Critical Appraisal of Early Remdesivir

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Critical Appraisal of Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients

Critical Appraisal of Early Remdesivir

The article intended to determine the effectiveness of remdesivir use in preventing hospitalization among symptomatic, non-hospitalized patients with Covid-19 who are at an increased risk for disease progression. The authors hypothesized that initiating a short course remdesivir treatment early among outpatients would minimize hospitalization and mortality. Results indicate that the treatment modality helped reduce Covid-related hospitalization or mortality, medically attended visits, and adverse events, confirming the hypothesis.4 Conclusively, the drug can be used to treat Covid-19 outpatients to reduce the risk of hospitalization or death, medically attended visits, and adverse events, offering healthcare providers an additional and effective treatment regimen.  (Critical Appraisal of Early Remdesivir)

Best Available Evidence

Evidence-based practice entails providers using the best available evidence to inform practice and clinical decision-making. Studies are of varying levels of evidence and evidence quality, and providers are expected to select the best available evidence to make the most appropriate decisions.2 This article adopts a randomized, double-blind, placebo-controlled trial, which offers the highest level of evidence available regarding remdesivir effectiveness in treating Covid-19 and preventing hospitalization and mortality among outpatients. Randomized double-blind placebo controls (RDBPC) are perceived gold standard of epidemiological scientific research.6 The design provides the strongest possible evidence showing causation. Therefore, providers can adopt the results of this article to inform practice and make clinical decisions when treating Covid-19 outpatients.    (Critical Appraisal of Early Remdesivir)

Clinical Guidelines

Clinical guidelines include recommendations to help optimize care informed by systematic evidence review and an evaluation of alternative care options’ benefits and harms.1 Remdesivir is an alternative treatment regimen in Covid-19 patients and this article offer recommendation for its use supported by gold-standard research methodology and evidence. This study recommends remdesivir use among outpatients and those with moderate-to-severe Covid-19, offering concrete evidence of its effectiveness in reducing hospitalization, mortality, medically intended visits, adverse events, quick recovery, and reduced risk of disease progression. The study also aligns with other trials, including the SIMPLE trial, which indicated that remdesivir helped achieve better clinical status among individuals with moderate Covid-19 and the ACTT-1, which showed remdesivir effectiveness in accelerating recovery and reducing disease progression. (Critical Appraisal of Early Remdesivir)

Clinical Judgment

Healthcare providers adopt evidence-based insights, their experience, and personally-developed knowledge to make clinical judgements. Clinical judgement includes skills and knowledge accumulated over time from experience and evidence-based research knowledge, which contribute to providers’ ability to analyze and synthesize patient data, objective and subjective and recommend or offer evidence-based nursing interventions to enhance patient outcomes.5 This study provides evidence to guide clinical judgement and decision-making when selecting a treatment regimen to treat moderate Covid-19 or Covid-19 in outpatients. The data offers another treatment option for providers treating Covid-19 with supported insights to inform clinical decisions. (Critical Appraisal of Early Remdesivir)

Patient Preferences

Patient preferences inform clinical decisions, implying the selection of clinical interventions depends on the patient’s deliberations, including anticipations regarding treatment or health outcomes.3 Patients prefer a treatment regimen with promising or proven positive health outcomes. These preferences result from clinician advice and patients’ cognition, experience, and reflection.3 The beneficial clinical benefits of remdesivir indicated in this study are likely to influence patient preferences. The data obtained adds another option for treating vulnerable patient populations to prevent Covid-19 progress.4 Patients have a better option in remdesivir, and they can anticipate improved health outcomes. (Critical Appraisal of Early Remdesivir)

References

  1. Bhaumik S. Use of evidence for clinical practice guideline development. Trop Parasitol. 2017;7(2):65-71. doi:10.4103/tp.TP_6_17
  2. Flecha OD, Douglas de Oliveira DW, Marques LS, Gonçalves PF. A commentary on randomized clinical trials: How to produce them with a good level of evidence. Perspect Clin Res. 2016;7(2):75-80. doi:10.4103/2229-3485.179432
  3. Gärtner FR, Portielje JE, Langendam M, et al. Role of patient preferences in clinical practice guidelines: a multiple methods study using guidelines from oncology as a case. BMJ Open. 2019;9(12):e032483. Published 2019 Dec 5. doi:10.1136/bmjopen-2019-032483
  4. Gottlieb RL, Vaca CE, Paredes R, et al. Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients. N Engl J Med. 2022;386(4):305-315. doi:10.1056/NEJMoa2116846
  5. Kinyon K, D’Alton S, Poston K, Navarrete S. Improving Physical Assessment and Clinical Judgment Skills without Increasing Content in a Prelicensure Nursing Health Assessment Course. Nurs Rep. 2021;11(3):600-607. Published 2021 Aug 2. doi:10.3390/nursrep11030057
  6. Misra S. Randomized double blind placebo control studies, the “Gold Standard” in intervention based studies. Indian J Sex Transm Dis AIDS. 2012;33(2):131-134. doi:10.4103/0253-7184.102130 https://pubmed.ncbi.nlm.nih.gov/23188942/
 
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French and Raven’s Five Sources of Power

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French and Raven’s Five Sources of Power

French and Raven's Five Sources of Power

French and Raven identified five power dynamics or power bases, including referent, expert, legitimate, reward, and coercive powers. Legitimate power originates from electoral mandates, cultural norms, organizational structure, and social hierarchies (James et al., 2022). This power can be unstable or unpredictable. When people lose their positions, their legitimate power can instantly disappear because individuals are attached to or influenced by the position rather than the position. Most people are promised rewards like salary increases, promotions, benefits, or education and training opportunities if they do well and help the company fulfil its goals and objectives. These situations create reward power held by people with the power to offer or influence these rewards, for instance, managers, supervisors, and CEOs in a company (Kovach, 2020). However, reward power is not as strong as it seems because individuals like managers and supervisors depend on those higher in the hierarchies to offer promotions or salary increases.

Coercive power is problematic because, in most instances, the followers are manipulated or threatened when they do not act or behave as instructed. It often occurs in the workplace when people in leadership positions threaten employees that they will be demoted, transferred, denied privileges, or fired if they fail to follow instructions (Kovach, 2020). An individual’s position can allow them to have this power, although they might like a justification to do so. Experts have in-depth knowledge and skills in particular fields, giving them power over others. People rely on experts to help understand circumstances, suggest solutions and judgments, and guide the implementation of these solutions. Expert power earns people the trust and respect of others (Kovach, 2020). Individuals tend to like and respect celebrities and act, behave, and dress like the celebrities they adore, giving celebrities referent power. Referent power is also present in the workplace, and those holding it make everyone feel good. Individuals with referent power have done nothing unique to earn, which can be overwhelming or a big responsibility (Kovach, 2020). It can also be abused, especially when a likeable individual lacks integrity, morals, and honesty, and be used to manipulate or hurt others for personal benefits. Referent power does not necessarily offer longevity and respect and cannot be relied on.

In the case study, Betty, the software expert, has power because she is more knowledgeable about complicated electronic medical records software. Betty has the knowledge to offer solutions and help other people, especially the new employees, understand the software, which would benefit the company. Betty has more seniority and experience in the company than Joe, but she prefers to do something other than helping people, which denied her the managerial position. Joe also understands that no one in the company has more knowledge and experience regarding the software, and he has minimal influence on what he can do to get Betty to help the new employees. Betty thinks no one can replace her, and her longevity in the company depends on consistent performance at the highest level. As long as she remains excellent, Joe has no power over her and cannot upset her plans.

References

James, S., Mwembezi, G., & Chusi, T. (2022). The effect of five French and raven’s managerial power bases on employee job satisfaction: a review and implications for managers in Tanzania. EPRA International Journal of Research and Development (IJRD), 7(5), 176-183. https://eprajournals.com/IJSR/article/6973/

Kovach, M. (2020, July). Leader Influence: A Resear Leader Influence: A Research Review of Fview of French & Raench & Raven’s (1959) s (1959) Power Dynamics. The Journal of values_Based leadership, 13. https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1312&context=jvbl

 

 
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Assessing and Diagnosing Patients with Anorexia Nervosa

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NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation

Assessing and Diagnosing Patients with Anorexia Nervosa

Assessing and Diagnosing Patients with Anorexia Nervosa 

Name: S.H.

DOB: November 29th, 2011

Minor: Yes

Accompanied by: Mother

Age: 11 Years

Gender: Female 

(Assessing and Diagnosing Patients with Anorexia Nervosa)

SUBJECTIVE:

CC: “S.H. has is experiencing difficulties in school, has problems paying attention, forgets easily, and cannot stay still.” (Assessing and Diagnosing Patients with Anorexia Nervosa)

HPI: The patient is an 11-year-old female presenting at the clinic with her mother who claims she is experiencing difficulties in school, problems paying attention, and remembering things. The mother states S.H. cannot stay as she jumps from one activity to another. She cannot remembers her assignments very well, and needs an assignment list, which she also fails to keep track of and losing it, necessitating the teacher to also giver her mother another list. She cannot stay still while reading, unless she really likes it, then she can stay still for about five minutes. S.H. has difficulties remembering what she read or what her teacher read her, and she loses her things easily. She loses her temper when her teachers ask her something she did not hear. S.H. states that she daydreams about different things, including good and bad times. Mother states that the patient’s concentration is impaired, but she loves art, although she jumps from one painting to another at the museum. Mother reports that S.H. loves video games, and she can stay on them for long periods. Mother reports risky behavior when S.H. was young and lack of perception of danger. (Assessing and Diagnosing Patients with Anorexia Nervosa)

Social History: S.H. lives with her parents in Washington, D.C. She has a younger borther. m

Substance Current Use and History: Denied any substance use history.

Legal History: None reported. 

Family Psychiatric/Substance Use History: Denied family mental health or substance use issues.

Past Psychiatric History:

Hospitalization: Denied previous hospitalization

Medication trials: No previous medical trails

Psychotherapy or Previous Psychiatric Diagnosis: No previous psychiatric diagnosis

Medical History: Denies medical history.

  • Current Medications:None reported.
  • Allergies:
  • Reproductive Hx:

Development Milestones:

Development milestones met on time

Health Promotion:

Vaccination up to date

Sleeps 9-10hrs/night

Has proper nutrition per PCP, although meals are difficult because she cannot stay still to eat.

ROS:   

General: Denies weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

Skin: No rash or itching.

Cardiovascular: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

Respiratory: Denies wheezes, shortness of breath, consistent coughs, and breathing difficulties while resting.

Gastrointestinal: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

Genitourinary: Denies burning on urination, urgency, hesitancy, odor, odd color

Neurological: Denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. Reports difficulties concentrating and paying attention. Reports memory difficulties.

Musculoskeletal: Denies muscle, back pain, joint pain, or stiffness.

Hematologic: Denies anemia, bleeding, or bruising.

Lymphatics: Denies enlarged nodes. No history of splenectomy.

Endocrinologic: Sweating, No reports of cold or heat intolerance. No polyuria or polydipsia.

OBJECTIVE:

Vital signs: Unstable

Temp: 98.8F

B.P.: 100/55

P: 60

R.R.: 15

O2: Room air

Pain: 4/10

Ht: 5’5 feet

Wt: 95 lbs

BMI: 15.8

BMI Range: Underweight

LABS:

Lab findings WNL

Tox screen: Negative

Alcohol: Negative

Physical Exam:

General appearance: The patient appears lean, malnourished, and dehydrated, with the BMI indicating she is underweight. The patient converses appropriately and regularly with the interviewer, but appeared irritated with some questions. The patient has impaired concentration and did not answer some questions appropriately.

HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.

Neck: Supple. No JVD. Trachea midline. No pain, swelling, or palpable nodules.

Heart/Peripheral Vascular: Regular rate and rhythm noted. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.

Cardiovascular: The patient’s heartbeat and rhythm are slow. The patient’s heart rate is slow, and capillaries refill in more than two seconds. The patient shows signs of hypotension.

Musculoskeletal: Normal range of motion. Low muscle mass for age. No signs of swelling or joint deformities. Patient indicates muscle wasting. Muscle and back pain are rated 4/10 on the pain scale.

Respiratory: No wheezes, and respirations are easy and regular.

Neurological: Balance is stable, gait is normal, posture is erect, the tone is good, and speech is clear. Patient has frequent headaches. Patient shows signs of mineral and vitamin deficiencies.

Psychiatric: The patient has a depressed mood, irritability, insomnia, impaired concentration.

Neuropsychological testing: Social-emotional functioning is impaired.

Behavior/motor activity: Patient behavior was appropriate and constant throughout the assessment

Gait/station: Stable.

Mood: Depressed mood.

Affect: The patient’s mood was depressed.

Thought process/associations: comparatively linear and goal-directed.

Thought content: Thought content was appropriate.

Attitude: patient was uncooperative at times

Orientation: Oriented to self, place, situation, and general timeframe.

Attention/concentration: Impaired

Insight: Good

Judgment: Good.

Remote memory: considered good

Short-term memory: considered good

Intellectual /cognitive function: considered good

Language: clear speech, with a tone, assessed to be normal

Fund of knowledge: Good.

Suicidal ideation: The patient reports suicidal ideation, but negative for active plans.

Homicide ideation: Negative.

ASSESSMENT:

Mental Status Examination:

The patient is a 25-year old female presenting with gradual weight loss, loss of appetite, feeling fatigued, and depressed mood. Patient reports easy irritability. During psychiatric interview, the patient was uncooperative at times and her concentration was impaired, making it difficult to establish a rapport. She expressed a low mood, persistent probing, decreased attention and concentration, apathy, and easy fatigability. The patient appeared bleak and expressed pessimistic ideas about her life, marriage, and future, fearing her husband would leave her. She reports suicidal ideation, but negative of active plans. She denies homicidal ideation. (Assessing and Diagnosing Patients with Anorexia Nervosa)

Differential Diagnosis:

  1. 0 Anorexia Nervosa:

Anorexia nervosa is characterized by a restriction of nutrient intake comparable to requirements, resulting in substantially low body weight. Patients suffering from this eating disorder will experience a fear of weight gain, as well as a distorted perception of themselves and difficulty comprehending the gravity of their condition. Menstrual irregularities, cold intolerance, bowel problems, extremity edema, exhaustion, and irritability are among the symptoms reported by patients. Patients describe food-related restrictive behaviors such as calorie restriction or portion control, and purging methods, including self-induced vomiting or the using diuretics or laxatives (Moore & Bokor, 2022). Many people exercise obsessively for long periods. Numerous complications result from anorexia nervosa patients’ extended fasting and purgation. DMS-5 criteria for Anorexia Nervosa requires a patient to indicate energy intake restriction relative to requirements, causing significant weight loss relative to age, sex, developmental trajectory, and physical health, less than minimally expected. To establish the diagnosis, the patient should report excessive fear to gaining weight or fattening or persistent behavior interfering with weight gain (Moore & Bokor, 2022). N.D. indicates nutritional restriction, weight gain fear and anxiety, persistent behaviors and activities to prevent weight gain, including exercising for extended period of time and using medication to help with weight loss. For this reason, the diagnosis was established. (Assessing and Diagnosing Patients with Anorexia Nervosa)

  1. 9 Major Depressive Disorder

Depression can co-occur with eating disorders, such as anorexia nervosa. Depression is a mood disorder leading to constant sorrow and disinterest. Between 50-70% of individuals experiencing eating disorders show signs of depression. The close relationship between these disorders makes it vital to consider when diagnosing and treating the eating disorder. All depressive disorders share the symptoms of melancholy, emptiness, or irritation, along with physical and mental changes that significantly impair the patient’s capacity to operate (Chand et al., 2021). Patients who are depressed have a noticeably lower interest in or enthusiasm for nearly all activities for the majority of the day, practically every day. According to the DMS-5 criteria, a diagnosis must include 5 of the following symptoms: trouble sleeping, decreased interest or enjoyment, feelings of guilt and worthlessness, fatigue and energy swings, difficulty focusing or paying attention, changes in appetite and weight, psychomotor problems, suicidal thoughts, and depressed mood. Because the patient does not exhibit 5 of the 9 symptoms mentioned above, this diagnosis cannot be made. (Assessing and Diagnosing Patients with Anorexia Nervosa)

  1. 10 Social Anxiety Disorder

Individuals with eating disorders such as anorexia nervosa commonly experience anxiety in social situations and are often concerned about how people perceive their body. Anorexia nervosa patients develop fear and anxiety eating in front of other people, including their spouses and children. Therefore, during the assessment, patients tend to indicate symptoms of social anxiety. Also, anorexia nervosa can indicate another underlying mental health disorder, such as social anxiety (Rose & Tadi, 2021). Per the DSM-5 criteria, a person must exhibit pronounced fear or anxiety in one or more social situations where they may come under others’ potential scrutiny. The individual worries that they will behave in a way that might be perceived adversely. Most of the time, social situations cause anxiety or fear, which is excessive compared to the threat they truly present. As a result, people either avoid them entirely or tolerate them with worry or fear. Usually lasting at least six months, the avoidance, fear, or worry significantly impairs or distresses one of the fundamental areas of functioning. The symptoms of another mental disorder or the consequences of a substance should not be linked to this fear. If a different medical issue is present, the anxiety, avoidance, or fear is also excessive or unconnected (Rose & Tadi, 2021). This diagnosis was refuted because, although the patient admits to anxiety and fear of weight gain, she does not indicate intense fear and anxiety relative to requirements. (Assessing and Diagnosing Patients with Anorexia Nervosa)

  PLAN:

The patient would benefit from a combination of nutritional rehabilitation and psychotherapy.

Safety Risk/Plan:

The patient indicates minimal intent to cause self-harm and is negative of active plans. The patient shows no intent to harm others. Patient has minimal suicidal and negative homicidal ideation. Initial admission is required to stabilize vitals.

Pharmacological Interventions:

Medications are not used initially. However, the patient can be prescribed olanzapine as first-line medication to help with weight gain (Moore & Bokor, 2022). Combination therapy with selective reuptake inhibitors (SSRIs) will help reduce symptoms such as fear and anxiety and the increased urge for nutritional restriction.

Psychotherapy:

The patient will undergo intensive therapy, 2-3 hours every weekday and partial hospitalization for about 6 hours a day to help stabilize vitals in the first one week. Family-based psychotherapy will help investigate and understand the underlying nature of the home environment and restructure it (Moore & Bokor, 2022). Cognitive behavioral therapy will help address behavioral changes to control eating and body perception. Self-control is required for successful behavioral changes, making CBT a fundamental intervention. (Assessing and Diagnosing Patients with Anorexia Nervosa)

Education:

  1. Educate the patient about side effects, potential complications, and need for medication adherence.
  2. Educate patient on the need to follow-up with therapy to manage complications and address body image.
  3. Monitor vital signs.
  4. Monitor withdrawal symptoms to determine risk of relapse.
  5. Educate the patient regarding making healthy lifestyle choices.
  6. Encourage the patient to work with the healthcare team and seek help anytime.
  7. Advise the patient to join a support group or group therapy to help enhance social skills.

Consultation/follow-up: Follow-up is in one week for further assessment.

Referral: The patient needs to see a gynecologist to address menstruation irregularities.

Reflection

The primary challenge in addressing anorexia nervosa is that patients do not realize the severity of their situations or the risk associated with nutritional restriction. Patients also experience fear and anxiety of weight gain, which increases non-adherence behavior and the probability of relapse mid-course treatment. Additionally, ordinary people, including patients and their families, do not consider anorexia nervosa a mental health disorder that significantly impacts an individual’s mental health. Treating this disorder requires commitment from the patient and a reliable support system because the risk of relapse is high. Ethical treatment of eating disorders is complicated because most patients lack insight into the severity of their situation and the need for treatment. Treating eating disorders has distinct ethical principles, including respect for persons, autonomy, veracity, nonmaleficence, privacy, duty to protect, and beneficence. However, these principles are weighed and applied differently depending on the situation and severity of anorexia nervosa. For instance, in severe anorexia, the need to protect the patient from harm might override the need to promote patient autonomy. Treatment refusal is an issue in treating eating disorders that conflicts with the principle of autonomy. This case offers insights into the categorization of eating disorders as mental health illnesses and the challenges associated with treating these disorders. Given another chance with the patient, I would inquire about their attitudes towards their eating habits and ask for the husband to be present to explore his attitude towards her wife’s lean body and eating habits and how the home environment contributes to the situation.   (Assessing and Diagnosing Patients with Anorexia Nervosa)

References

Chand, S. P., Arif, H., & Kutlenios, R. M. (2021). Depression (Nursing). In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568733/

Moore C.A., & Bokor, B.R. (2022). Anorexia Nervosa. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459148/

Rose, G. M., & Tadi, P. (2021). Social anxiety disorder. In StatPearls [Internet]. StatPearls Publishing.https://www.ncbi.nlm.nih.gov/books/NBK555890/

 
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Medication Administration Errors in Nursing

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Thread Title: “Medication Administration Errors in Nursing”

Medication Administration Errors in Nursing

1.Thread

Thread Title: “Medication Administration Errors in Nursing”

Nurses strive for perfection, but the work environment is pressuring, and often nurses make mistakes that can jeopardize a patient’s safety and health outcomes. Most mistakes involving nurses at work are unintentional; nonetheless, they can bear legal upshots if they lead to adverse events or a patient decides to push ahead with a lawsuit. Patient safety is an indicator of the quality of health and other significant aspects of protocol adherence (Mahrous, 2018). Nurses’ primary role is to ensure patients receive the needed care, promoting their health and well-being. Nurses promote quality of care and patient safety by supporting patients in their recovery journey and after discharge. Throughout my career, I have been involved in several mistakes, some life-changing, particularly in the first years of practice. I will discuss a nursing mistake I was involved in during my clinical placement.

2. Call Dibs

“Alarm Fatigue Is Real”

3. Read Essay

“Alarm Fatigue Is Real”

4. Response to Essay

Plot
The essay is about alarm fatigue and its impact on care. The author discusses alarm fatigue in general, pointing out contributing factors, how it occurs, how nurses deal with alarms that constantly go off, and the potential impact on patient outcomes. The author then discusses a personal experience with alarm fatigue and how it affected the patient and clinical outcomes. Finally, the author provides lessons from this experience and recommends an improvement on the system because the current one is not as effective as intended, contributing to nursing burnout. The author recommends a system that would stop going off when the patient has achieved desired or within-normal vital signs and also recommends a better way to connect the patient to the monitor because the sticker approach leads to inaccurate readings and constant alarms when it falls off, especially when a patient is constantly moving, typical in pediatric care. (Medication Administration Errors in Nursing)
Personal Feelings
Alarm fatigue is a patient safety issue because, in most cases, nurses switch off alarms that go off constantly and sometimes fail to notice when the patient needs help. Also, the sticker falling off the patient leads to incorrect readings impacting clinical decisions. The author’s experience shows how challenging the healthcare environment is and how environmental factors affect nursing practice, including providing quality and safe care. The high exposure to medical alarms can be tiring and frustrating, leading to harm desensitization from missed alarms, meaning nurses might respond late, which can be detrimental to the patient. (Medication Administration Errors in Nursing)
Purpose of Sharing
The author’s primary purpose is to discuss how alarm fatigue impacts nursing practice and patient outcomes. This experience seems significant to the author and a fundamental learning experience that was life-changing and majorly impacting future practice. In such a situation, the outcome can be a patient’s death, which new nurses can find difficulty dealing with. Therefore, sharing this patient encounter elaborates more on nursing responsibility and how factors can impact nurses’ effectiveness in deliberating the responsibility.
Personal Experience that Connects with Author’s
I can relate to this experience because medical device alarms are also common at the workplace, and the frequency of the alarms determines nurses’ development of alarm fatigue. Frequent alarms are tiring and frustrating because more than half of the alarms are false, and you end up running up and down or leaving a current task to respond to a false one. It is a sensory overload that leads to desensitization because, in some instances, I have failed to respond immediately, especially when the alarm seems false. I understand this can be dangerous, but I can wait to see if another nurse is calling before moving in to help. Other nurses calling for assistance seems a more effective way of responding to an emergency because it is never a false alarm.
Something from my Learning that may Interest the Author
Interestingly, alarm fatigue is well-documented and is recognized by the Joint Commission National Patient Safety Goal as a patient safety issue. Patient deaths have been associated with alarm fatigue linked to missed alarms and delayed responses. However, there are strategies I can recommend to adopt at the healthcare organization to help address the problem, including alarm parameter customization and using adopting electrocardiogram electrode changes to minimize false alarms. (Medication Administration Errors in Nursing)
Theme to Explore
Alarm fatigue has been widely researched, but interventions to address the problem and promote patient safety need more research. I would be interested in exploring how AI and other contemporary technologies can help address the problem and replace the stickers, which often fall off, leading to false alarms.
Keywords
1.Alarm fatigue*
2.Impact of alarm fatigue on patient safety*
3.Alarm fatigue best practices
4.Nurses’ perspectives on alarm fatigue*
5.Theoretical underpinnings of alarm fatigue
6.Hospital policy and procedure to decrease alarm fatigue

5. Do Research

Article selected:
Claudio, D., Deb, S., & Diegel, E. (2021). A Framework to Assess Alarm Fatigue Indicators in Critical Care Staff. Critical care explorations, 3(6), e0464. https://doi.org/10.1097/CCE.0000000000000464

6. Share the Article

Authors: Claudio et al.
Publication year: 2021
Article full title: A Framework to Assess Alarm Fatigue Indicators in Critical Care Staff
Functional Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205220/
Database: PubMed Central
Justification: I selected the article because it goes overboard to assess work-related and personality factors influencing providers’ experience with alarm fatigue. The article posits that individualities can impact behavior towards alarm fatigue and recommends alternative strategies like work rotation, shift reduction, and breaks to reduce alarm fatigue. (Medication Administration Errors in Nursing)

 
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Comprehensive Psychiatric Evaluation of ADHD

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Comprehensive Psychiatric Evaluation of ADHD

Comprehensive Psychiatric Evaluation of ADHD

Name: S.H.

DOB: November 29th, 2011

Minor: Yes

Age: 11 Years

Gender: Female 

Accompanied by: Mother

 

SUBJECTIVE:

CC: “S.H. is experiencing difficulties in school, has problems paying attention, forgets easily, and cannot stay still.”

HPI: The patient is an 11-year-old female presenting at the clinic with her mother, who claims she is experiencing difficulties in school, problems paying attention, and remembering things. The mother states S.H. cannot stay still as she jumps from one activity to another. She cannot remember her assignments very well and needs an assignment list, which she also fails to keep track of and loses, necessitating the teacher to give her mother another list. She cannot stay still while reading unless she really likes it; then, she can stay still for about five minutes. S.H. has difficulties remembering what she read or what her teacher read her, and she loses her things easily. She loses her temper when her teachers ask her something she did not hear. S.H. states that she daydreams about different things, including good and bad times. She is frustrated when she makes a mistake while doing her assignments because she is trying to do it right. The mother states that the patient’s concentration is impaired but loves art, although she jumps from one painting to another at the museum. The mother reports that S.H. loves video games, and she can stay on them for long periods. The mother reported risky behavior when S.H. was young and a lack of perception of danger.   (Comprehensive Psychiatric Evaluation of ADHD)

Social History: S.H. lives with her parents in Washington, D.C. She has a younger brother.

Substance Current Use and History: Denied any substance use history.

Legal History: None reported. 

Family Psychiatric/Substance Use History: Denied family mental health or substance use issues.

Past Psychiatric History:

Hospitalization: Denied previous hospitalization

Medication trials: No previous medical trails

Psychotherapy or Previous Psychiatric Diagnosis: No previous psychiatric diagnosis

Medical History: Denies medical history.

  • Current Medications:None reported.
  • Allergies:
  • Reproductive Hx:

Development Milestones:

Development milestones met on time

Health Promotion:

Vaccination up to date

Sleeps 9-10hrs/night

Has proper nutrition per PCP, although meals are difficult because she cannot stay still to eat.

ROS:   

General: Denies weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

Skin: No rash or itching.

Cardiovascular: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

Respiratory: Denies wheezes, shortness of breath, consistent coughs, and breathing difficulties while resting.

Gastrointestinal: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

Genitourinary: Denies burning on urination, urgency, hesitancy, odor, odd color

Neurological: Denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. Reports difficulties concentrating and paying attention. Reports memory difficulties.

Musculoskeletal: Denies muscle, back pain, joint pain, or stiffness.

Hematologic: Denies anemia, bleeding, or bruising.

Lymphatics: Denies enlarged nodes. No history of splenectomy.

Endocrinologic: Sweating, No reports of cold or heat intolerance. No polyuria or polydipsia.

 

OBJECTIVE:

Vital signs: Stable

Temp: 97.4F

B.P.: 100/80

P: 58

R.R.: 14

O2: Room air

Pain: 0/10

Ht: 4’5 feet

Wt: 65 lbs

BMI: 16.3

BMI Range: Healthy weight

Physical Exam:

General appearance: The patient looks well-fed and in good health. Her conversation and engagement with interviewer is irregular, requiring intervention from the mother to help answer the questions or ask the patient to answer. She drifts from the conversation quickly, not paying full attention to the questions asked. Her attention and concentration are impaired, making inquiry challenging.

HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.

Neck: Supple. No JVD. Trachea midline. No pain, swelling or palpable nodules.

Heart/Peripheral Vascular: Regular rate and rhythm noted. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.

Cardiovascular: Although the patient’s heartbeat and rhythm are regular, there are murmurs and other sounds coming from her chest. The patient’s heart rate is constant and capillaries refill in two seconds.

Musculoskeletal: Normal range of motion. Regular muscle mass for age. No signs of swelling or joint deformities.

Respiratory: No wheezes and respirations are easy and regular.

Neurological: Balance is stable, gait is normal, posture is erect, tone is good, but speech is irregular. She has memory problems and cannot remember the questions asked by the interviewer. Her concentration and attention are impaired.

Psychiatric: The patient fast switches from one thing to another and cannot stick to the discussion and the interview, indicating impaired attention and concentration. Patient is easily distracted, yet occasionally appears to pay attention to the interviewer.

Neuropsychological testing: Patient has difficulties executing functions like reading, doing assignments and homework, and eating, where she is required to prioritize, plan, inhibit behavior, and attend to processing speed. (Comprehensive Psychiatric Evaluation of ADHD)

 

ASSESSMENT:

Mental Status Examination:

The patient is an 11-year-old female presenting with difficulties in school and attention and memory problems. The patient reports easy irritability and being short-tempered when teachers ask about something she did not hear. During the psychiatric interview, the patient was sometimes uncooperative, and her concentration was impaired, making it difficult to conduct the inquiry, necessitating the mother’s intervention to help answer the questions. However, the patient was polite, making it easy to establish a rapport. She indicated decreased attention and concentration. The patient is forgetful and shows short- and long-term memory issues. Additionally, she is fidgety and cannot stay still throughout an activity.   (Comprehensive Psychiatric Evaluation of ADHD)

Differential Diagnosis:

  1. 9. Attention-Deficit hyperactivity disorder (Confirmed):

Millions of children are affected with attention-deficit/hyperactivity disorder (ADHD), a long-term mental health problem that often worsens as people get older. Hyperactivity, impulsive conduct, and problems maintaining attention are all persistent symptoms of ADHD. Low self-esteem, problematic relationships, and poor involvement are common problems for people with ADHD, especially children (Magnus et al., 2017). The patient indicated difficulties at school, memory issues, and impaired attention and concentration. The mother noted inattention symptoms since the patient was in kindergarten. The DSM-5 diagnostic criteria for children with ADHD include a pervasive inattention and/or hyperactivity-impulsivity pattern interfering with functioning or development as indicated by inattention, with six or more symptoms persisting for a minimum of six weeks to a point it is inconsistent with developmental level and negatively affects directly social and academic activities, including often failing to offer close attention to details and committing careless mistakes in assignments and homework or during other activities, difficulty maintaining attention in tasks or play, seeming not listening when spoken to directly, failing to follow through instructions or finishing schoolwork, problems with task an activities organization, avoiding or being reluctant to engage in issues calling for sustained mental effort, losing things needed for particular tasks, being easily distracted by external stimuli, and indicating forgetfulness in daily activities (Abuse & Administration, 2018). Regarding hyperactivity and impulsivity, the DSM-5 criteria require a patient to indicate at least six of the following symptoms: being fidgety or tapping hands or feet or moving in the seat, failing to remain seated when expected, running or climbing inappropriately, inability to remain quiet during play or leisure activities, being on the go and failing to stay still, talking excessively, answering before a question is asked, trouble engaging in turn-taking, and often interrupting or intruding others. The patient displays at least six symptoms of inattention and six of hyperactivity and impulsivity, confirming ADHD diagnosis.  (Comprehensive Psychiatric Evaluation of ADHD)

  1. 9. Generalized Anxiety Disorder:

Generalized anxiety disorder is marked by excessive, exaggerated anxiety and worries about ordinary events without a clear reason (Munir et al., 2021). About 3.1 percent of the population, or more than 8.8 million children, are affected. While it can begin at any age and progress gradually, the risk is most between the ages of five and middle age. Biological variables, family history, life events, and other stressors contribute to GAD, despite the exact cause being unknown (Toussaint et al., 2020). Excessive, persistent worry and tension, unrealistic views of problems, restlessness or a sense of being “edgy,” difficulty focusing, easily becoming exhausted, increased crankiness or irritability, difficulty sleeping, and muscle tension are all symptoms of general anxiety disorder, according to the DMS-5 criteria. People with GAD frequently anticipate disaster and are overly concerned with everyday events such as work. GAD is diagnosed when a person cannot control their worrying, which was refuted in this case because the patient did not exhibit persistent worry and tension.

  1. 23. Adjustment Disorder:

Those who have trouble adjusting after a stressful event at a degree disproportionate to the severity or intensity of the stressor are said to have adjustment disorder (AD), defined as a maladaptive emotional and/or behavioral reaction to a recognized psychosocial stressor. Stress responses that are inconsistent with socially or culturally expected responses to the stressor and/or that significantly affect every day functioning are characteristics of AD symptoms (O’Donnell et al., 2019). The criteria for adjustment disorder do not include any prerequisites for what might be regarded as a stressor, in contrast to the criteria for posttraumatic stress disorder (PTSD) or acute stress disorder (ASD), which clearly define what constitutes a traumatic experience. Per the DSM-5 criteria, a diagnosis is established when an individual indicates emotional or behavioral symptoms development to respond to stressor(s) occurring within three months of the stressor(s) onset. The second criterion requires the symptoms to be clinically significant, as indicated by considerable stress that is unproportional to the stressor(s) severity or intensity, considering external context and cultural aspects that would influence symptom severity and presentation and the patient to indicate severe impairment ins social, occupation, and other fundamental functioning areas (Abuse & Administration, 2017). The third criterion requires stress-related disturbances not to meet criteria for another mental condition and are minimally affected by a preexisting mental condition. The symptoms should also not represent typical bereavement.    (Comprehensive Psychiatric Evaluation of ADHD)

 

PLAN:

The patient would benefit from a combination of pharmacological interventions and psychotherapy.

Pharmacological Interventions:

To address ADHD symptoms, start Buspar 10 mg 1 tab PO BID. Also, prescribe venlafaxine 18.75-75 mg/day; may increase to 150 mg/day after 4 weeks and Bupropion Initial: 150 mg/day PO. Give imipramine 75 PO qDay initially; may increase to 150 mg/day gradually and metadate CD: Initial, 20 mg PO qAM before breakfast. Atomoxetine 40 mg PO once daily initially; increase after ≥3 days to 80 mg PO once daily or divided q12hr can also help manage ADHD symptoms.

Psychotherapy

Behavioral psychotherapy is needed to enhance executive function and improve ADHD symptoms. ADHD symptoms can be reduced with the help of psychosocial interventions, such as short-term psychodynamic psychotherapy, applied relaxation interpersonal psychotherapy, and social skills training. Cognitive-behavioral therapy will help reduce restlessness sensations that arise when performing tasks, improve focus and time management, and improve organization (Lopez et al., 2018).

Patient education

  • Talk to the patient and parent about risks and benefits of medication, including non-treatment, probable side effects.
  • Discuss with patient and parent when to stop medication, how to recognize and when to report adverse events.
  • Talk to the patient and parent about the dangers of combining prescription pharmaceuticals with other substances.
  • Educate patient and parent to develop structured daily routines, daily schedule, and minimize changes.
  • Engage patient in skills training.
  • Encourage patient to make time for exercise every day.
  • Teach patient and parent to create a system for prioritizing the day and create deadlines for activities.

Follow-up: Patient should follow-up after one week.

Reflection

ADHD is common among children, affecting their social and cognitive functioning. Dealing with ADHD patients, particularly children, can be challenging because it is difficult to make an inquiry or sustain a conversation when the patient is easily distracted by extraneous stimuli, cannot stay still, has difficulty paying attention, and shifts from one thing to another, necessitating parental intervention. Patients are defiant and can be aggressive, refusing to follow instructions and having emotional outbursts. In this case, the patient was polite, which helped establish a rapport and framework for the interview. The mother was of great help in answering the questions to help understand the patient’s condition and how it affects her life. Hyperactivity and inattention symptoms present providers with ethical conflicts between justice and beneficence or non-maleficence. Therapeutic use for ADHD in minors presents ethical issues, including safety, risk/benefit ratio, informed consent, nonmedical use, and labeling problems. Given another chance with the patient, I would inquire more about the family history of ADHD and coping mechanisms or interventions adopted at home and school to help address challenges presented in ADHD patients.   (Comprehensive Psychiatric Evaluation of ADHD)


References

Abuse, S., & Administration, M. H. S. (2017). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health.

Abuse, S., & Administration, M. H. S. (2018). DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet].

Lopez, P. L., Torrente, F. M., Ciapponi, A., Lischinsky, A. G., Cetkovich-Bakmas, M., Rojas, J. I., Romano, M., & Manes, F. F. (2018). Cognitive-behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane database of systematic reviews, 3(3), CD010840. https://doi.org/10.1002/14651858.CD010840.pub2

Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2017). Attention deficit hyperactivity disorder (ADHD).

Munir, S., Takov, V., & Coletti, V. A. (2021). Generalized Anxiety Disorder (Nursing). StatPearls [Internet].

O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment Disorder: Current Developments and Future Directions. International journal of environmental research and public health, 16(14), 2537. https://doi.org/10.3390/ijerph16142537

Toussaint, A., Hüsing, P., Gumz, A., Wingenfeld, K., Härter, M., Schramm, E., & Löwe, B. (2020). Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7). Journal of affective disorders, 265, 395-401.

 
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Benner Caring, Clinical Wisdom and Ethics

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Week 5 Topic: Benner Caring, Clinical Wisdom and Ethics

Benner Caring, Clinical Wisdom and Ethics

Dr. Patricia Benner has contributed to nursing theory through her From Novice o Expert concept. The concept has been used in research to understand the gap between knowledge and skills development and patient care understanding and how new graduates transition to practice (Murray et al., 2019). The difference in quality and safety among graduate registered nurses remains an issue that significantly impacts patient outcomes. Effective facilitation of the transition process helps enhance experiential learning, allowing them to develop and establish a safe, quality nursing practice. An in-depth understanding of the transition process helps understand barriers and appropriate enablers to ensure a successful transition (Murray et al., 2019). Benner’s theory plays a critical role in shaping nursing research and education, providing nursing educators and leaders with an understanding of how to facilitate knowledge and skills acquisition and transition into practice for newly graduated registered nurses (Nursing Theory, 2023). This model that describes nurses’ transition through five nursing experience levels: novice, advanced beginner, competent, proficient, and expert is used as a theoretical framework in research to help measure, understand and improve the safety and quality of nursing care and influence on the future of the nursing workforce. (Benner Caring, Clinical Wisdom and Ethics)

Nurses point to experience as critical to providing safe and quality care, and hospitals and educational institutions should bolster nurses’ experience via recruitment, orientation, and continuous learning and retention (Nyikuri et al., 2020). Therefore, Benner’s theory has seen considerable interest from nurse educators since it was published, who adopted it to improve nursing curricula. The theory is widely accepted across all stages apart from the efficacy of the intuitive practice, an attribute of an expert practitioner. Benner’s concept has been valuable, becoming widely used to inform and guide nursing practice, education, research, and administration. However, some reviews of her work indicate that the theory is not clearly a theory or philosophy but leans more on the philosophical side. Understanding whether the concept is a theory or a philosophy would help with its appropriate use. ((Benner Caring, Clinical Wisdom and Ethics))

References

Murray, M., Sundin, D., & Cope, V. (2019). Benner’s model and Duchscher’s theory: Providing the framework for understanding new graduate nurses’ transition to practice. Nurse education in practice, 34, 199–203. https://doi.org/10.1016/j.nepr.2018.12.003

Nursing Theory. (2023). Dr. Patricia Benner Novice to Expert – Nursing Theorist. https://nursing-theory.org/nursing-theorists/Patricia-Benner.php/

Nyikuri, M., Kumar, P., English, M., & Jones, C. (2020). “I train and mentor, they take them”: A qualitative study of nurses’ perspectives of neonatal nursing expertise and its development in Kenyan hospitals. Nursing open, 7(3), 711–719. https://doi.org/10.1002/nop2.442

 

 
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HIV in Infants and Children

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Write a discussion that includes a brief summary of;

HIV in Infants and Children

HIV in Infants and Children

Vertical transmission contributes to most HIV infections in pediatric cases. HIV pathophysiology in infants and children is similar to that of adults, but the clinical presentation, therapeutic options, and mode of infection differ. HIV is more detrimental, with a higher risk of opportunistic diseases, and can progress quickly in pediatric and neonatal populations because they have a weaker immune system (Ward Susan & Hisley Shelton, 2009). The risk of an infant getting the infection through lactation is minimal, but the risk increases with women with a high viral load. The risk of infection through vertical transmission is more significant. Factors including elevated maternal plasma viral RNA concentrations, maternal milk viral load, decreased maternal CD4+ T-cell count, advanced maternal illness, and acute maternal seroconversion increase the risk of infection. ART therapy during pregnancy can help reduce the risk of infection. (HIV in Infants and Children)

Systemic Lupus Erythematosus

Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a systematic immune condition that affects multiple systems and is linked to high morbidity and mortality in infants and children. The disease occurs when pathogenic autoantibodies that damage tissue via various mechanisms appear after the loss of immunological tolerance against self-antigens (Ward Susan & Hisley Shelton, 2009). Genetic, environmental, endocrine, and immunological factors contribute to the loss of immunological tolerance. The cause of the disease is still unknown, but genetic factors contribute significantly to its development.

Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis

Juvenile rheumatoid arthritis (JIA) is a heterogenous group of chronic arthritis and a common chronic rheumatological disease among infants and children below 16 years, lasting at least six weeks. JIA subtypes include systemic arthritis, oligoarthritic, undifferentiated arthritis, enthesitis-related arthritis, psoriatic arthritis, RF enthesitis-related arthritis, and rheumatoid factor (RF) (Ward Susan & Hisley Shelton, 2009). These subtypes differ in genetic predispositions, phenotypes, prognosis, lab findings, disease course, and pathophysiology. The cause is still unclear, but environmental factors such as antibiotic exposure and C-section deliveries triggering abnormal immune responses in genetically vulnerable individuals are speculative. Genetic factors play the most significant role in JIA development, especially when JIA subtypes and uveitis attack particular HLA alleles and non-HLA genes. Breastfeeding is protective against JIA.

Tetralogy of Fallot

Tetralogy of Fallot

Tetralogy of Fallot describes a congenital anomaly leading to pulmonary stenosis, interventricular defects, right ventricular hypertrophy, and biventricular aorta origin. Tetralogy of Fallot is a cyanotic condition common among children who managed above neonatal times without treatment, leading to congenital defects (Ward Susan & Hisley Shelton, 2009). It is critical to identify the disease early and begin intervention before the infant turns one year to prevent congenital defects. Many factors, including untreated maternal diabetes, retinoic acid use by the mother, chromosomal anomalies, and phenylketonuria, are associated with the disease development. The disease is linked to an intrauterine pathological process involving the pulmonary artery and the subpulmonary infundibulum leading to pulmonary stenosis.

References

Ward Susan, L., & Hisley Shelton, M. (2009). Maternal-Child Nursing Care Optimizing Outcomes for Mothers. Children, and Families. Philadelphia, FA Davis https://books.google.co.ke/books/about/Maternal_Child_Nursing_Care.html?id=MOBbRAAACAAJ&redir_esc=y

 

 
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Steps followed in strategic planning

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Steps followed in strategic planning

Steps followed in strategic planning

Strategic planning is the process by which a company sets what it wants to look like in the coming years and the means of reaching there. An organization comes up with a vision and checks out what is important, the methods, and tasks that can be attained. It mostly concentrates on long-term targets and objectives. Planning as a whole makes the company remain focused and therefore contributes to its progress and stability. Hence it must be carried out in an organized way by following some steps. (Steps followed in strategic planning)

One of the measures is to agree on the strategic planning process. This is done by a meeting of the board with key members present including staff and some external stakeholders. It falls under the formulation stage as it involves determining how the strategic planning will be done, its importance, the cost of carrying out the planning and considering whether the organization is ready to take a plan that takes a longer period or a plan that takes a shorter time. This step is important as it gives the company a chance to determine if it’s ready for the plan regarding financial resources, staff involvement and decide on whether to take long-term or short-term project. To make the step successful, the participants of the planning should be chosen carefully by determining their commitment. For the staff involved, ensure that much staff time is devoted to the planning and reduce the workloads and responsibilities of the staff.

Another step is to agree on the main strategies to meet the targets and the key issues that have been identified by carrying out an environmental scan. The scan involves the SWOT analysis and also the external factors that affect the company. There should be a relation between the strategies and specific goals. It includes prioritizing the strategies to ensure the key strategies like the new programs are carried out first. Identifying viable strategies is also important, and for the non-potential strategies, the board may suggest changes be done. Choosing among the strategies follows a criterion which involves determining the value, appropriateness, feasibility, acceptability, cost-benefit and the timing of the strategy. The step falls under the implementation stage. The importance of this stage is that it allows the planning board to precisely evaluate the responsibilities for their implementation. For the establishment of this process to be successful, selection, evaluation and prioritizing the strategies should be carried out carefully based on any agreed criteria. (Steps followed in strategic planning)

Building in a method for supervising, and for changing plans about variations in the external components of the environment or the company is also another step. It falls under the review stage as it involves monitoring the planning. Strategies are discussed and annual goals developed by checking the progress made, difficulties encountered and environmental changes. The plan should be used to give direction and therefore should be flexible. Both the board and the staff play key role in revising progress and modification of the strategies where necessary. This stage is of benefit as it allows the organization to monitor progress to see if the targets are met and evaluate reasons for some difficulties in the accomplishment. For the process to be successful, the planning and evaluation sectors should work hand in hand. The planning unit may carry out documentation of data which is used by the evaluation unit to review the progress of the organization.

The steps above are necessary for any organization, and they can be broken further to sub-steps that will clearly define every vital issue to be addressed. Through the steps above, strategic planning becomes that relies on the board and the staff working together. The planning also may involve knowledgeable outsiders consultation who may give precise information about the external environment and the community .(Steps followed in strategic planning)

REFERENCES

Buchanan, S., & Gibb, F. (1998). The information audit: an integrated strategic approach. International journal of information management, 18(1), 29-47.  https://www.sciencedirect.com/science/article/abs/pii/S0268401297000388

Hofer, C. W. (1975). Toward a contingency theory of business strategy. Academy of Management journal, 18(4), 784-810.

 
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Study of manometry and polarography

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Study of manometry and polarography

Study of manometry and polarography

Manometry refers to measuring of pressure by use of the manometer device.  Examples of manometry activities include; Esophageal manometry, is carried out to determine movements and muscle pressure in the esophagus when evaluating achalasia (smooth muscle fibers failure to relax), the doctors can determine the ability of the esophagus to move food to the stomach, forecast the reason behind you experiencing a digestive problem and know the processes of digesting and swallowing. Normally administered to people with swallowing difficulties and pain, heartburn and chest pain; the anal manometry, involves measuring the pressure the anal sphincter produces. Anal manometry is beneficial when evaluating anal and fecal incompetence and incontinence respectively. (Study of manometry and polarography)

Manometry operation theory

Manometry involves pressure measurement on the different areas in the GI-tract. Its operation involves use of a catheter with transducers filled with a liquid or in solid state (Ghosh, Pandolfino, Zhang, Jarosz, & Kahrilas, (2006). The catheter is passed through the mouth or anal into the canal of part to be studied. The operation is performed more so to evaluate disorders that cannot be explained by other studies. This disorder can be of the esophagus, duodenum, stomach, anal and rectal sphincters which give minor discomforts but have very little complications. A patient undergoing manometric tests is accustomed to several restrictions like, they are not allowed to eat anything past midnight. (Study of manometry and polarography)

Instrument used in manometric study

A manometer is widely used since it can measure and at the same time indicate the pressure, it uses a liquid column in its measurements. There are various types of manometers, the U-Tube manometer, two types; differential and inverted U-Tube manometers, the micro manometer, and the inclined manometer. The Bourdon gauge instrument is also commonly used, it operates mechanically and can also measure and indicate pressure. A vacuum gauge is also used, it measures the pressure below ambient atmospheric pressure. Other methods used to measure evolution of pressure involve sensors, the sensors are used in transmitting the pressure readings to a control system. (Study of manometry and polarography)

Types of manometry

Manometry is classified into three major categories, esophageal manometry, anorectal manometry, rhinomanometry. Esophageal test is carried out in patients experiencing heartburn, swallowing difficulties, and having chest and stomach pains. It involves two types of tests which are determined by your instructing physician. The standard manometry is the first test, it entails examining the functioning of the esophagus muscles and how effective the valve between the stomach and the esophagus is. The procedure involves inserting a tube in an anesthetized nose and pulling the tube back slowly through the esophagus, swallows with water are also undertaken. The second test is the impedance manometry which works closely as the standard manometry but involves assessment of bolus movements in the esophagus. The procedure involves a tube which is passed into the esophagus, performing swallows with saline and undertaking swallows with applesauce.

Anorectal manometry is performed by a gastroenterologist or any other assistant with special training. The pressure produced by the anal and rectal sphincter is measured by a transducer attached to a tube which is inserted into the anal canal and pulled slowly. The relaxation and contraction of the anal and rectal sphincter controls the bowel movements. The procedure can be performed alternatively by use of a metal cylinder that has three balloons attached to it to measure the pressure. Anorectal manometry is undertaken to determine anal canal functioning and understand the reasons for chronic constipation occurring, used as a treatment in restructuring contraction of anal muscles in those people with fecal inconsistency.

Rhinomanometry is carried out to evaluate the airflow in the nasal canal. The procedure involves a probe which is placed at the end of a nostril and attached by a tape. Masks are used in the test to cover the faces of patients who breath in severally through their noses. A sensor placed at the back of the cavity is sometimes used to check on the airflow and report the observation to a computer. (Study of manometry and polarography)

Applications of manometry

Esophageal manometry is applied clinically to patients with GERD and it involves pH monitoring. Extended esophageal pH monitoring is used to manage patients having symptoms which are typical or atypical and are under the standard therapy for GERD. This test is also applicable in monitoring abnormal reflux in a person without esophagitis being examined for anti-reflux surgery. The multichannel intraluminal impedance is a technic used to evaluate movements of the bolus in the esophagus. Its information relevance is expanded by combining it with manometry or the pH monitoring. Manometry is also applied when identifying non-functionality of the gastrointestinal tract. Problems in the GI tract involving smooth muscles and extrinsic nerves may be detected by measuring the pressure inside the tract and examining the phasic contraction of the tract. (Study of manometry and polarography)

Limitations of manometry

Analyzing esophageal disorder tracings is tiring, consumes a lot of time also and has different reader views. The procedure for undertaking esophageal test is uncomfortable and is accompanied by pain due to the anesthetization of the nostril through which the tube is inserted. Esophageal test has side effects like the, sore throats that are not severe, irritations and sinus problems. The patient may also suffer from nose bleeds. Anorectal manometry has side effects which include, slight discomfort and exposure to radiation associated with Defacograghy and Sitzmark test used when examining patients with chronic constipation. Nerve injuries may occur when the pudendal nerve testing is undertaken, this test is used to examine bladder and rectal sphincters. Intranasal corticosteroids like sildenafil citrate are used to treat nasal obstructions in people with allergic rhinitis. This treatment has associated side effects like sneezing. Itching of the nasal cavity and running nose. (Study of manometry and polarography)

What is polarography?

Polarography is an analysis method that involves subjecting a sample to electrolysis by use of specific electrodes and voltages of a given range, plotting a graph of current against voltage which shows procedures corresponding to a certain chemical and their concentration proportionality (Study of manometry and polarography)

Polarography theory

Polarography has a theory behind its operation, it includes the processes of oxidation, reduction, absorption, and catalysis. It is a subclass of voltammetry and involves voltammetric measurements in which convection mass transport determines their responses. Polarographic study involves examining solutions and electrode processes by applying the process of electrolysis. Electrolysis consists of polarized and un-polarized electrodes. The polarized electrode is formed by mercury which drops from a capillary tube more often. The electrode potential is changed linearly from the starting to the final potential and the graph produced has a sigmoid shape. The use of an electrode formed from a dropping mercury differentiates polarography from other voltammetry measurements. (Study of manometry and polarography)

Types of polarography

There are different types of polarography which are categorized in relation to their sensitivity and resolution; the classical polarography and the high-frequency polarography. (Study of manometry and polarography)

Applications of polarography

Polarography is applied in pharmaceutical analysis where it is used to differentiate reducible and oxidisable compounds (Zuman, (2006).). A base solution is used in which the sample to be studied is dissolved and placed in an electrolytic cell with a liquid mercury in a pool as anode and dropping mercury as cathode. Increasing voltage is applied in the cell and current measured with a galvanometer is used to evaluate the characteristics of the reducible compound. Changing the dropping mercury to be the anode helps determine the characteristics of the oxidisable compound. Polarography and voltammetry are applied in marine and aquatic chemistry; mercury is known to be toxic to aquatic life since it is dissolved in inland waters in small quantities that are hard to trace and when the water reacts with sediments there is a risk mercury entering the food chain of aquatic organisms, therefore polarography and voltammetry are used to detect mercury concentrations in aquatic environment. Direct current polarography in relation with other technics are used to determine derivatives of metals in ethylenebisdithiocarbamic acid where the stripping of a cathode is evaluated to be the most suitable methods (Busk, Horsman, Jakobsen, Keiding, van der Kogel, Bussink & Overgaard, (2008).)   (Study of manometry and polarography)

limitations of polarography

The classical experiment of polarography that consists of quantitative analysis of different measurements has complications due to the rapidly changing electrode potentials applied to the electrode formed by the mercury drop in the whole experiment. The direct current polarography has limitations like, there is lack of clear explanations of the sigmoid curve; to distinguish two different waves and measure their potentials in a halfwave and limiting currents, they should have differing potentials above 200mV, instead the highest resolution is of about 50mV. Another limitation is the noise of the oscillations which increases after a substance is reduced hence making the calculation of other compounds undergoing reduction difficult. There are also some drawbacks in relation to the current needed to change the dropping mercury electrode potential, there is slight difference of the current and Faradaic current when a depolarizer concentration with number of moles ranging between 10-5 is used. (Study of manometry and polarography)

References

Von Renteln, D., Inoue, H., Minami, H., Werner, Y. B., Pace, A., Kersten, J. F., … & Fuchs, K. H. (2012). Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. The American journal of gastroenterology, 107(3), 411-417. 10.1038/ajg.2011.388

Ghosh, S. K., Pandolfino, J. E., Zhang, Q., Jarosz, A., & Kahrilas, P. J. (2006). Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry. American Journal of Physiology-Gastrointestinal and Liver Physiology, 291(3), G525-G531.

Pandolfino, J. E., Ghosh, S. K., Zhang, Q., Jarosz, A., Shah, N., & Kahrilas, P. J. (2006). Quantifying EGJ morphology and relaxation with high-resolution manometry: a study of 75 asymptomatic volunteers. American Journal of Physiology-Gastrointestinal and Liver Physiology, 290(5), G1033-G1040.

Busk, M., Horsman, M. R., Jakobsen, S., Keiding, S., van der Kogel, A. J., Bussink, J., & Overgaard, J. (2008). Imaging hypoxia in xenografted and murine tumors with 18 F-fluoroazomycin arabinoside: a comparative study involving microPET, autoradiography, pO 2-polarography, and fluorescence microscopy. International Journal of Radiation Oncology* Biology* Physics, 70(4), 1202-1212.

Zuman, P. (2006). Principles of applications of polarography and voltammetry in the analysis of drugs. FABAD Journal of Pharmaceutical Science, 31, 97115.

 
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THE ROLE OF STAKEHOLDERS

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THE ROLE OF STAKEHOLDERS

THE ROLE OF STAKEHOLDERS

Any project planning by an organization includes identifying the aim of the project, the resources required to undertake the project and the way they will be allocated, the operations needed to  implement the plan and deliver the final products. Also, there is need to respond to significant  issues and evaluate the results.

Stakeholder’s involvement in the project planning is a critical problem in that, the trust on the  project is heightened, there is a high commitment to the project goals and operations, and  the  project’s results are highly credited ( Manetti & Toccafondi,  2012).

The key role of stakeholders is to provide capital to carry out the project. They sometimes also  provide the way forward, or they are consulted (Newcombe, 2003). In public organizations, they can be present in meetings, and they may need to know the decision reached and the progress of  the company from the top officials.

Some internal stakeholders may be held accountable for anything in the process, and they play a  significant role in the success of the project, and the external stakeholders who provide advice  but are not held accountable for anything

For a company to successfully involve stakeholders in their operations, it is important the follow some steps which include; identifying the stakeholders, developing an issue map and creating an engagement plan.

A company needs to know its areas of interest, what speakers are suitable for this areas and how  much vital they are in your operation. Knowing the areas of interest helps you to use less time,  and maximize the value of your production. After successfully identifying the stakeholders, it is  important to come up with a list of key issues and analyze the list with the stakeholders and also  take note of the areas of influence. The company also has to measure its progress about its goals  by use of an engagement plan. The program help realizes how effective your efforts are.

The success of you engaging the stakeholders can be determined by how the stakeholder has  impacted on your business and the way the business has affected the stakeholder. This  marks the sustainability strategy.

References

Manetti, G., & Toccafondi, S. (2012). The role of stakeholders in sustainability reporting assurance. Journal of Business Ethics, 107(3), 363-377. https://link.springer.com/article/10.1007/s10551-011-1044-1

Newcombe, R. (2003). From client to project stakeholders: a stakeholder mapping approach. Construction Management and Economics, 21(8), 841-848.

 
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