Fluid and Electrolyte Case Study

Case Study:

A 65 year old female is admitted to your unit complaining of nausea vomiting and diarrhea for 3 days. Her history is unremarkable except hypertension for which she takes hydrochlorothiazide. She relates feeling exhausted and having leg cramps which interfere with her sleeping. Notable assessment findings include:

Temp: 38.6C. AP 102 and irregular, BP 90/50; absent bowel tones, dry skin and poor turgor, and poor muscle tone. As the causes

Labs: K 2.0mEq/L; NA 137 mEq/L; CL 97 mEq/L; and WBC 20,000/ul.

MD orders:

I V D50 .9%Nacl with 20mEq KCL/L to infuse @ 90cc/hr.

40mEq of KCL IV over the next 2 ho0urs

K level 30 minutes after the 40mEq IV KCL has infused.

Bedrest: May use Bathroom

NPO

Questions

1. What fluid and electrolyte disturbances does this client have?

2. What electrolyte disturbance is o0f most concern with this client and why?

3. What signs and symptoms that the patient exhibits can result from this electrolyte disturbance?

4. What do you suspect as the cause(s) of this electrolyte disturbance?

5. What type of solution is D50NS + 20 mEq KCL?

6. Would you question any of these orders? Why or why not?

7. Would you expect to see any changes on an EKG if one is taken?

Week 4 – Assignment: Analyze Quality Performance

Improvement requires the ability to effectively analyze data. While extensive knowledge in using statistical analysis tools is desirable, health administrators adept at constructing charts and analyzing the organizational data as compared to established benchmarks yields valuable information.

For your assignment this week, you will prepare an Analysis Report paper. Begin your assignment with the following steps:

1.Read the case study published by the Agency for Healthcare Research and Quality (AHRQ) featuring Tampa General Hospital's use of the AHRQ tools to improve quality measures. The link to the Tampa General Hospital's case study is found in your Weekly Resources.

 After reading the Tampa General Hospital case study, you will access the
Hospital Compare website link found in your Weekly Resources. At this site, you will insert Tampa, Florida into the location box, select Hospital as the type of facility, and insert Tampa General Hospital into the name box. Once the webpage for Tampa General Hospital is accessed, click on
Patient Survey Ratings. Here you will find the hospital's patient satisfaction ratings along with the state and national ratings in each category.

 With these data, you will use an Excel spreadsheet to insert the type of indicator (i.e.,
Patients who reports their nurses always communicated well and the observed score for Tampa General Hospital as well as the average Florida and National scores provided). Repeat this process to include all 10 statements of patient satisfaction.

Once your spreadsheet data is complete, create a bar graph by clicking on Insert in the top header and selecting the bar graph to visually display the comparison of Tampa General Hospital's scores to the state and national average scores. Instead of using Excel, you may alternately create a Table in Microsoft Word using the same data as described above placed in a table. Once the table is complete, click Insert from the ribbon at the top of the page, and then click Chart. From here, select Bar chart and use the Clustered Bar Chart style. For either method, make sure all three data sources are depicted in the chart. An example of how to set up your table and the resulting bar graph that is both required in your paper are shown. Keep in mind the information you retrieve is a single data set and does not represent performance over time, but rather represents a snapshot of organizational performance as compared to external standards.

 Next, you will click on
Quality in the Tampa General Hospital's website header and scroll down to
Complications and Deaths. Once the section expands, scroll down to
Infections. In the
Infection's section, you will find the quality score for the topic in the case study regarding catheter-associated urinary catheter infections (CAUTI). Record the score for Tampa General Hospital for this measure and note the national benchmark score of 1. You will analyze this score as it compares to the national score and its relevance to the case study.

 Lastly, you will prepare your Analysis Report paper that contains an introductory section, the body of your report containing your analysis of Tamps General Hospital's patient satisfaction ratings and the comparison of the ratings to the state and national scores, and your analysis of the CAUTI infection rate compared to the national rate. You will also include a summary section in your paper. You will insert your Clustered Bar graph (see example) with the 10 statements and scores as a Figure into your discussion and analysis of the scores. The table you created (see example) to display the 10 statements and the hospital, state, and national scores will be in an appendix to your report. Be sure to check APA guidelines for using an appendix in a report, how to label figures and tables.

Table example: 

Patient satisfaction survey statements	Tampa General Hospital rating	Florida rating	National rating
Patients who reports their nurses always communicated well	81%	81%	77%

Clustered Bar graph example from data in table example:

length: A minimum of 5 pages, not including the title page, reference page, and the appendix

ppt presentetion, with 20 slides about skin, hear, and nail

 using the paradigms of health, discuss the link between health and behavior.  Describes how this relationship affects social determinants of health.  500 words APA format at least 2 references of less than 5 years old

TO PREPARE

• Refer to the “Population-Focused Nurse Practitioner Competencies” in the Learning Resources, and consider the quality measures or indicators advanced practice nurses must possess in your specialty.
• Refer to your “Clinical Skills Self-Assessment Form” you submitted in Week 1 and consider your strengths and opportunities for improvement.
• Refer to your Patient Log in Meditrek; consider the patient activities you have experienced in your practicum experience and reflect on your observations and experiences.

In 450–500 words, address the following:

Learning From Experiences

• Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.
• Reflect on the 3 most challenging patients you encountered during the practicum experience. What was most challenging about each? 
• What did you learn from this experience? 
• What resources were available?
• What evidence-based practice did you use for the patients?
• What would you do differently? 
• How are you managing patient flow and volume?  How can you apply your growing skillset to be a social change agent within your community?

Communicating and Feedback

• Reflect on how you might improve your skills and knowledge and how to communicate those efforts to your Preceptor.
• Answer these questions: How am I doing? What is missing? 
• Reflect on the formal and informal feedback you received from your Preceptor.