Assessment Instructions 

Your supervisor has asked you to do a 15-minute oral presentation at a staff meeting about a recent issue that occurred at another hospital in town. Following an industrial accident, two patients arrived at the emergency room of that hospital at the same time, presenting with very similar inhalation injuries. The hospital received a great deal of negative press due to how the patients were triaged in the ER. Your supervisor would like you to use the specifics of this case to review triage procedures and best practices at your facility. Here are the details:

• One is a 32-year-old firefighter, Frank Jeffers, who is presenting with respiratory difficulties that he obtained while evacuating victims of an industrial accident. He is a married homeowner and father of two young boys. He has lived in the community all his life. He has full and comprehensive health insurance through his employer.
• The other is Brent Damascus, a 58-year-old man. Brent is presenting with respiratory difficulties with the same intensity as Mr. Jeffers above. He is well known at the hospital emergency room, as he is a frequent visitor with various complaints, including asthma, headaches, and tremors. He is homeless, unemployed, and uninsured. He stays many nights at the YMCA and eats lunch at the soup kitchen. He has lived in the community for over 10 years and has been arrested several times for petty theft.

Preparation

Search the Capella library and the Internet for scholarly and professional peer-reviewed articles on best practices in triage nursing. You will need at least three articles to use as support for your work on this assessment.

Directions

Create a 15-minute presentation (3–4 pages) that examines the moral and ethical issues that occurred when triaging these two patients and the best practices for managing this in the future.

Divide your draft into a number of talking points that you can summarize neatly. Keep in mind that an oral presentation requires slightly different language than an essay. The aim is to communicate your message so keep sentences simple and focus on the key points you want to deliver. Address the following in your presentation:

• Explain the health care policies and protocols that are in place that direct triage care in an emergency situation.
• Explain how health care disparities impact treatment decisions.
• Identify the health care policies that are in place that direct care for uninsured individuals. Is there a difference in how these individuals are triaged?
• Describe the moral and ethical challenges nurses can face when following hospital policies and protocols. Is there a conflict when a severely injured person is also uninsured?
• Recommend evidence-based strategies that should be applied for managing the care of uninsured and indigent population.

Additional Requirements

Your presentation should meet the following requirements:

• Written communication: Written communication should be free of errors that detract from the overall message.
• References: Include a reference section with a minimum of three references; a majority of these should be peer-reviewed sources. All resources should have been published within the last 5 years.
• APA format: Resources and citations should be formatted according to current APA style and formatting.
• Length: 3–4 typed, double-spaced pages, excluding title page and reference page. Use Microsoft Word to complete the assessment.
• Font and font size: Times New Roman, 12-point.

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Instructions

For this assignment, you will write emails explaining a situation to both an employer and a friend.

Your employer has asked you to work on a day that you have already requested off for personal reasons. You are unable to change your plans and must therefore explain why you are unable to work (a family wedding or similar event is a possible choice for this). Your friend has asked you to assist him or her with moving on the same day. Again, you are unable to help because of the same prior engagement.

1. Write an email to your employer explaining why you are unable to work on the day specified.
2. Write an email to your friend explaining why you are unavailable to help with his or her move.
3. In a short, 1-page reflection, explain the differences between how you have communicated in the two emails. Familiarity with the other person, formality, type of language used, and other factors you may wish to include.
4. Keep in mind the audiences to whom you are writing. Ideas of grammar, formality, and word choice may be very different depending on your audience, but in both cases, clarity and succinctness are important

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It is important to identify and understand your own family culture in order to be able to understand and respect other cultures. Interview a family member, and an individual from another culture with which you are unfamiliar. Some examples of an individual from another culture to consider for the assignment include a neighbor, coworker, patient, or friend. Please inform the individuals of the purpose of this assignment and make sure you receive their consent.

Interviews:

Review the “Family Interview” template prior to the interview. Additional space is designated on the template for you to create three additional questions to ask both interviewees (family member and person from another culture). Additional questions should be relevant to the readings or discussion and should provide value to the interview by helping to understand culture.

Some of the questions may include:

1. Family beliefs: Have they changed over generations?
2. Educational and occupational status in the culture and in the family
3. Communication methods: verbal and nonverbal
4. Current family goals/priorities
5. Family member roles and organizational systems
6. Spiritual beliefs: current practice and death and dying
7. Alternative lifestyles
8. Work attitudes and structure

Written Paper:

Using the “Family Interview” template, interview your designated family member and the person from another culture. Be sure to write your responses in a way that will assist you in writing your paper. After the interview is completed, write a paper of 750-1,000 words that includes the following:

1. An introductory paragraph with the reasons for selecting the interviewees.
2. A summary of the responses from the interview template gathered from the interviewees.
3. A comparison and contrast of your findings between the two interviewees.
4. A reflective concluding paragraph on how family roles affect the cultural domains and relationships for each individual.

General Requirements:

Submit both the completed “Family Interview” template and the written paper” to the instructor.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Attachments 

  College of Nursing and Health Care Professions

When conducting the “Family Interview,” please make sure that you inform the individual you choose to interview that you will be using their responses in a compare and contrast cultural paper for HLT-324V. It is important that people give you approval to use their personal stories prior to doing so. Please use this template and the following questions below when conducting your interviews. In addition to these questions, you are required to ask another three questions, which you are to include on this template.  Please submit this template with your paper by the end of Module 2. 

1. What are your family roles/gender roles? How are they the same as or different from those traditionally practiced by your culture (who is the head of the household, who makes decisions, how are decisions made, etc.)?

2. What does your culture and family see as primary family goals (education, marriage, etc.)?

3. What is your culture’s view on alternative lifestyles (living together prior to marriage, domestic partnerships, single parenting, etc.)?

4. What are your family’s religious beliefs, and have they changed over generations?

5. What are your family’s spiritual beliefs around death and dying?

6. What are your culture’s education and occupational status within the family unit? 

7. What are your culture’s preferred communication methods (verbal and nonverbal)?

8. Additional question:

9. Additional question:

10. Additional question:

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Respond to at least two of your colleagues who selected at least one different factor than you in one of the following ways:

Share insights on how the factor your colleague selected impacts the pathophysiology of anaphylactic shock.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

                                                             Main Post

                                               Anaphylactic Shock 

Anaphylactic shock is a life-threatening medical emergency from an allergic reaction that requires immediate treatment. Rapid-onset respiratory compromise, skin/mucosal involvement, and hypotensive end-organ dysfunction are all characteristic presentations (Brasted & Ruppel, 2016). The body’s response to the allergen is to release inflammatory mediators at a local site, but ultimately, the response is systemic, which leads to an overwhelming cascade that affects the homeostasis of the body. Due to an increase in vascular permeability, fluid shift from the intravascular to extravascular space can occur within minutes, resulting in edema, respiratory arrest, and circulatory collapse (Brasted & Ruppel, 2016). The effect leads to vasodilation and consequently, intravascular volume depletion resulting in systemic hypotension; the hypoperfusion affects every end organ. 

Emergency Versus Treating as an Outpatient

Hindsight is always 20/20, but, the respiratory compromise in this scenario should have led the school nurse to deem this a medical emergency. Urticaria and other skin symptoms were significantly more common in food-induced anaphylaxis (Kim, Kim, & Cho, 2018). I am not aware of emergency medicines available at the school levels, but; the girl did not have any medications specifically assigned to her. First line treatment would have been epinephrine or an Epi-pen, a device that people with known allergies carry with them or in this case; the girl would have had available for the school nurse to administer. Epinephrine is a powerful catecholamine that the body produces naturally for the “fight or flight” response. When administered in an anaphylactic shock situation, it acts on many levels to combat the allergen’s triggered processes. First, it is a potent alpha-1 adrenergic agonist, and it vasoconstricts and increases the peripheral vascular resistance. This increases blood pressure and reduces mucosal edema, especially relevant in alleviation of upper airway obstruction (Brasted & Ruppel, 2016). Epinephrine is also a powerful inotropic agent, allowing the heart to generate an increased cardiac output by strengthening the contractions of the heart. It decreases the inflammatory mediators with its beta-2 adrenergic effect, slowing the process of the allergen response. If an Epi-pen is used, the patient should still go to the emergency room for further evaluation as hypoperfusion may have damaged some organs. There is no situation that anaphylactic shock should be managed in an outpatient setting, especially with a six-year-old child.  

Age and Gender’s Role in Anaphylactic Shock

Anaphylaxis does not differentiate between old and young or male and female if you have an allergy and come in contact with the allergen, you have the potential for anaphylaxis or even anaphylactic shock. However, research by Kim, Kim, and Cho (2018) acknowledged that severe symptoms were more frequent in the drug-induced anaphylaxis, and risk factors for the severe anaphylaxis were found to be age, sex, and drug-induced anaphylaxis. The results showed that older males were at more risk for severe anaphylaxis when the allergen was a drug. 

Conclusion

Anaphylactic shock requires a practitioner’s immediate attention to preserve the life of the patient. All practitioners should know the early warning signs and advanced warning signs when dealing with this life-threatening situation. Understanding the factors associated with anaphylaxis can help guide preventive and management strategies both within and outside of the school setting (White, Silvia, Muniz, Herrem, & Hogue, 2017). All schools should be able to treat anaphylaxis, in the early stages and life-saving medications should be available, even if not available in the child’s medicine bin. 

                                                                                                                                          References

Brasted, I. D., & Ruppel, M. C. (2016). Anaphylaxis and Its Treatment. EMS World, 45(9), 31–37. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=117794702&site=eds-live&scope=site

Kim, S.-Y., Kim, M.-H., & Cho, Y.-J. (2018). Different clinical features of anaphylaxis according to cause and risk factors for severe reactions. Allergology International, 67(1), 96–102. https://doi-org.ezp.waldenulibrary.org/10.1016/j.alit.2017.05.005

White, M. V., Silvia, S., Muniz, R., Herrem, C., & Hogue, S. L. (2017). Prevalence and triggers of anaphylactic events in schools. Allergy And Asthma Proceedings, 38(4), 286–293. https://doi-org.ezp.waldenulibrary.org/10.2500/aap.2017.38.4066

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