During the course, you have done a thorough analysis of a company and the health care subsector in which the company operates now is the time to look at all your findings and insights and frame the situation of the company in terms of cost, access, and quality. Specifically:

1. Are there any major cost-containment policies or practices from private insurers or the government that affect your company? Are there any internal/ competitive forces that are trying to do the same?
2. How does your company (and industry) is assessed in terms of its ability to offer access to all populations?
3. What kind of quality assessment and assurance is done? Are there any positive or negative stories about the quality of health care services of the organization?

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Clinical Decision-Making NU671

Unit 2Weekly Clinical Communication and Documentation Requirements. 600w. 3 references. Due 11-11-22

For this assignment the focus is a 50y/o male patient. construction worker. Came in for follow up after a 2024 ICD-10-CM Diagnosis Code M75. 102: Unspecified rotator cuff tear or rupture of left shoulder, not specified as traumatic. The injury occurred 1 month prior. The patient has not returned to work since his injury and is suffering from chronic pain, anxiety and depression related to his financial obligations at home. Patient is the head of his household; his wife does not work. He came in for a follow-up with his primary care provider. His blood pressure was also elevated due his stress. He was placed on fluoxetine (Prozac) 20 milligrams (mg) once a day in the morning and Carvedilol 6.25 milligrams (mg) 2 times a day. Over the counter Tylenol and ibuprofen recommended for pain. Patient education was provided regarding medication management and stress management.

1. Clinical Highlights.

· On your journey to become a psychiatric mental health nurse practitioner discuss a patient encounter that was particularly interesting and what you learned from it?

· Identify a personal learning need you discovered while assessing or managing a specific diagnosis. What steps will you take to improve your understanding or skills?

2. Looking Ahead

· What clinical goal would you like to tackle next week?

· What is your proposed clinical schedule (date/time/total hours) for next week?

Old assignment-paper
This is the assignment that was completed previous semester. I am retaking this class. The assignments are the same but I cannot submit the same work, the instructor runs all papers through the plagiarism checker. Please redo this assignment so I can resubmit it the content will be the same. Thanks

Unit 3 Weekly Clinical Preceptee Communication And Documentation

Name

Student’s Number

Course Title and Number

Professor’s Name

Institution

Date

Unit 3 Weekly Clinical Preceptee Communication And Documentation

Clinical Highlights

I had a patient interaction that was especially intriguing and taught me essential lessons throughout my training to become a psychiatric mental health nurse practitioner. A session was held with a young adult experiencing acute anxiety and depression. The patient's background of childhood trauma had a significant effect on how she felt mentally. It was challenging to develop a therapeutic connection with her when we first started our session because she looked reserved and guarded. I eventually won her trust through attentive listening and compassionate conversation. I discovered the extent of the patient's emotional suffering as she opened up and the survival skills she had developed. The experience showed me the value of being persistent and patient while establishing a connection with people who have undergone trauma. It reaffirmed how crucial it is to give people a secure, judgment-free area to express their emotions.

The incident also highlighted the challenges of treating coexisting mental health disorders. Her depression and anxiety were linked and exacerbated each other, which posed special difficulties in creating an all-encompassing treatment strategy. I saw the significance of providing mental health treatment using a holistic approach that considers all facets of a patient's life, particularly their social network, way of life, and coping mechanisms.

Personal Learning Need

I discovered a personal learning needs for treating individuals with personality disorders throughout my evaluations and management of various conditions. I found that there was room for development in the areas of understanding and treating borderline personality disorder (BPD). I felt the need to improve my knowledge and abilities since BPD is a complicated and sometimes misunderstood disorder. Acquiring evidence-based clinical knowledge is important in ensuring that people with BPD have better treatment (Iliakis et al., 2019). I have various actions I want to take to increase my knowledge about and management abilities for BPD. I will first do an in-depth study and analyze recent BPD literature to understand the underlying causes, symptoms, and evidence-based treatment options for BPD. This study will help me stay current on the most recent developments and suggestions for treating personality disorders.

I intend to seek mentoring or supervision from seasoned mental health practitioners knowledgeable about treating people with personality problems. Mentoring often provides mental health practitioners with insightful advice that will make them handle challenging situations easier (Zajac et al., 2021). I will look for chances for continuing education relevant to BPD and similar personality disorders. I will be able to communicate with professionals, gain knowledge from practical examples, and have conversations with others with similar learning interests by participating in these educational activities. Ultimately, I want to use my clinical rotations to put my newfound understanding of BPD and its treatment into practice. I may use evidence-based therapies and assess their efficacy while getting feedback from seasoned preceptors by actively interacting with BPD patients.

Looking Ahead

My clinical objective for the coming week is to improve my capacity for performing thorough mental health evaluations. A comprehensive assessment is crucial to psychological mental health practice since it is the basis for a precise diagnosis and efficient treatment planning (Maruish, 2019). The following is the proposed clinical schedule for next week.

Day	Activity
Monday	Shadow an experienced psychiatric mental health nurse practitioner during patient assessments in the morning. In the afternoon, review assessment tools and protocols.
Tuesday	Conduct mental health assessments under the supervision of a preceptor, focusing on gathering patient history, current symptoms, and potential risk factors.
Wednesday	Attend a workshop on the importance of cultural competence in mental health assessments, exploring techniques for conducting culturally sensitive interviews.
Thursday	Discuss assessment findings with preceptors, receive feedback, and participate in case discussions with fellow students to learn from their experiences.
Friday	Engage in self-directed study, reviewing assessment guidelines and practicing documentation skills to ensure accurate and thorough recording of patient information.

I intend to spend 30 hours on clinical work, education, and independent study during the week. I plan to considerably enhance my assessment abilities as a psychiatric mental health nurse practitioner by devoting time and effort to this clinical objective and offering better treatment to my future patients.

References

Iliakis, E. A., Sonley, A. K., Ilagan, G. S., & Choi-Kain, L. W. (2019). Treatment of borderline personality disorder: is supply adequate to meet public health needs?.
Psychiatric Services,
70(9), 772-781.

Maruish, M. E. (2019).
Essentials of treatment planning. John Wiley & Sons.

Zajac, S., Woods, A., Tannenbaum, S., Salas, E., & Holladay, C. L. (2021). Overcoming challenges to teamwork in healthcare: a team effectiveness framework and evidence-based guidance.
Frontiers in Communication,
6, 606445.

 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.

Respond to the four colleagues in the attachment file by offering additional ideas to overcome the barriers to strategies suggested by your colleagues and/or by offering additional ideas to facilitate dissemination. Please include AT LEAST 2 REFERENCES EACH