NUR456 E-Portfolio
I have been a nurse since 2006. I have worked in several hospitals in several different states. I have worked in Emergency Room (ER), labor and delivery, postpartum, medical/surgical, surgical/trauma, orthopedics, and currently intensive care (ICU). I worked as an Associate’s Degree Nurse (ADN) RN for several years before I decided to go back to school to earn a BSN degree. At that time, about 10 years ago, there was no incentive for getting a Bachelor of Science in Nursing (BSN) degree, not pay increase and no change in my position at work. I eventually decided that someday a BSN might be a necessity to work in the hospital setting, so I began taking classes for RN to BSN at Jacksonville University (JU). Some years only taking 1 class, I have finally made it to the final class. It is daunting looking back over all of the papers and PowerPoints I’ve created for this program to choose 2 for each of the 10 objectives for the E-portfolio.
Objective # 1: Synthesize Knowledge from the Liberal Arts and Sciences and Nursing Science:
For the first objective, I chose my Personal Career Development Plan paper (Artifact 1A), which I wrote for a Professional Nursing class in fall 2011. I chose this paper because it details many of the different steps and goals it takes and knowledge in many areas of discipline to obtain and BSN and become an intensive care nurse. My Personal Career Development Plan paper mentions obtaining a BSN degree and becoming an intensive care nurse. I am now an intensive care nurse and will, hopefully, be passing this current/final class in the BSN program in just a few weeks. This paper outlines specific step to reach my goals, looking through the steps now I see I have accomplished them.
In comparison, I wrote a paper for a nursing leadership and management class in January 2020 titled Leadership Philosophy/Professional Leadership Style. I chose this paper to show the synthesis of knowledge in writing and writing format skills along with growth in nursing science knowledge. This paper is written better overall, has better APA format, and has more references. You can see the evolution of my papers through the program when you look at these 2 papers. This writing discusses my own leadership style, the evolution of my style, and what style I think I will be in the future. This was an easy paper for me to write since I have been in this field for many years at this point and work as a charge nurse. This paper describes examples of why I identified myself as the team leader leadership style.
Link to artifact 1A LeadershipPhilosophyPaper.docx
Link to artifact 1B Personal Career Development Plan.docx
Objective #2: Make Sound Decisions:
For the second E-portfolio objective I chose my Case Study One and Case Study 4 papers. Both of these papers were written for a critical care nursing class in fall 2020. Case Study One (Artifact 2A) is about an elderly female who was recently admitted to a hospital with acute on chronic congestive heart failure (CHF). I chose these papers for this objective because its important to make the right assessments and decisions for patient care, these papers display some decisions based on assessments of patients. She had come with complaints of worsening shortness of breath (SOB), edema, and fatigue. She had history atrial fibrillation (A-fib), myocardial infarction (MI), renal insufficiency, and hypothyroidism. She had to be intubated for acute decompensated heart failure due to a massive MI. Post intubation she was alert but not able to make decisions for herself. She was too vitally unstable for a cardiac catheterization and had needed vasoactive medications to support her blood pressure. Her renal function had worsened. She was needing hemodialysis. When speaking with patient’s husband, he said, “She would not have wanted all of this”.
For the paper, I discussed the pros and cons of patient receiving hemodialysis. Considerations to review prior to deciding to cancel hemodialysis were discussed, such as patient’s wishes. The need for an ethics consultant was brought up along with patient’s advanced care directive. The purpose and contents of advanced care directives was detailed in this paper. After discussion amongst patient, patient’s husband, physician, palliative care provider, ethics consultant, and nurse the overall decision/goal was to make the patient’s final months, days, hours, minutes as easy and comfortable as possible for patient and her family. Therefore, no hemodialysis or cardiac stenting will occur for this patient. While still in hospital, nursing will remove the telemetry, no longer do vital sign checks, or anything uncomfortable to patient. Intravenous catheter will be left in if patient is receiving common end-of-life comfort medications such as Ativan and/or morphine. The social worker will discuss the option of hospice at home versus at a facility with the husband. The social worker will make phone calls either to a facility chosen or to a home health hospice agency to assist with keeping patient cared for and comfortable in her final months, days, or hours.
The other paper I chose for this objective is a Diabetic Ketoacidosis (DKA) case study titled Case Study 4 (artifact 2B). This patient was a diabetic who had gotten sick. She had poor intake due to acute illness. She had not been checking her glucose or giving her insulin for a few days. Her presenting complaint was weakness, fatigue, and vomiting. Lab results consistent with DKA. Positive blood cultures and R lung rhonchi.
In this paper I described insulin hormone function in the body, the pancreas, insulin resistance and sensitivity, type 1 diabetes, type 2 diabetes, damage to nerves and organs from uncontrolled blood sugars leading to peripheral neuropathy, blindness, amputation and other possible negative effects. Also discussed the risk factors for type 2 diabetes, such as obesity and sedentary lifestyle. In this paper I discussed the cause of this patient’s DKA on a pathophysiologic level. Talked about the excess of ketones and symptoms of DKA. Listed the classic signs and symptoms of DKA, including excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruit-scented breath, confusion, high blood sugars. I then detailed this specific patient’s DKA symptoms and the pathophysiology of her symptoms, such as fatigue and weakness: glucose is not entering cells like it should be therefore brain and rest of body not getting adequate O2, vomit: body is trying to expel ketone excess and lower blood glucose, hyperglycemia: high level of glucose in blood, because glucose is not moving into cells. ketones in blood: ketones are released when body uses fat for energy. Tachypnea/sob: Ketones are causing blood acidity. Body compensates/attempts to correct acidic pH by hyperventilation to get rid of carbon dioxide. This patient also has pneumonia which is also causing SOB, fatigue, positive blood culture. This is the acute illness which caused her weakness and fatigue in the first place. If it were not for her pneumonia she would have been eating/drinking, monitoring her glucose and taking insulin as normal. I went on to describe the pathophysiology of the anion gap, goals of treatment and interventions needed for her care, as well of education needed for the patient on how to manage her diabetes when she is acutely ill so this doesn’t happen to her again.
Link to artifact 2A NUR455 Case Study One.docx
Link to artifact 2B NUR455CaseStudy4 (2).docx
Objective #3: Demonstrate Clinical Excellence to Provide Caring, Compassionate, and culturally appropriate care:
For the E-portfolio objective 3 I chose a paper and a PowerPoint to show caring and compassionate care to the patients in these pieces. Pediatric Assessment and Vaccine Teaching (artifact 3A) and Prevention of VAP PowerPoint (artifact 3B). My pediatric paper discusses abnormal finding in a pediatric assessment of a male under the age of 13, consisting of enlarged tonsils and neck being tender to palpation on one side. I go on to discuss that an ear, nose, and throat (ENT) physician should be consulted as he may need a tonsillectomy for tonsillitis. As a nurse I take this visit as an opportunity to educate the patient and his mother on which vaccinations he may be needing currently and coming up. Upon looking over his vaccine history, the nurse finds that this child is up to date with recommended vaccines per Center for Disease Control (CDC) guidelines up to this point. Vaccines recommended for his age (12) are Influenza (IIV), Meningococcal (menACWY-D), Tetanus, diphtheria, pertussis (Tdap), and Human papilloma virus (HPV). Patient and parent teaching for recommended vaccines: Indications and importance for each vaccine for the patient, community, and globally. Contraindications, risks and benefits of each vaccine. Give a copy of and go over the Vaccine information statement (VIS) for each vaccine with patient and parent. Educate on more serious side effects and what to do if one presents. Educate on if/when a booster is needed for each vaccine. I then attached an education sheet that I made regarding each vaccine that is recommended for this patient.
The second piece I chose for this objective is a group PowerPoint I made for a critical care class in fall 2020, made up of 19 slides. Ventilator-associated pneumonia (VAP) sometimes develops in intubated/ventilated patients. Being intubated and on a ventilator increases a person’s risk for pneumonia. Pneumonia occurs when bacteria gets into the lungs and clogs up the tiny air sacs (alveoli), decreasing or preventing gas exchange. This PowerPoint presentation discusses evidence-based ways to prevent and treat VAP. Many visuals and diagrams are shown and described in this PowerPoint presentation.
Link to artifact 3A Pediatric Assessment and Vaccine Teaching (1).docx
Link to artifact 3B Evidence-based practices for ventilator acquired pneumonia prevention (1) (2).pptx
Objective #4: Communicate, Collaborate, and Negotiate effectively to Improve Patient Healthcare Outcomes:
For E-portfolio objective 4 I chose Interviews of People in the Community (artifact 4A) and Evidence-based Pressure Ulcer Prevention Poster (artifact 4B). I had to communicate and collaborate with many people in order to interview and obtain responses from each of them for the community project. Nurses need to communicate and collaborate with other nurses and nursing assistants for cleaning, feeding, and repositioning patients to prevent pressure ulcers.
The paper on interviews of people in my community of Albertville, MN was written for a community health class in fall 2020. Five people with different occupations who live and work in Albertville, MN were interviewed about their perceptions of the health of the community. Albertville is a suburb, urban community, on the North West tip of Minneapolis.
I discussed the history, name changes, and development of Albertville. Then described the questions and answers of the five people who were interviewed. They were all asked the same 6 questions: What do you think is healthy about living in this community, what do you think is not healthy about living in this community, what do you think could make this community healthier, what would you like to be changed in this community, what resources would someone need to make healthy changes happen in this community, and what do you have to say about the overall health of this community.
Then I summarized and compared the responses of the five people who were interviewed to find overall similarities and suggest health goals for this community. There is a consensus among these interviews that Albertville is moderately healthy and safe with a great school district. The 26-year-old female did mention the safety concern of being so close to a hot spot for human trafficking. It seemed very easy for each one of them to think of ways the community’s health could improve, as if they had already had these thoughts. They, for the most part, all had the same ideas such as a community pool, better/more trails, better/more parks, more activities, and healthier restaurants. If I were interviewed, I would have mentioned the high incidences of cancer a couple miles down from the nuclear power plant in the town a few miles North East of here, Otsego, MN. There is a group on Facebook for this community where people are noticing correlations with symptoms and illnesses in relation to where their homes are located. They keep each other updated on any progress made with the city, county, and state on this subject.
The other artifact I chose for objective for is Evidence-based Pressure Ulcer Prevention Poster (artifact 4B). This poster was made for a class called Evidence-based Nursing in spring 2018. This poster showcases a few statistical diagrams about the rate of pressure ulcer development in hospitalized patients between in years 2008-2012, another diagram shows statistics on stage 3 and 4 hospital acquired pressure ulcers in patients years 2007-2012 amongst 55 university health system consortiums. This poster lists evidence-based practice guidelines for pressure ulcer prevention.
Link to artifact 4A Interviews of People in the Community of Albertville (1).docx
Link to artifact 4B EBN Guideline Poster.pptx
Objective #5: Exhibit Professional Values and Behaviors as outlined:
For E-portfolio objective 5 I chose a discussion board paper I wrote for a leadership and management class in spring 2020 to show nursing values and behaviors which are important in this career. I summarized my nursing experience in different areas of nursing and different roles in nursing other than staff nurse, such as charge nurse, preceptor, admission nurse and a flyer nurse (jumping between units, helping nurses as needed). I also spoke about the various quality and improvement committees I have been a part of.
In this paper I described many leaders I have worked with and their style of leadership and whether they were effective or not. I also discussed what I think is the most important quality in a leader: I think selling is the most important quality in a leader. If you can explain the purpose for a task/change and it makes sense to each employee, they are far more likely to comply with the task/change than if nobody understands the reasoning behind the task/goal. Including employees in decision making can help with this greatly. Something I learned from a nursing manager in the past is that in this field patient perception is our reality. Nurses need to be mindful of their non-verbal’s. How a patient perceives you is what matters. I discussed if I feel supported by my current nursing leadership and why. In this paper I identified three words to describe my leadership skills: emergent, democratic, and transformative.
The other piece I chose for this objective was a group PowerPoint presentation that I helped create for Information management in Nursing class in fall 2011. Discussed the term consensus, basic concept for needing electronic health records, and several levels of involvement for electronic healthcare records to transition from paper to electronic, including political, vendor, and healthcare providers.
Link to artifact 5A Leadership_Week1Discussion.docx
Link to artifact 5B Building Consensus for Electronic Health Records with audio.pptx
Objective #6: Promote Healthy Lifestyles:
For E-portfolio objective 6 I chose an adobe presentation I created for a Pathophysiology and Nursing Assessment class in fall 2019. This presentation is a case study review in which I detail a patient assessment, vitals, labs, and imaging of a pulmonary embolism patient. I describe what a pulmonary embolism (PE) is including pathophysiology, signs and symptoms of PE, and treatment for PE including pharmacologic management. This presentation discusses prevention which is an important part of any healthy lifestyle.
The other piece I chose for this objective is another paper I wrote for the same class. This paper promotes a healthier lifestyle, with the goals being weight loss and HTN control. This paper is titled Weight loss to Cure Hypertension (artifact 6B). For this paper I chose a person who needed education about their diagnosis. I detailed an assessment of the person’s learning needs relating to their diagnosis, identified learner objectives and goals, created a teaching plan specific to this patient and diagnosis, then did an evaluation of the teaching plan and its effectiveness.
Link to artifact 6A https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:8b8a88d0-9d38-4249-8147-0b261c337d61
Link to artifact 6B Weight loss to Cure Hypertension.docx
Objective #7: Incorporate Evidence-based Knowledge and Theory into Nursing Practice:
For E-portfolio objective 7 I chose a paper I wrote titled Reviewing this guideline: Interventions for prevention and treatment of pressure ulcers. In: Prevention and treatment of pressure ulcers: clinical practice guideline (artifact 7A). This paper goes over evidence-based practices to improve patient outcomes.
Nursing concepts for this guideline include: nutrition: Including energy intake, protein, vitamins, minerals, and hydration status of patients with pressure ulcers and for pressure ulcer prevention, repositioning frequency to prevent and to heal pressure ulcers, positioning of patients to prevent and to heal pressure ulcers, positioning medical devices: to prevent ulcers and to heal existing ulcers, medical device related pressure ulcers and risk for device related ulcers, skin care under medical devices to prevent pressure ulcers/skin breakdown. I reviewed 7 different articles and identified the purpose for each, the method, independent variables, dependent variables, specified each articles sample size, listed how the data for each article/study was collected, discussed results, implications for nursing practice, implications for future research, strengths and weakness of each article/study, then specified how each of the 6 articles related to the guideline.
The other paper I chose for objective 7 is my Anaphylaxis Management paper (article 7B). This paper reviews evidence-based information regarding the care of anaphylactic patients. In this paper I listed common misconceptions surrounding anaphylaxis. One of the misconceptions is that shock needs to be present. If shock isn’t present, some physicians are not treating the patient adequately or aggressively enough, which leads to poor outcomes. This brings up another misconception that many physicians have about epinephrine being dangerous. My paper discusses the safety of epinephrine and the reasons/errors that sometimes occur which created this misconception. My paper discusses the way the UK treats patients with anaphylaxis and that those patients have better outcomes, statistically. I then describe the pathophysiology of anaphylaxis. My paper goes on to talk about patient-centered medical and nursing management. The most important part of the nursing management of suspected anaphylaxis is to maintain an open airway with adequate oxygenation. Finally, I discuss how to apply this knowledge to nursing practice, including the education of parents/caregivers to educate day care, school, babysitters, siblings, grandparents, and anyone else who may be in care of a child or vulnerable adult about anaphylaxis and use of epi-pen.
Link to artifact 7A EBN My Literature Review Matrix (1).docx
Link to artifact 7B Anaphylaxis Management.docx
Objective #8: Demonstrate Leadership and Collaboration:
I chose my Electronic Medical Record (EMR) project (artifact 8A) and my (Information) Info. Systems Site Visit paper (artifact 8B) for E-portfolio objective 8. For this paper, I needed to collaborate with an employee who knows what it takes to convert paper to electronic documentation. In the EMR paper I gave a run down of the history of the hospital and noted that most of the charting at this hospital was already electronic. A form that was not yet electronic at this time of this paper was the MRI Safety Checklist. (Now, in 2021, this checklist is electronic). I discussed what the paper process was at the time and that the process could be made safer if it was converted to electronic. I discussed the timeline for building the electronic document, challenges that could occur, and mandatory components. I compared and contrasted the differences between paper and electronic checklist then wrote a conclusion.
In the Information System Site Visit paper I collaborated with a pharmacist and used leadership skills to determine a time and place for interview. I interviewed Vincent Odane, Pharm.D. Vincent was the Director of Pharmacy Services and had been in pharmacy for over 20 years. He said pharmacy procedures have been evolving to improve patient safety and pharmacist efficiency. Interview questions focused on medication reconciliation and medication administration safety. Vincent had much to say about these topics since medication reconciliation has made such a positive impact on patient safety and medication administration safety has grown with the use of technology. He described the medication reconciliation (med rec) process. I concluded, technology has improved healthcare and patient safety.
Link to artifact 8A EMR Project.docx
Link to artifact 8B Info. systems site visit paper.docx
Objective #9: Allocate and Manage Resources to Ensure Patient Safety and High-quality Healthcare:
I chose my paper Reviewing a trail of miscommunications which ended in patient death (link is titled Safety Case Study, artifact 9A) for objective 9 to identify areas of safety impairments to gain awareness and approve safety measure for future. I, also, chose my Chronic Pain Flyer (artifact 9B) for E-portfolio objective 9 because many people resort to unsafe medications and practices to get pain relief these days. This flyer could help educate someone with chronic pain on other ways to overcome their pain.
The safety case study gives an overview of the case. Busy day at a hospital, on call physician’s phone not working, miscommunications, and patient’s vital signs deteriorated to point of death. The paper discusses the details of scenario in detail. Patient died at 12:30 pm. Doctor arrived in ED approximately 12:45 pm. Autopsy results: septic shock due to infection of small bowel obstruction. In this paper I dissected each error and miscommunication then identified ways in which the hospital could improve and prevent a situation such as this from occurring again.
The other piece I chose for objective 9 is my Chronic Pain Flyer (artifact 9B). For this assignment students were to choose a clinic and make a flyer to provide information on where a person could get some education on services available at the clinic. I chose a pain clinic, listed the name, address, location, phone number of the clinic, along with date and time of the information session. Informational session not only goes over available procedures but talks about pain control techniques, managing and coping with pain, physiological and pshycological dependence, adverse effects of long-term narcotic use, and chronic pain program.
The flyer lists pain relief procedures available at the clinic: trigger point injections, Epidural steroid injections, nerve blocks, discography, radiofrequency neurolysis, spinal facet joint injections, vertebroplasty, percutaneous disc decompression, balloon kyphoplasty, baclofen pump, epidural lysis of adhesions, intradiscal electrothermal therapy, implantable spinal cord stimulation, implantable spinal drug infusion therapy, and headache management therapies.
Link to artifact 9A SafetyCaseStudy.docx
Link to artifact 9B Chronic Pain Flyer.docx
Objective #10: Engage in Life-long Learning and Scholarly Inquiry to Continue Professional Career Development:
I chose my Pulmonary embolism (PE) Case study (artifact 10A) to show that I am staying current on new information for evidence-based practices in care of patients with common diagnoses. I, also, chose my Community Clinical Evaluation (artifact 10B) for E-portfolio objective 10 because it shows collaboration with classmates, collaboration is important for professional career development. PE is the most common cause of preventable death in post-operative patients. The risk of getting a blood clot, whether it’s a deep venous thrombosis (DVT) or a PE, increases after any surgery. Surely there are patients who wonder why getting surgery on their knee, for example, would cause a clot in their lung. Clots formed anywhere in the body (such as the knee) can break away and travel through the vessels to the lung (PE), heart, or brain. I then go into detail about the pathophysiology, pathogenesis, risk factors, and clinical features of PE. This is a case study, so I review that history and physical assessment findings on patient with PE. Including biographical data, source of history, patient’s reason for seeking care, current medications, family history, review of systems, functional assessment, physical exam, vital signs, diagnostics, medical management, and pharmacologic therapy for PE. Medical management recommendations and nursing management. I go on to discuss plan of care and interventions for the patient then write a conclusion.
The second piece I chose for objective 10 is a group PowerPoint presentation Community Clinical Agency Evaluation (link is titled Community Clinical Eval, artifact 10B). Slides 1-5 are about the clinical agency/facility that I chose for the elderly patient who was described on slide 2. Each person in the group chose a facility in their area of the United States that would be a good fit for this patient, each student then did research on the facility to gain information needed to give a thorough review and educate each other about each place.
Link to artifact 10A PulmonaryEmbolismCaseStudy.docx
Link to artifact 10B CommunityClinicalEval.pptx
Objective # 1: Synthesize Knowledge from the Liberal Arts and Sciences and Nursing Science:
For the first objective, I chose my Personal Career Development Plan paper (Artifact 1A), which I wrote for a Professional Nursing class in fall 2011. I chose this paper because it details many of the different steps and goals it takes and knowledge in many areas of discipline to obtain and BSN and become an intensive care nurse. My Personal Career Development Plan paper mentions obtaining a BSN degree and becoming an intensive care nurse. I am now an intensive care nurse and will, hopefully, be passing this current/final class in the BSN program in just a few weeks. This paper outlines specific step to reach my goals, looking through the steps now I see I have accomplished them.
In comparison, I wrote a paper for a nursing leadership and management class in January 2020 titled Leadership Philosophy/Professional Leadership Style. I chose this paper to show the synthesis of knowledge in writing and writing format skills along with growth in nursing science knowledge. This paper is written better overall, has better APA format, and has more references. You can see the evolution of my papers through the program when you look at these 2 papers. This writing discusses my own leadership style, the evolution of my style, and what style I think I will be in the future. This was an easy paper for me to write since I have been in this field for many years at this point and work as a charge nurse. This paper describes examples of why I identified myself as the team leader leadership style.
Link to artifact 1A LeadershipPhilosophyPaper.docx
Link to artifact 1B Personal Career Development Plan.docx
Objective #2: Make Sound Decisions:
For the second E-portfolio objective I chose my Case Study One and Case Study 4 papers. Both of these papers were written for a critical care nursing class in fall 2020. Case Study One (Artifact 2A) is about an elderly female who was recently admitted to a hospital with acute on chronic congestive heart failure (CHF). I chose these papers for this objective because its important to make the right assessments and decisions for patient care, these papers display some decisions based on assessments of patients. She had come with complaints of worsening shortness of breath (SOB), edema, and fatigue. She had history atrial fibrillation (A-fib), myocardial infarction (MI), renal insufficiency, and hypothyroidism. She had to be intubated for acute decompensated heart failure due to a massive MI. Post intubation she was alert but not able to make decisions for herself. She was too vitally unstable for a cardiac catheterization and had needed vasoactive medications to support her blood pressure. Her renal function had worsened. She was needing hemodialysis. When speaking with patient’s husband, he said, “She would not have wanted all of this”.
For the paper, I discussed the pros and cons of patient receiving hemodialysis. Considerations to review prior to deciding to cancel hemodialysis were discussed, such as patient’s wishes. The need for an ethics consultant was brought up along with patient’s advanced care directive. The purpose and contents of advanced care directives was detailed in this paper. After discussion amongst patient, patient’s husband, physician, palliative care provider, ethics consultant, and nurse the overall decision/goal was to make the patient’s final months, days, hours, minutes as easy and comfortable as possible for patient and her family. Therefore, no hemodialysis or cardiac stenting will occur for this patient. While still in hospital, nursing will remove the telemetry, no longer do vital sign checks, or anything uncomfortable to patient. Intravenous catheter will be left in if patient is receiving common end-of-life comfort medications such as Ativan and/or morphine. The social worker will discuss the option of hospice at home versus at a facility with the husband. The social worker will make phone calls either to a facility chosen or to a home health hospice agency to assist with keeping patient cared for and comfortable in her final months, days, or hours.
The other paper I chose for this objective is a Diabetic Ketoacidosis (DKA) case study titled Case Study 4 (artifact 2B). This patient was a diabetic who had gotten sick. She had poor intake due to acute illness. She had not been checking her glucose or giving her insulin for a few days. Her presenting complaint was weakness, fatigue, and vomiting. Lab results consistent with DKA. Positive blood cultures and R lung rhonchi.
In this paper I described insulin hormone function in the body, the pancreas, insulin resistance and sensitivity, type 1 diabetes, type 2 diabetes, damage to nerves and organs from uncontrolled blood sugars leading to peripheral neuropathy, blindness, amputation and other possible negative effects. Also discussed the risk factors for type 2 diabetes, such as obesity and sedentary lifestyle. In this paper I discussed the cause of this patient’s DKA on a pathophysiologic level. Talked about the excess of ketones and symptoms of DKA. Listed the classic signs and symptoms of DKA, including excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruit-scented breath, confusion, high blood sugars. I then detailed this specific patient’s DKA symptoms and the pathophysiology of her symptoms, such as fatigue and weakness: glucose is not entering cells like it should be therefore brain and rest of body not getting adequate O2, vomit: body is trying to expel ketone excess and lower blood glucose, hyperglycemia: high level of glucose in blood, because glucose is not moving into cells. ketones in blood: ketones are released when body uses fat for energy. Tachypnea/sob: Ketones are causing blood acidity. Body compensates/attempts to correct acidic pH by hyperventilation to get rid of carbon dioxide. This patient also has pneumonia which is also causing SOB, fatigue, positive blood culture. This is the acute illness which caused her weakness and fatigue in the first place. If it were not for her pneumonia she would have been eating/drinking, monitoring her glucose and taking insulin as normal. I went on to describe the pathophysiology of the anion gap, goals of treatment and interventions needed for her care, as well of education needed for the patient on how to manage her diabetes when she is acutely ill so this doesn’t happen to her again.
Link to artifact 2A NUR455 Case Study One.docx
Link to artifact 2B NUR455CaseStudy4 (2).docx
Objective #3: Demonstrate Clinical Excellence to Provide Caring, Compassionate, and culturally appropriate care:
For the E-portfolio objective 3 I chose a paper and a PowerPoint to show caring and compassionate care to the patients in these pieces. Pediatric Assessment and Vaccine Teaching (artifact 3A) and Prevention of VAP PowerPoint (artifact 3B). My pediatric paper discusses abnormal finding in a pediatric assessment of a male under the age of 13, consisting of enlarged tonsils and neck being tender to palpation on one side. I go on to discuss that an ear, nose, and throat (ENT) physician should be consulted as he may need a tonsillectomy for tonsillitis. As a nurse I take this visit as an opportunity to educate the patient and his mother on which vaccinations he may be needing currently and coming up. Upon looking over his vaccine history, the nurse finds that this child is up to date with recommended vaccines per Center for Disease Control (CDC) guidelines up to this point. Vaccines recommended for his age (12) are Influenza (IIV), Meningococcal (menACWY-D), Tetanus, diphtheria, pertussis (Tdap), and Human papilloma virus (HPV). Patient and parent teaching for recommended vaccines: Indications and importance for each vaccine for the patient, community, and globally. Contraindications, risks and benefits of each vaccine. Give a copy of and go over the Vaccine information statement (VIS) for each vaccine with patient and parent. Educate on more serious side effects and what to do if one presents. Educate on if/when a booster is needed for each vaccine. I then attached an education sheet that I made regarding each vaccine that is recommended for this patient.
The second piece I chose for this objective is a group PowerPoint I made for a critical care class in fall 2020, made up of 19 slides. Ventilator-associated pneumonia (VAP) sometimes develops in intubated/ventilated patients. Being intubated and on a ventilator increases a person’s risk for pneumonia. Pneumonia occurs when bacteria gets into the lungs and clogs up the tiny air sacs (alveoli), decreasing or preventing gas exchange. This PowerPoint presentation discusses evidence-based ways to prevent and treat VAP. Many visuals and diagrams are shown and described in this PowerPoint presentation.
Link to artifact 3A Pediatric Assessment and Vaccine Teaching (1).docx
Link to artifact 3B Evidence-based practices for ventilator acquired pneumonia prevention (1) (2).pptx
Objective #4: Communicate, Collaborate, and Negotiate effectively to Improve Patient Healthcare Outcomes:
For E-portfolio objective 4 I chose Interviews of People in the Community (artifact 4A) and Evidence-based Pressure Ulcer Prevention Poster (artifact 4B). I had to communicate and collaborate with many people in order to interview and obtain responses from each of them for the community project. Nurses need to communicate and collaborate with other nurses and nursing assistants for cleaning, feeding, and repositioning patients to prevent pressure ulcers.
The paper on interviews of people in my community of Albertville, MN was written for a community health class in fall 2020. Five people with different occupations who live and work in Albertville, MN were interviewed about their perceptions of the health of the community. Albertville is a suburb, urban community, on the North West tip of Minneapolis.
I discussed the history, name changes, and development of Albertville. Then described the questions and answers of the five people who were interviewed. They were all asked the same 6 questions: What do you think is healthy about living in this community, what do you think is not healthy about living in this community, what do you think could make this community healthier, what would you like to be changed in this community, what resources would someone need to make healthy changes happen in this community, and what do you have to say about the overall health of this community.
Then I summarized and compared the responses of the five people who were interviewed to find overall similarities and suggest health goals for this community. There is a consensus among these interviews that Albertville is moderately healthy and safe with a great school district. The 26-year-old female did mention the safety concern of being so close to a hot spot for human trafficking. It seemed very easy for each one of them to think of ways the community’s health could improve, as if they had already had these thoughts. They, for the most part, all had the same ideas such as a community pool, better/more trails, better/more parks, more activities, and healthier restaurants. If I were interviewed, I would have mentioned the high incidences of cancer a couple miles down from the nuclear power plant in the town a few miles North East of here, Otsego, MN. There is a group on Facebook for this community where people are noticing correlations with symptoms and illnesses in relation to where their homes are located. They keep each other updated on any progress made with the city, county, and state on this subject.
The other artifact I chose for objective for is Evidence-based Pressure Ulcer Prevention Poster (artifact 4B). This poster was made for a class called Evidence-based Nursing in spring 2018. This poster showcases a few statistical diagrams about the rate of pressure ulcer development in hospitalized patients between in years 2008-2012, another diagram shows statistics on stage 3 and 4 hospital acquired pressure ulcers in patients years 2007-2012 amongst 55 university health system consortiums. This poster lists evidence-based practice guidelines for pressure ulcer prevention.
Link to artifact 4A Interviews of People in the Community of Albertville (1).docx
Link to artifact 4B EBN Guideline Poster.pptx
Objective #5: Exhibit Professional Values and Behaviors as outlined:
For E-portfolio objective 5 I chose a discussion board paper I wrote for a leadership and management class in spring 2020 to show nursing values and behaviors which are important in this career. I summarized my nursing experience in different areas of nursing and different roles in nursing other than staff nurse, such as charge nurse, preceptor, admission nurse and a flyer nurse (jumping between units, helping nurses as needed). I also spoke about the various quality and improvement committees I have been a part of.
In this paper I described many leaders I have worked with and their style of leadership and whether they were effective or not. I also discussed what I think is the most important quality in a leader: I think selling is the most important quality in a leader. If you can explain the purpose for a task/change and it makes sense to each employee, they are far more likely to comply with the task/change than if nobody understands the reasoning behind the task/goal. Including employees in decision making can help with this greatly. Something I learned from a nursing manager in the past is that in this field patient perception is our reality. Nurses need to be mindful of their non-verbal’s. How a patient perceives you is what matters. I discussed if I feel supported by my current nursing leadership and why. In this paper I identified three words to describe my leadership skills: emergent, democratic, and transformative.
The other piece I chose for this objective was a group PowerPoint presentation that I helped create for Information management in Nursing class in fall 2011. Discussed the term consensus, basic concept for needing electronic health records, and several levels of involvement for electronic healthcare records to transition from paper to electronic, including political, vendor, and healthcare providers.
Link to artifact 5A Leadership_Week1Discussion.docx
Link to artifact 5B Building Consensus for Electronic Health Records with audio.pptx
Objective #6: Promote Healthy Lifestyles:
For E-portfolio objective 6 I chose an adobe presentation I created for a Pathophysiology and Nursing Assessment class in fall 2019. This presentation is a case study review in which I detail a patient assessment, vitals, labs, and imaging of a pulmonary embolism patient. I describe what a pulmonary embolism (PE) is including pathophysiology, signs and symptoms of PE, and treatment for PE including pharmacologic management. This presentation discusses prevention which is an important part of any healthy lifestyle.
The other piece I chose for this objective is another paper I wrote for the same class. This paper promotes a healthier lifestyle, with the goals being weight loss and HTN control. This paper is titled Weight loss to Cure Hypertension (artifact 6B). For this paper I chose a person who needed education about their diagnosis. I detailed an assessment of the person’s learning needs relating to their diagnosis, identified learner objectives and goals, created a teaching plan specific to this patient and diagnosis, then did an evaluation of the teaching plan and its effectiveness.
Link to artifact 6A https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:8b8a88d0-9d38-4249-8147-0b261c337d61
Link to artifact 6B Weight loss to Cure Hypertension.docx
Objective #7: Incorporate Evidence-based Knowledge and Theory into Nursing Practice:
For E-portfolio objective 7 I chose a paper I wrote titled Reviewing this guideline: Interventions for prevention and treatment of pressure ulcers. In: Prevention and treatment of pressure ulcers: clinical practice guideline (artifact 7A). This paper goes over evidence-based practices to improve patient outcomes.
Nursing concepts for this guideline include: nutrition: Including energy intake, protein, vitamins, minerals, and hydration status of patients with pressure ulcers and for pressure ulcer prevention, repositioning frequency to prevent and to heal pressure ulcers, positioning of patients to prevent and to heal pressure ulcers, positioning medical devices: to prevent ulcers and to heal existing ulcers, medical device related pressure ulcers and risk for device related ulcers, skin care under medical devices to prevent pressure ulcers/skin breakdown. I reviewed 7 different articles and identified the purpose for each, the method, independent variables, dependent variables, specified each articles sample size, listed how the data for each article/study was collected, discussed results, implications for nursing practice, implications for future research, strengths and weakness of each article/study, then specified how each of the 6 articles related to the guideline.
The other paper I chose for objective 7 is my Anaphylaxis Management paper (article 7B). This paper reviews evidence-based information regarding the care of anaphylactic patients. In this paper I listed common misconceptions surrounding anaphylaxis. One of the misconceptions is that shock needs to be present. If shock isn’t present, some physicians are not treating the patient adequately or aggressively enough, which leads to poor outcomes. This brings up another misconception that many physicians have about epinephrine being dangerous. My paper discusses the safety of epinephrine and the reasons/errors that sometimes occur which created this misconception. My paper discusses the way the UK treats patients with anaphylaxis and that those patients have better outcomes, statistically. I then describe the pathophysiology of anaphylaxis. My paper goes on to talk about patient-centered medical and nursing management. The most important part of the nursing management of suspected anaphylaxis is to maintain an open airway with adequate oxygenation. Finally, I discuss how to apply this knowledge to nursing practice, including the education of parents/caregivers to educate day care, school, babysitters, siblings, grandparents, and anyone else who may be in care of a child or vulnerable adult about anaphylaxis and use of epi-pen.
Link to artifact 7A EBN My Literature Review Matrix (1).docx
Link to artifact 7B Anaphylaxis Management.docx
Objective #8: Demonstrate Leadership and Collaboration:
I chose my Electronic Medical Record (EMR) project (artifact 8A) and my (Information) Info. Systems Site Visit paper (artifact 8B) for E-portfolio objective 8. For this paper, I needed to collaborate with an employee who knows what it takes to convert paper to electronic documentation. In the EMR paper I gave a run down of the history of the hospital and noted that most of the charting at this hospital was already electronic. A form that was not yet electronic at this time of this paper was the MRI Safety Checklist. (Now, in 2021, this checklist is electronic). I discussed what the paper process was at the time and that the process could be made safer if it was converted to electronic. I discussed the timeline for building the electronic document, challenges that could occur, and mandatory components. I compared and contrasted the differences between paper and electronic checklist then wrote a conclusion.
In the Information System Site Visit paper I collaborated with a pharmacist and used leadership skills to determine a time and place for interview. I interviewed Vincent Odane, Pharm.D. Vincent was the Director of Pharmacy Services and had been in pharmacy for over 20 years. He said pharmacy procedures have been evolving to improve patient safety and pharmacist efficiency. Interview questions focused on medication reconciliation and medication administration safety. Vincent had much to say about these topics since medication reconciliation has made such a positive impact on patient safety and medication administration safety has grown with the use of technology. He described the medication reconciliation (med rec) process. I concluded, technology has improved healthcare and patient safety.
Link to artifact 8A EMR Project.docx
Link to artifact 8B Info. systems site visit paper.docx
Objective #9: Allocate and Manage Resources to Ensure Patient Safety and High-quality Healthcare:
I chose my paper Reviewing a trail of miscommunications which ended in patient death (link is titled Safety Case Study, artifact 9A) for objective 9 to identify areas of safety impairments to gain awareness and approve safety measure for future. I, also, chose my Chronic Pain Flyer (artifact 9B) for E-portfolio objective 9 because many people resort to unsafe medications and practices to get pain relief these days. This flyer could help educate someone with chronic pain on other ways to overcome their pain.
The safety case study gives an overview of the case. Busy day at a hospital, on call physician’s phone not working, miscommunications, and patient’s vital signs deteriorated to point of death. The paper discusses the details of scenario in detail. Patient died at 12:30 pm. Doctor arrived in ED approximately 12:45 pm. Autopsy results: septic shock due to infection of small bowel obstruction. In this paper I dissected each error and miscommunication then identified ways in which the hospital could improve and prevent a situation such as this from occurring again.
The other piece I chose for objective 9 is my Chronic Pain Flyer (artifact 9B). For this assignment students were to choose a clinic and make a flyer to provide information on where a person could get some education on services available at the clinic. I chose a pain clinic, listed the name, address, location, phone number of the clinic, along with date and time of the information session. Informational session not only goes over available procedures but talks about pain control techniques, managing and coping with pain, physiological and pshycological dependence, adverse effects of long-term narcotic use, and chronic pain program.
The flyer lists pain relief procedures available at the clinic: trigger point injections, Epidural steroid injections, nerve blocks, discography, radiofrequency neurolysis, spinal facet joint injections, vertebroplasty, percutaneous disc decompression, balloon kyphoplasty, baclofen pump, epidural lysis of adhesions, intradiscal electrothermal therapy, implantable spinal cord stimulation, implantable spinal drug infusion therapy, and headache management therapies.
Link to artifact 9A SafetyCaseStudy.docx
Link to artifact 9B Chronic Pain Flyer.docx
Objective #10: Engage in Life-long Learning and Scholarly Inquiry to Continue Professional Career Development:
I chose my Pulmonary embolism (PE) Case study (artifact 10A) to show that I am staying current on new information for evidence-based practices in care of patients with common diagnoses. I, also, chose my Community Clinical Evaluation (artifact 10B) for E-portfolio objective 10 because it shows collaboration with classmates, collaboration is important for professional career development. PE is the most common cause of preventable death in post-operative patients. The risk of getting a blood clot, whether it’s a deep venous thrombosis (DVT) or a PE, increases after any surgery. Surely there are patients who wonder why getting surgery on their knee, for example, would cause a clot in their lung. Clots formed anywhere in the body (such as the knee) can break away and travel through the vessels to the lung (PE), heart, or brain. I then go into detail about the pathophysiology, pathogenesis, risk factors, and clinical features of PE. This is a case study, so I review that history and physical assessment findings on patient with PE. Including biographical data, source of history, patient’s reason for seeking care, current medications, family history, review of systems, functional assessment, physical exam, vital signs, diagnostics, medical management, and pharmacologic therapy for PE. Medical management recommendations and nursing management. I go on to discuss plan of care and interventions for the patient then write a conclusion.
The second piece I chose for objective 10 is a group PowerPoint presentation Community Clinical Agency Evaluation (link is titled Community Clinical Eval, artifact 10B). Slides 1-5 are about the clinical agency/facility that I chose for the elderly patient who was described on slide 2. Each person in the group chose a facility in their area of the United States that would be a good fit for this patient, each student then did research on the facility to gain information needed to give a thorough review and educate each other about each place.
Link to artifact 10A PulmonaryEmbolismCaseStudy.docx
Link to artifact 10B CommunityClinicalEval.pptx
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