Risk Management In Healthcare Settings.

Risk Management In Healthcare Settings.

We saw that risk management involves playing the devil’s advocate and asking, “What could go wrong?” Creating scenarios and thinking through situations will help you understand the nature of the risk better. This is your exercise for the week.

Create three fictional incidents for the risk area you selected in Week 1. Write about each scenario in not more than a page. Include the following information about each scenario:

1. Details of the incident—What, where, when, and who?
2. Explain the cause—How and why?

Submit your assignment to the W3: Assignment 2 Dropbox by Tuesday, August 9, 2016.

Name your file SUO_HCM4002_W3_A2_LastName_FirstInitial.doc.

On a separate page, cite all sources using the APA style.

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You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

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What potential benefit of targeted therapies should the nurse highlight in this education session

What potential benefit of targeted therapies should the nurse highlight in this education session

Question 1 A nurse educator who coordinates the staff education on an oncology unit is conducting an inservice on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session? What potential benefit of targeted therapies should the nurse highlight in this education session

A) Targeted therapies achieve the therapeutic benefits of traditional chemotherapy with no risk of adverse effects.
B) Targeted therapies have the potential to provide prophylactic protection against neoplasia in high-risk individuals.
C) Targeted therapies are significantly more cost-effective than traditional chemotherapeutic drugs.
D) Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected.

Question 2 An oncology nurse is aware of the risks for injury that exist around the preparation, transportation, and administration of chemotherapeutic agents. In order to reduce these risks of injury, the nurse should take which of the following actions?

A) Dispose of intravenous lines used for chemotherapy administration in a covered trash can in the patient’s room.
B) Use an IV system for administration that includes needles to reduce the risk of accidental spills.
C) Prime the IV tubing with an approved IV solution rather than with the drug itself.
D) Encourage patients who have been receiving chemotherapy to use a bedside commode rather than a toilet.

Question 3 A patient has just received her first dose of imatinib and the nurse on the oncology unit is amending the patient’s care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient’s drug regimen?

A) Risk for Infection related to bone marrow suppression
B) Risk for Acute Confusion related to adverse neurological effects of imatinib
C) Risk for Impaired Skin Integrity related to exaggerated inflammatory response
D) Risk for Deficient Fluid Volume related to changes in osmotic pressure

Question 4 A nurse has administered filgrastim to a diverse group of patients in recent months. Which of the following patients should the nurse observe for extremely elevated white blood cell counts following administration of the drug?

A) A 19-year-old male receiving radiotherapy
B) A 25-year-old female with a diagnosis of congenital neutropenia
C) A 39-year-old female with a nonmyeloid malignancy
D) A 47-year-old male with aplastic anemia

Question 5 A patient with chronic lymphocytic leukemia (CLL) will imminently begin a course of treatment with rituximab. In order to minimize the risk of adverse effects, what strategy for administration will be adopted?

A) Admitting the patient to the intensive care unit in anticipation of the initial bolus of the drug
B) Administering diphenhydramine 30 minutes prior to the initial dose of rituximab
C) Administering the drug by slow infusion to two peripheral IV sites simultaneously
D) Administering the initial doses by slow infusion while observing for adverse reactions

Question 6 A 45-year-old woman with acute leukemia is going to begin chemotherapy with vincristine. The nurse is aware that vincristine must always be administered

A) at a rapid infusion rate.
B) at a slow infusion rate.
C) through an IV line primed with vincristine.
D) through a central line.

Question 7 Mr. Singh is a 66-year-old man who is receiving chemotherapy for the treatment of lung cancer that has metastasized to his liver. In an effort to prevent infection, Mr. Singh has been prescribed filgrastim (Neupogen). Which of the nurse’s following assessment questions most directly addresses a common adverse effect of filgrastim?

A) “Have you noticed any bleeding in your gums or cheeks?”
B) “Do you feel like you’re having any pain in your bones?”
C) “Are you experiencing any waves of cool, clammy skin?”
D) “Have you had any shortness of breath lately?”

Question 8 A 67-year-old man who is being treated for prostate cancer is taking epoetin alfa. The nurse will instruct the patient to

A) stop taking the drug after a 2-week period.
B) schedule an appointment to measure hemoglobin twice a week for at least 2 to 6 weeks.
C) schedule an appointment to check if the patient has a high WBC count.
D) begin taking a calcium channel blocker to treat hypertension, which usually develops as an adverse effect of epoetin alfa therapy.

Question 9 A male patient is receiving heparin by continuous intravenous infusion. The nurse will instruct the patient and family members to report which of the following should it occur?

A) A skin rash
B) Sudden occurrence of sleepiness and drowsiness
C) Dizziness
D) Presence of blood in urine or stools

abcd

Question 10 A nurse is caring for a 64-year-old female patient who is receiving IV heparin and reports bleeding from her gums. The nurse checks the patient’s laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which of the following drugs may be ordered?

A) Coumadin
B) Alteplase
C) Ticlopidine
D) Protamine sulfate

Question 11 A nurse has been assigned to a 55-year-old woman who has a malignant brain tumor. The patient is receiving her first dose of carmustine. It will be critical for the nurse to observe for which of the following?

A) Nausea and vomiting
B) Respiratory difficulty
C) Inability to drink fluids for 6 hours
D) Reddish urine

Question 12 A nurse is assessing a patient who has chronic lymphoblastic myelogenous leukemia. The treatment plan includes hydroxyurea (Hydrea). The nurse will assess the patient for which of the following?

A) Diabetes mellitus
B) Hypertension
C) Leukopenia
D) Hypoglycemia

Question 13 A patient’s current course of cancer treatment involves the administration of a conjugated monoclonal antibody. What characteristic of the drug is specified by the fact that it is classified as a conjugated drug?

A) The drug is derived from nonhuman sources.
B) The targeted therapy is combined with another substance that causes cell death.
C) The targeted therapy is combination of a monoclonal antibody, a kinase inhibitor, and an inorganic cytotoxin.
D) The drug is able to adapt its pharmacokinetics to the etiology of the patient’s cancer.

Question 14 An oncology nurse is reviewing the pathophysiology of cancer and is discussing with a colleague the factors that contribute to the success or failure of a patient’s chemotherapy. Which of the following cancerous cells is most susceptible to the effects of chemotherapeutic drugs?

A) Cells with a long generation time
B) Cells that lack contact inhibition
C) Cells that have a rapid mitotic rate
D) Cells that lack a blood supply

Question 15 A patient receiving high-dose cisplatin therapy exhibits symptoms of hypomagnesemia. Which of the following should the nurse suggest to help offset the magnesium losses from the cisplatin therapy?

A) Consuming dairy products
B) Consuming chocolates
C) Drinking 2 to 3 liters of fluid a day
D) Consuming potassium-rich foods

Question 16 An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which of the following characteristics of this patient’s current health status may preclude the use of imatinib?

A) The patient has type 2 diabetes mellitus that is controlled using diet and oral antihyperglycemics.
B) The patient has chronic heart failure resulting in significant peripheral edema.
C) The patient experienced a mild ischemic stroke several years ago and had transient ischemic attacks last year.
D) The patient had a total knee arthroplasty several months earlier.

Question 17 A female patient is prescribed oprelvekin therapy to treat thrombocytopenia. Which of the following should the nurse continuously monitor to determine the efficacy and duration of the oprelvekin therapy?

A) Weight gain
B) Platelet count
C) Red and white blood cell count
D) Cardiac arrhythmias

Question 18 During ongoing assessment of a patient receiving 5-FU therapy, the nurse finds the patient’s platelet count to be 92,000 cells/mm3. The nurse should do which of the following?

A) Consult the prescriber for an increase in dosage
B) Consult the prescriber for a decrease in dosage
C) Consult the prescriber for discontinuation of the drug
D) Continue the therapy as prescribed

Question 19 A nurse has been assigned to a female patient who is to begin chemotherapy. The nurse will initiate the prescribed oprelvekin therapy

A) 6 to 24 hours after chemotherapy.
B) 2 days after chemotherapy.
C) 6 days after chemotherapy.
D) 10 days after chemotherapy.

Question 20 A patient with a recent diagnosis of chronic myelogenous leukemia (CML) is discussing treatment options with his care team.What aspect of the patient’s condition would contraindicate the use of cyclophosphamide for the treatment of leukemia?

A) The patient has a diagnosis of type 2 diabetes and takes oral antihyperglycemics.
B) The patient has had a history of nonadherence to medical treatment.
C) The patient’s bone marrow function is significantly depressed.
D) The patient has decreased renal function.

Question 21 A female patient has follicular non-Hodgkin’s lymphoma and is receiving thalidomide (Thalomid). It will be most important for the nurse to monitor this patient for which of the following?

A) Angina
B) Fever
C) Chills and rigors
D) Bleeding

Question 22 When planning care for a patient who is receiving filgrastim (Neupogen) for a nonmyeloid malignancy, the nurse should formulate which of the following patient outcomes? (Select all that apply.)

A) The patient will not develop an infection.
B) The patient will not experience bone pain.
C) The patient will be able to self-administer filgrastim at home.
D) The patient will not develop febrile neutropenia.
E) The patient will not retain fluid.

Question 23 A nurse is to use a single-dose 1 mL vial to administer 0.5 mL of epoetin alfa to a 39-year-old woman who is being treated for chemotherapy-induced anemia. Which of the following will the nurse do with the unused portion of the drug?

A) Refrigerate the medication for a future use.
B) Discard the unused portion of the drug.
C) Store the medication in the drug cart for the next dose.
D) Put the medication in the freezer compartment of the refrigerator.

Question 24 nurse is discussing oprelvekin therapy with a male patient. Which of the following will the nurse tell the patient is the most common adverse effect of the drug?

A) Medullary bone pain
B) Papilledema
C) Fluid retention/weight gain
D) Atrial arrhythmia

Question 25 A patient with chronic heart failure has begun treatment with epoetin alfa, which she will receive in her own home from a home health nurse. The nurse should teach the patient to supplement this treatment with a diet that is high in

A) iron-rich foods such as beans and leafy green vegetables.
B) complex carbohydrates and vegetable-source proteins.
C) calcium, such as dairy products, fish and vegetables.
D) protein and low in carbohydrates.

Question 26 A nurse is administering rituximab to a patient via the IV route. The nurse will set the IV pump at 50 mg/hour for the first half hour of the initial infusion. If there are not apparent reactions after 30 minutes of the infusion, the nurse will increase the dosage every 30 minutes by 50 mg/hour until the maximum infusion rate reaches which of the following?

A) 250 mg/hour
B) 300 mg/hour
C) 400 mg/hour
D) 500 mg/hour

Question 27 A 62-year-old patient taking tamoxifen exhibits increased bone and tumor pain along with a local disease flare. The nurse interprets this as an indication of which of the following?

A) A hypersensitivity reaction
B) The tumor responding to treatment
C) Nephrotoxic effects of tamoxifen
D) Cardiomyopathy

Question 28 A male patient is receiving rituximab therapy for non-Hodgkin’s lymphoma. Which of the following would be a priority nursing intervention to reduce the risk for cytotoxicity and tumor lysis syndrome?

A) Ensure that the patient maintains a normal breathing pattern.
B) Ensure that the patient maintains a normal fluid and electrolyte balance.
C) Protect the patient from exposure to infections.
D) Monitor the patient for deterioration in renal function.

Question 29 A patient with a diagnosis of chronic myeloid leukemia has met with her oncologist, who has recommended treatment with the kinase inhibitor imatinib. What route of administration should the nurse explain to the patient?

A) Daily intramuscular injections throughout the course of treatment
B) Peripheral IV administration three times a day for 7 to 10 days
C) Weekly IV infusions over 6 to 8 hours through a central line
D) Oral administration of imatinib in a home setting

Question 30 A 60-year-old patient experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The patient has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect?

A) By promoting the rapid excretion of vitamin K by the gastrointestinal mucosa
B) By inhibiting the action of vitamin K at its sites of action
C) By inhibiting platelet aggregation on vessel walls and promoting fibrinolysis
D) By inactivating clotting factors and thus stopping the coagulation cascade

Question 31 A male patient has been on long-term bicalutamide (Casodex) therapy. In order to assess adverse effects of the drug therapy, the nurse will closely monitor which of the following?

A) Visual function
B) Blood counts
C) Pap test results
D) Liver function

Question 32 Intravenous carmustine has been prescribed for a patient with cancer. The nurse should help relieve the discomfort of pain and burning during the infusion by

A) slowing the infusion.
B) decreasing the volume used for dilution.
C) decreasing the total volume of the primary IV infusion.
D) administering a dose of 2 units of bleomycin before carmustine.

 

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Question 33 A middle-aged patient has received a diagnosis of GI stromal tumor following an extensive diagnostic workup. Imatinib has been recommended as a component of the patient’s drug regimen. What patient education should the nurse provide to this patient?

A) “It’s important that you let us know if you develop any significant swelling or puffiness.”
B) “Try to keep your PICC line dressing as dry as possible at all times.”
C) “You’ll likely experience a lot of dry mouth while you’re taking this drug, so it’s helpful to chew ice chips.”
D) “If you experience significant nausea after taking a dose, stop taking the drug and schedule an appointment at the clinic.”

Question 34 A nurse has completed a medication reconciliation of a patient who has been admitted following a motor vehicle accident. Among the many drugs that the patient has received in the previous year is rituximab. The nurse would be justified in suspecting the patient may have received treatment for which of the following diseases?

A) Non-Hodgkin’s lymphoma
B) Malignant melanoma
C) Nonsmall cell lung cancer
D) Renal cell carcinoma

Question 35 Mr. Lepp is a 63-year-old man who was diagnosed with colon cancer several weeks ago and who is scheduled to begin chemotherapy.He reports to the nurse that he read about the need for erythropoietin in an online forum for cancer patients and wants to explore the use of epoetin alfa with his oncologist. Which of the following facts should underlie the nurse’s response to Mr. Lepp?

A) Epoetin alfa is normally contraindicated in patients who are receiving radiotherapy or chemotherapy.
B) Treatment with epoetin alfa will likely begin 4 to 6 days before Mr. Lepp’s first round of chemotherapy and continue indefinitely.
C) The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients.
D) Mr. Lepp’s oncologist should have begun treatment with epoetin alfa immediately after he was diagnosed.

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Learning Objectives

Students will:

· Create progress notes

· Create privileged notes

· Justify the inclusion or exclusion of information in progress and privileged notes (SEE ATTACHED SAMPLE OF PROGRESS AND PRIVILIGED NOTE)

· Evaluate preceptor notes

To prepare:

· Reflect on the client family you selected for the Week 3 Practicum Assignment (SEE ATTACHED WEEK 3 NOTE),

                                                             The Assignment

                 Part 1: Progress Note

Using the client family from your Week 3 Practicum Assignment address in a progress note (without violating HIPAA regulations) the following:

· Treatment modality used and efficacy of approach

· Progress and/or lack of progress toward the mutually agreed-upon client goals

(reference the treatment plan for progress toward goals)

· Modification(s) of the treatment plan that were made based on progress/lack of

progress

· Clinical impressions regarding diagnosis and or symptoms

· Relevant psychosocial information or changes from original assessment (e.g.,

marriage, separation/divorce, new relationships, move to a new

house/apartment, change of job)

· Safety issues

· Clinical emergencies/actions taken

· Medications used by the patient, even if the nurse psychotherapist was not the

one prescribing them

· Treatment compliance/lack of compliance

· Clinical consultations

· Collaboration with other professionals (e.g., phone consultations with physicians,

psychiatrists, marriage/family therapists)

· The therapist’s recommendations, including whether the client agreed to the

recommendations

· Referrals made/reasons for making referrals

· Termination/issues that are relevant to the termination process (e.g., client

informed of loss of insurance or refusal of insurance company to pay for

continued sessions)

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· Issues related to consent and/or informed consent for treatment

· Information concerning child abuse and/or elder or dependent adult abuse,

including documentation as to where the abuse was reported

· Information reflecting the therapist’s exercise of clinical judgment

Note: Be sure to exclude any information that should not be found in a discoverable progress note.

                       Part 2: Privileged Note

· Based on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your client family from the Week 3 Practicum Assignment. (SEE ATTACHED WEEK 3 NOTE),

In your progress note, address the following:

· Include items that you would not typically include in a note as part of the clinical record.

· Explain why the items you included in the privileged note would not be included in the client family’s progress note.

· Explain whether your preceptor uses privileged notes. If so, describe the type of information he or she might include. If not, explain why.

Theoretical Assertions and Propositions

 

According to Ruland & Moore, the relational statements identified as theoretical assertions for theory as follows:

A. Monitoring and administering pain relief and applying pharmacological or non-pharmacological interventions contribute to the patient’s experiences of not being in pain.

B. Preventing, monitoring and relieving physical discomfort, facilitating rest, relaxation and contentment, and preventing complications contribute to the patient’s experience of comfort.

C. Including the patient and significant others in decision making regarding patient care, treating the patient with dignity, empathy and respect, and being attentive to the patient’s expressed needs, wishes, and preference contribute to the patient’s experience of dignity and respect.

D. Providing emotional support, monitoring and meeting the patient’s expressed needs for anti anxiety medications, inspiring trust, providing the patient and significant others with guidance in practical issue, and providing physical preference of another caring person if desired contribute to the patient’s experience of being at peace.

E Facilitating participation of significant others’ grief, worries, and questions, and facilitating opportunities for family closeness contribute to the patient’s experience of closeness to significant others or person who care.

Advocating For The Nursing Role In Program Design And Implementation.

Advocating For The Nursing Role In Program Design And Implementation.

As their names imply, the honeyguide bird and the honey badger both share an affinity for honey. Honeyguide birds specialize in finding beehives but struggle to access the honey within. Honey badgers are well-equipped to raid beehives but cannot always find them. However, these two honey-loving species have learned to collaborate on an effective means to meet their objectives. The honeyguide bird guides honey badgers to newly discovered hives. Once the honey badger has ransacked the hive, the honey guide bird safely enters to enjoy the leftover honey.

Much like honeyguide birds and honey badgers, nurses and health professionals from other specialty areas can—and should—collaborate to design effective programs. Nurses bring specialties to the table that make them natural partners to professionals with different specialties. When nurses take the requisite leadership in becoming involved throughout the healthcare system, these partnerships can better design and deliver highly effective programs that meet objectives.

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In this Assignment, you will practice this type of leadership by advocating for a healthcare program. Equally as important, you will advocate for a collaborative role of the nurse in the design and implementation of this program. To do this, assume you are preparing to be interviewed by a professional organization/publication regarding your thoughts on the role of the nurse in the design and implementation of new healthcare programs.

To Prepare:

• Review the Resources and reflect on your thinking regarding the role of the nurse in the design and implementation of new healthcare programs.
• Select a healthcare program within your practice and consider the design and implementation of this program.
• Reflect on advocacy efforts and the role of the nurse in relation to healthcare program design and implementation.
• Review the User Guide for Uploading Media in your Blackboard Classroom by accessing the Kaltura Media Uploader on the Left Navigation Bar in preparation to record your narrated video or audio for this Assignment.

The Assignment: (2–3 pages)

In a 2- to 3-page paper, create an interview transcript of your responses to the following interview questions:

• Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?
• Who is your target population?
• What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?
• What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?
• What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?
• Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?

 

 

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