafizadeh et al. (2021) conducted a qualitative study. In this study, the authors mention that they incorporated various ethical considerations, including approval by the respective university’s Ethics committee. Additionally, they incorporated the voluntary nature of participation, obtained informed written consent forms and anonymity of the participants, and informed them of their right to withdraw from the study at any point. Further, they ensured the confidentiality of the information provided by the participants and guaranteed of using the said information for the sole purpose of the research.

In a cross-sectional study that involved fifty formal caregivers and fifty informal caregivers of Alzheimer’s disease patients, Sołtys & Tyburski (2020) sought to understand the predictors of mental health problems among these caregivers. The authors ensured that all surveyed caregivers willingly agreed to participate, and an ethics committee approved the study. Also, participants provided informed consent. Ashrafizadeh et al. (2021) ethical approach was relatively different, as the key ethical considerations were approval and the participant’s rights. This is seen in how the study guaranteed anonymity by providing nicknames for the participants that also assured confidentiality of the information provided. The participants were also assured of the publication of the results. At the same time, the authors obtained both oral and written consent to ensure the participants understood their involvement, including their right to withdraw from the study. Ethical considerations are similar as long as they involve human participants, even through virtual communication. Rodríguez-Mora et al conducted their interviews virtually but also had to seek informed consent and approval, and in this case, ensure no harm came to the participants by upholding the containment measures as the study was conducted during the recent pandemic.

2. Ethical approaches in research studies entail setting principles that help achieve the goal of research designs and practices. The approaches help the researchers to achieve a code of conduct when interacting with people to collect data. The primary goals of any short or comprehensive research entail enhancing the research validity, maintaining scientific or academic integrity, and acknowledging researchers who performed various research earlier. These practices are mainly for the research conducted using printed or recorded data sources.

Human research entails comprehensive ethical considerations, with voluntary participation being one of them. There is no pressure or compulsion used on any research participants to participate. Everyone enrolled in the study can stop at any time without feeling obligated to continue (Newman et al., 2021). Participants cannot be coerced into justifying leaving the study. As a result, it is critical to make it evident to participants that declining to participate will not have any detrimental effects.

Another consideration is whether participants provided informed consent and where the data was collected. The prospective participants should be provided with and comprehend the information necessary for making a participation decision (Newman et al., 2021). This includes information about the study’s advantages, hazards, funding, and institutional endorsement. Participants should be given a text to read and asked if they have any questions before proceeding. They can initial or sign the consent form if they are willing to participate. When working with particularly vulnerable groups of people, remember that this might not be enough to obtain informed consent.

Further confidentiality must be integrated into research by granting all participants the right to privacy. The researchers must protect participants’ data for a long provided they hold it (Horton & Lucassen, 2023). this consideration should be maintained when the data is collected anonymously. Assumptions such as research process grant confidentiality automatically grants confidentiality should not be taken (Horton & Lucassen, 2023). Some research designs are not conducive to confidentiality, but it is essential to make all attempts and inform participants of the risks involved. Therefore, achieving confidentiality should be explicitly planned for and met by the researchers.

In conclusion, ethical approaches to conducting research should entail observing a code of conduct that enhances research validity when collecting, storing, and interpreting data. Academic integrity should be considered when dealing with records. In human research, participants should be allowed to provide data voluntarily. They should be informed of the research details before being subjected to the research participation. Confidentiality of personal information should be significantly upheld even when research designs do not appear to favor confidentiality. Thus, researchers must ensure that research validity is enhanced by taking the ideal measures of research ethics.