Thursday, November 28, 2019

TPN &Hypokalemia Essays - Medicine, Potassium,

TPN Hypokalemia Alys Latimer, Layla Mohamed, and Sandra Zheng what IS tpn? Total Parenteral Nutrition (TPN): Infusion of intravenous nutrition (macro- and micro- nutrients) Those with contraindications to oral dietary approach Specialized mixtures of amino acids, dextrose, lipid emulsions, electrolytes, vitamins and minerals Infused centrally into internal jugular or subclavian veins INDICATIONS: comatose, inadequate GI function, completebowel rest, and paediatric disorders ADVERSE COMPLICATIONS: infections, post-op wound complications, immune compromise, fluid/electrolyte imbalance, GI bleeding, etc. (Arya et al., 2013) What is hypokalemia? Hypokalemia: Normal Findings: 3.5 5.0 mEq/L Critical Values: 2.5 mEq/L Potassium (K+), important part of protein synthesis and maintenance of normal oncotic pressure and cellular electrical neutrality (Pagana Pagana, 2013) Signs and Symptoms of Hypokalemia Typically not present until Potassium levels are less than 3.0 mEq/L Signs and symptoms of hypokalemia are typically related to cardiac, skeletal, and smooth muscle weakness CARDIOVASCULAR: flattened T-wave and prominent U-wave, ST segment depression, conduction abnormalities, dysrhythmias, worsening hypertension, sudden death KIDNEY: polyuria, hypokalemic nephropathy, increased risk of nephrolithiasis, and chloride-depletion metabolic alkalosis CNS/NEUROMUSCULOSKELETAL: fatigue, malaise, hyporeflexia, weakness, cramps, paralysis, myalgia, and rhabdomyolysis GI TRACT: Constipation, vomiting, prolonged gastric emptying, paralytic ileus, anorexia, worsening hepatic encephalopathy GU TRACT: hypotonic bladder PULMONARY: respiratory acidosis, respiratory failure ENDOCRINE: insulin resistance and impairment in insulin release (Asmar et al., 2012; Elgart, 2004; Pagana Pagana, 2013) How to treat hypokalemia? Treatment Options: GOAL: identifying definitive cause of hypokalemia, prevent the development of life-threatening consequences, and correct any potassium deficit which avoiding hyperkalemia MILD MODERATE HYPOKALEMIA (3.0 3.5 MEQ/L): Treat underlying disorder if possible Treat with 60 80 mEq/d of KCl via PO in divided doses Reassess serum potassium concentration after replacement therapy and adjust accordingly SEVERE HYPOKALEMIA ( 3.0 MEQ/L): Preferred: 40 mEq/d of KCl via PO q3-4h TID Reassess serum potassium concentration after replacement therapy and adjust accordingly If necessary: 10 20 mEq/h of KCl via IV (in setting of cardiac arrhythmias, recent or ongoing cadiac ischemia, and digitalis toxicity Continuous cardiac monitoring is mandatory Reassess serum potassium concentration q2-4h (ensure that serum potassium concentration is 3.5 mEq/L) (Asmar et al., 2012) Thank you References: Asmar, A., Mohandas, R., Wingo, C.S. (2012). A physiologic-based approach to the treatment of a patient with hypokalemia. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 60(3), 492 497. doi: 10.1053/j.ajkd.2012.01.031 Arya, I. N., Shah, B., Arya, S., Dronavalli, S., Karthikenyan, N. (2013). A review of literature on modern parenteral nutrition. International Journal of Medical Science and Public Health, 2(4), 801 806. doi: 10.5455/jimsph.2013.030920131 Elgart, H. N. (2004). Assessment of fluids and electrolytes. AACN Clinical Issues, 15(4). 607-621. Retrieved from: https://learn.humber.ca/bbcswebdav/pid-4534008-dt-content-rid 24071933_1/courses/1528.201750/Assessment%20of%20Fluids%20and.pdf Pagana, K. D., Pagana, T. J. (2013). Mosbys Canadian manual of diagnostic and laboratory tests (First Canadian ed.). Toronto, ON: Elsevier Canada

Sunday, November 24, 2019

Foundations of Learning and Collaborative Working Essays

Foundations of Learning and Collaborative Working Essays Foundations of Learning and Collaborative Working Essay Foundations of Learning and Collaborative Working Essay Discuss the construct of collaborative working within your professional area To be able to understand the principle. the different factors act uponing the result of collaborative working and how this can be applied to Perioperative pattern. it is of import to hold a sound apprehension of the construct Collaborative Working. This construct has many terminological fluctuations. one of the more often used is Inter-professional working. Hornby and Atkins ( 2000 ) province that collaborative working is a relationship between two or more people. groups or administrations. working together to specify and accomplish a common intent. Barrett et Al ( 2005 ) declares that inter-professional working is the procedure whereby members of different professions and/or bureaus work together to supply incorporate wellness and/or societal attention for the benefit of service users. Ignoring what is seen as the correct/incorrect nomenclature. the common denominator here is that all wellness attention staff/ agencies’ are working together to supply the best health care possible for patients and service users. There have been many arguments about the fluctuation in nomenclature. Leathard ( 1994:5 ) refers to it as terminological quagmire that has been created due to rapid developments in pattern. and in her analysis of footings. Leathard ( 1994:6 ) prefers to utilize the term multi-professional as it infers a wider group of professionals. In this case the term Collaborative working will be used. Over the old ages at that place have been many drivers behind the principle for collaborative working dating as far back as the 1960’s in the USA. where Henderson ( 1966 ) studies that one infirmary has weekly inter-professional ward conferences. The thought of collaborative working is hence non a comparatively new construct. In recent old ages increased accent has been placed on collaborative working and the demand to work together due to alterations in engineering. answerability and authorities studies. Technological progresss such as telecommunication is now used by surgical staff to po pulate provender surgical processs to other parts of the universe. This has aided remote-area sawboness in their ain patterns ( Shields A ; Werder 2002 ) : Similarly. the debut of the National Health Service ( NHS ) direct advice line has created a manner in which physicians can confer with patients over the telephone. However a survey by the Economic and Social Research Council ( 2005 ) concluded that telemedicine is disappearing compared to NHS direct advice line. The debut to new machinery which takes blood force per unit areas automatically instead than manually. this and other technological progresss have all required health care staff to alter the ways in which they work collaboratively. On the other manus. Government studies besides change the manner in which health care professionals work as they are frequently compulsory steps. The NHS Knowledge and Skills Framework ( KSF ) was introduced in 1999 under the Agenda for Change. Day ( 2006 ) claims that the usage of KSF will enable squad leaders to place spreads in the cognition and accomplishments of their inter-professional squads. KSF is an indispensable demand carried out every twelvemonth to guarantee wage patterned advances. Collaborative working is besides brought about by answerability. All health care professionals are governed by a professional organic structure such as the Health Professions Council ( HPC ) in which it is their responsibility to guarantee conformity with the statute law on the usage of protected rubrics ( HPC. 2008 ) Not merely are registrants accountable to the HPC they are besides accountable to statutory and condemnable jurisprudence which means healthcare professionals must interact with patients and staff on an acceptable degree at the hazard of being prosecuted for their actions. Another driver for collaborative working is seen through the of all time scrutinizing media. A recent intelligence study by Hughes ( 2011 ) titled Emergency surgery patients’ lives at hazard. state surgeons is one of the many illustrations of negative media that is seting more force per unit area on health care professionals to work more collaboratively. On the other manus. many of the public viewing audiences do non see the prejudice in the bulk of these intelligence studies and many illustrations of good coaction is missed. Resulting from the principle behind why people work together it is of import to understand the ways in which people do work together. Safe Surgery Saves Lives was an enterprise that arose in 2006 by the World Health Organization and in 2008 a Surgical Safety Checklist was released globally. Research proved that postoperative complication rates fell by 36 % on average and the checklist has besides improved communicating among the surgical squads. ( Haynes. B. A et Al. 2009. Pg: 496 ) Many trusts besides have a theatre list policy and this ensures that staff are working collaboratively to guarantee the lists are right. accurate and the most of import processs have been prioritised. The thought differentiates among the trusts. but is most normally referred to as a Group clinch. This is carried out each forenoon before any surgical processs commence and it is a opportunity for staff to collaborate and portion any thoughts or concerns over that day’s list. A large portion of collaborative work. particularly in peri-operative attention. is about recognizing each other’s accomplishments and importance therefore the thought of inter-professional acquisition. Kenward A ; Kenward ( 2011. pg ; 35-39 ) outlines the importance of wise mans. saying that mentors should move as function theoretical accounts for pupils of all professions. Further advancing this the General Medical Council ( 2006 ) papers on Good Medical Practice propounds that physicians besides act as function theoretical accounts to seek and inspire and actuate others. It is apparent that there are many ways in which healthcare staff work together. nevertheless major issues are still identified around the factors that influence the results of collaborative working. Miscommunication has been identified as a reoccurring job. Certain behavioural forms among peri-operative staff which included disregarding petitions they did non understand. neglecting to seek elucidation. neglecting to talk aloud adequate to be heard and pass oning information to the incorrect individual. ( Gardezi et al 2009. pg: 1390-1399 ) This can be fatal particularly in the instance of Elaine Bromiley who had undergone a everyday fistula surgical process. Due to a dislocation in communicating between sawboness. Elaine unluckily died. A picture titled Just a everyday operation. ( LaerdalMedical. 2011 ) released after the decease of Elaine Bromiley. identifies the dislocation in communicating between the sawboness and the theater nurses who had really witnessed the surgeon’s hurt and suggested an alternate method to cannulating the patient which was ignored. This construct has been antecedently recognised as professional segregation. D’Amour et Al ( 2005 ) argued that because professional groups are educated individually they are so socialised into discipline-specific thought. Research concluded that 69 % of respondents to a questionnaire they set out reported dissension between sawboness and nurses. And that 53. 4 % reported sing aggressive behaviour from adviser sawboness ( Coe and Gould. 2008. Pg: 609-618 ) Therefore intending the results of coaction will endure if all professionals do non interact and acknowledge the importance of other professionals’ accomplishments. It is apparent that coaction and inter-professional working mostly exists but with the changeless alterations in peri-operative pattern as mentioned antecedently and the manner health care is invariably observed. particularly by the media. it is apparent that collaborative working is a uninterrupted development or a womb-to-tomb acquisition procedure. As engineering alterations and authorities policies are continually released it is inevitable that the ways in which health care professionals work together will besides alter and develop. Mentions Barret. G. Sellman. D and Thomas. J ( 2005 ) Inter-professional working in Health and Social Care: Professional Positions. Basingstoke: Palgrave Macmillan. Coe. R and Gould. D ( 2008 ) Disagreement and aggression in the operating theater. ’ Journal of Advanced Nursing. Volume: 61. Issue: 6. Pg: 609-618. Day. J ( 2006 ) Inter-professional working: An indispensable usher for health-and social-care professionals. Cheltenham: Nelson Thornes. D’Amour. D. Ferrada-Videla. M. San Martin Rodrigues. L and Beaulieu. M ( 2005 ) The conceptual footing for inter-professional Collaboration: Core constructs and theoretical models. ’ Journal of Inter-professional Care. Addendum: 1. Pg: 116-131. Economic and Social Research Council ( 2005 ) Telemedicine revolution is disappearing’ from the NHS. [ Online ] Available at: World Wide Web. esrc. societytoday. Ac. United Kingdom. ( Accessed: 8 October 2011 ) Gardezi. F. Lingard. L. Espin. S. Whyte. S. Orser. B and Baker. G. R ( 2 009 ) Silence. power and communicating in the operating room. ’ Journal of Advanced Nursing. Volume: 65. Issue: 7. Pg: 1390-1399. General Medical Council ( 2006 ) Good Medical Practice guidelines: working in squads. ’ [ Online ] Available at: hypertext transfer protocol: //www. gmc-uk. org/guidance/good_medical_practice/working_with_colleagues_working_in_teams. asp ( Accessed: 9 October 2011 ) Haynes. B. A. Weiser. G. T. Berry. R. W. Lipsitz. Sc. D et Al ( 2009 ) A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. ’ The New England Journal of Medicine. Volume: 360. Issue: 5. Pg: 496. Health Professions Council ( 2008-09 ) Continuing professional development one-year study. [ Online ] Available at: hypertext transfer protocol: //www. hpc-uk. org/publications/reports/ ( Accessed: 8 October 2011 ) Henderson. V ( 1966 ) The nature of Nursing: A definition and its deductions for pattern. research and instruction. New York. Macmillan. Hornby. S and Atkins. J ( 2000 ) Collaborative Care: Inter-professional. interagency and interpersonal. Oxford: Blackwell. Hughes. D ( 2011 ) Emergency Surgery patients’ lives at hazard. state sawboness. ’ BBC intelligence. [ Online ] Available at: hypertext transfer protocol: //www. bbc. co. uk/news/health-15098114 ( Accessed: 8 October 2011 ) Kenward. L and Kenward. L ( 2011 ) Promoting Inter-professional Care in the Perioperative environment. ’ Nursing Standard. Volume: 25. Issue: 41. Pg: 35-39. Proquest [ Online ] Available at: hypertext transfer protocol: //proquest. umi. com/ ( Accessed: 9 October 2011 ) Laerdal Medical ( 2011 ) Just a Routine Operation’ [ Online ] Available at: hypertext transfer protocol: //www. youtube. com/watch? v=JzlvgtPlof4 ( Accessed: 9 October 2011 ) Leathard. A ( 1994 ) Traveling Inter-pro fessional: Working Together for Health and Welfare. London: Routledge. Shields. L and Werder. H ( 2002 ) Perioperative Nursing. Cambridge University Press.

Thursday, November 21, 2019

MGMT 4440 Essay Example | Topics and Well Written Essays - 1250 words - 2

MGMT 4440 - Essay Example This can lead to more advantage over competition with better skilled human capital. It can also change the organizational culture so that workers are more team-focused. Especially if they receive rewards for their efforts, they become more motivated and faithful to the business. The end result is higher productivity if goals are linked with systems to gain consistent, dependable worker results. The value for the individual is more recognition for their worthwhile contributions and might lead to more independence at their jobs if they are proven to be dependable and meet organizational goals. The feedback provided in these systems helps them to develop their strengths and gain an understanding of the organization’s mission. Rewards associated with their contributions could also motivate them to achieve and build their self-confidence in the process. The term business is behavior means that the business is very much reliant on the skills, motivations, attitudes, and dedication of workers in order to be effective and successful. A business cannot be a thriving organization without all of the efforts of its workers and it is through their motivation and dedication that the company earns a profit. Therefore, business is behavior because without human capital and ambition, they cannot outperform competition or achieve their strategic mission or goals. The unbreakable behavior law are those beliefs that are driven by personal needs and personality factors that are part of lifelong learning. Businesses try to adapt their culture to fit a specific need, however if they conflict with these very important values or personality traits, it is likely they can never be broken. Behavior is key to quality because most businesses rely on teamwork in order to be successful, especially as the environment of business becomes more complex. Information