Application of Nursing Interventions Classification (NIC)

Application of Nursing Interventions Classification (NIC) Leslie Bruchey Elements of the Professional Nursing Role Nursing care is provided in all hospitals, in different states, different countries with different practices. But with that being said, the nursing process using NANDA –I Taxonomy of Nursing diagnoses, the Nursing Outcomes Classification (NOC) and Nursing Intervention Classification (NIC) can provide some standards in care where it is received. Throughout this paper, we will discuss a clinical case that uses these tools in providing care and looking at the patient outcome and discuss the systems that were in place. Clinical Encounter This patient was admitted to a medical surgical unit with the diagnosis of pulmonary fibrosis, shortness of breath and pain with inspiration, atrial fibrillation and MRSA in the urine. Patient’s other history included chronic kidney disease, oxygen dependent at home and a low ejection fraction. With this being said, this patient had several things happening, but was being treated with antibiotics and Cardizem to control A-Fib. In the middle of the night, the patient was a rapid response for hypotension and moved to the intensive care. Because of a previous echo that revealed the patient’s EF was only 12%, large fluid boluses were not really an option to treat hypotension. The hypotension was caused by a few different reasons, the nurse in med surg had given this patient multiple blood pressure medications, and the critical care doctor felt that she was becoming septic due to her presentation. Also, the critical care doctor decided that the patient needed a stat VQ scan to rule out the possibility of a pulmonary embolism. The patient results concluded that there was a high probability of a pulmonary embolism which warranted the patient to be placed on IV heparin, have a venous ultrasound of her legs and an echo. These tests reviewed no clots in her legs or heart. With heparin, a PT/INR was drawn for baseline and then a hep xa was drawn every 6 hours until the heparin was therapeutic. A BNP and CBC were drawn to monitor blood cell counts and a central line was placed and the patient was placed on Levophed to prevent hypotension for a few hours. After a few hours, the patient was able to keep blood pressure controlled without medications. Antibiotics were continued as patients WBC’s were 14000 and the patient was continuously monitored in the ICU for a few days. CVP’s were measured at 5 and urine output was monitored closely. Nursing Diagnosis This patient had multiple nursing diagnoses’ that fit her condition. One of the diagnoses that fit this patient is decreased cardiac output. With the patient being in A-fib and with an EF of only 12% this patient does not have optimal cardiac output. The patient also prevents with hypotension which is believed to may have been caused by medications that effect preload and afterload which will also decrease the cardiac output of this patient. This diagnosis is a part of NANDA- I Taxonomy of Nursing Diagnoses and falls under domain 4 Activity and Rest and class 4 which discusses Cardiovascular/ Pulmonary Responses (NANDA, 2012). Nursing Interventions Classification Interventions The following are nursing interventions that were used on this patient using the NIC (Nursing Interventions Classification). Hemodynamic Regulation (4150) Definition: â€Å"Optimization of heart rate, preload, afterload and contractility† (Bulechek, Butcher, Dochterman, 2008) Ways to intervene: Patient was placed on a presser, i.e Levophed to cause vasoconstriction and promote an increase in blood pressure A small 250ml fluid bolus was given prior to coming to the intensive care unit The patient was placed on hemodynamic monitoring to check central venous pressures and allowed us to monitor fluid status Medication parameters were in place for medications that would effect HR, preload, afterload Oxygen Therapy (3320): Definition: â€Å"Administration of oxygen and monitoring of its effectiveness† (Bulechek, Butcher, Dochterman, 2008) Ways to intervene: Oxygen provided by nasal cannula was titrated by oxygen saturation, patient was on 3L. Continuous oxygen saturation monitoring by a pulse ox on the finger. Respirations and patient comfort were also monitored, i.e. no shortness of breath or trouble breathing. Urinary Catheterization (0580): Definition: â€Å"Insertion of a catheter into the bladder for temporary or permanent drainage of urine† (Bulechek, Butcher, Dochterman, 2008). Ways to intervene: Foley was placed to monitor urine output. Output was monitored to check fluid balance because of patient’s history of CKD, the MRSA infection and having a low ejection fraction. The catheter was temporary and was used for strict input and output. Family Presence Facilitation (7170): Definition: â€Å"Facilitation of the family’s presence in support of an individual undergoing resuscitation and or invasive procedures† (Bulechek, Butcher, Dochterman, 2008). Ways to intervene: Family contacted because patient was moved to intensive care and needed a emergent central line placement. Patient was extremely anxious and requested that we contact her family to come in for needed support. Family came in and educated on what happened and any other information that was needed at that time. Nursing Outcomes Classification Outcomes Now that we have defined a nursing diagnosis and provided some interventions that this patient needed, it is time to discuss the patient outcome. These interventions help the patient achieve multiple goals and as a nurse, all of our interventions help us improve patient outcomes. This patient has multiple nursing diagnoses, but because decreased cardiac output was addressed, the outcome will be as follows: Cardiac Pump Effectiveness (0400) Definition: â€Å"Adequacy of blood volume ejected from the left ventricle to support systemic perfusion pressure† (Moorhead, Johnson, Maas, Swanson, 2008). The patient will be able to maintain blood pressure without pressers. Patient will have a follow up echo that showed her ejection fraction was 45%. Patient will have adequate urine output. CVP measurements will be within normal limits. Patient will have activity tolerance when getting out of bed and ambulating around room. Patient will continue outpatient rehab to rebuild strength over time. Advantages and Disadvantages The nursing process allows for a standard of care to be provided anywhere that a nurse cares for a patient. With being able to identify what the patients problems are through a nursing diagnosis, we are able to next focus on the interventions that best fit and will provide the best patient outcome. When looking at a patient, we all have our own outcomes that we want to achiever to better the patient. In the patient above, there are many problems that could results in a long list of nursing diagnoses. With being able to focus on one at a time, a nurse is able to think about the needed steps to achieve the positive outcome that we all look at. With using the NIC, NOC and NANDA-I, nurses anywhere are able to identify a problem, the steps to improve the problems and the hopefully outcome for this issue. While these tools help standardize care that nurses provide and focus on and to make sure that the needed interventions to improve the outcome are being performed and are being documented . It is important that the nurse can focus on the needs of the patient and to take credit for all the important things we do during our time with a patient. I also think the nursing process is great for other disciplines to look out what nursing is focusing on and also may help guide the rest of the care that is provided. With this documenting process and just using in the clinical setting, newer nursing can use it to help focus the care their patients may need. These tools are a great resource for nurses but they do have some disadvantages. In day to day care in the nursing realm, these tools are a great resource, but in reality are hard to find time to access and continually document on them. I have seen these types of programs being used in the clinical setting and because nurses are busy, some just copy and paste the same thing over and over day to day. This does not show how we are intervening to meet the outcome. If used right, it is a great tool, but there are a lot of nurses that look at it as just another silly hoop to jump through during patient care and just another thing to document. Some nurses do not take the time to think about what interventions would help our patients. Also, I think that the various lists are good; however, sometimes it is hard to find the exact name of the intervention that we want to use. It takes time to look through the list to find the exact intervention or outcome that best fits out patient needs. Also, it would be hard to get all nurses on board to document with this type of syste m because some are resistant to change and others just are already overwhelmed with the amount of documentation that is required throughout the day. Conclusion The NIC, NOC and NANDA-I Taxonomy of Nursing Diagnoses are a great guide for standard nursing care. Anyone can use these documents to help focus the care their patients need. I believe documenting to nursing process throughout this system will allow for better patient outcomes to continuously reevaluate what the patients’ needs are and what is going on with a patient. Other disciplinary team members would be able to look at what the problems nursing are focusing on and see where they can help support that patients care. Overall, the standardized care would support patient outcomes and allow for nurses to focus on what they can do, improving the patients care by identifying problems, inventions and outcomes. References Bulechek, G.M., Butcher, H. K., Dochterman, J.C. (Eds.). (2008). Nursing Interventions Classification (NIC) (5th ed.). St. Louis, MO: Mosby Elsevier. Moorhead, S., Johnson, M., Maas, M., Swanson, E. (Eds.) (2008). Nursing Outcomes Classification (NOC) (4th ed.). St. Louis: Mosby/Elsevier. NANDA International. (2012). NANDA international nursing diagnoses: Definitions classification 2012-2014. T.H. Herdman, (ED.). Kaukauna, WI: Author.

Construction Management Essay

a. (1) Stanley’s focus is on maximizing profits. This is the correct goal because the goal of anyfirm, and therefore its financial manager, should be to maximize its value and by extensionthe wealth of the shareholders. (2) There is potential for an agency problem if Stanley decides to go ahead and invest in thesoftware developer. This investment will cause a temporary decrease in the earnings per share (EPS) of the firm which will mean fewer earnings at the present time for thestakeholders. This may be a problem if the goal of the shareholders is to gain moneysooner than later. However, it the goal of the shareholders is simply to maximize wealth,there may not be an agency problem since the goal of the financial manager, Stanley, is the same as the shareholders’. b. Since there is no preferred stock; Earnings available for common stockholders= Net Profit After Taxes No of shares of common stock outstanding = 50 000 EPS = NPAT/ no. of shares of common stock outstanding EPS show a steady increase over the past five years indicating that Stanley is achieving hisgoal of maximizing profits. c. Operating Cash Flow (OCF) for 2012OCF = {Earnings Before Interest and TaxesÃâ€"(1– Tax rate)} + Depreciation OCF = {EBIT Ãâ€" (1– T)} + Depreciation = {$89 000 Ãâ€" (1 – 0.20)} + $11 000 = $82 200 Free Cash Flow (FCF) for 2012 FCF = OCF1– Net Fixed Assets Investments – Net Current Assets Investment FCF = OCF – NFAI – NCAI NFAI = Change in net fixed assets + Depreciation= ($132 000– $128 000) + $11000 = $15 000 NCAI = Chance in current assets – Change in (Accounts Payable + Accruals) = ($421 000 – $62 000) – {($136 000 + $27 000) – ($126 000 + $25 000)}=$47 000 FCF = $82 200 – $15 000 – $47 000 = $20 200 Both the operating cash flow and the free cash flow are positive indicating that Stanley wasable to generate adequate cash flow to cover both operating expenses and investments inassets. There was also $20 200 left over to pay to investors. a. (1) Upon what financial goal does Stanley seem to be focusing? Is it the correct goal? Why or why not? Stanley seems to be focusing on profit maximization, in another word the EPS performance. It is not the correct goal, as profits do not necessarily result in cash flows available to the stockholders, only when earnings increases are accompanied by increased future cash flows would a higher stock price be expected, therefore the stockholders’ wealth would be maximized. (2) Could a potential agency problem exist in this firm? Explain. There is a potential agency problem exist in this firm. First of all, he owns only 40% of the firm, but he manages actively all aspects of its activities and the other stockholders are not active in management of the firm, so he is an agent of the other owners. Secondly he is reluctant to take more than moderate risk, which might jeopardize his goal of profit maximization and reduce his personal wealth, so there is a conflict between owner wealth maximization and his personal goals. Scri Bd: (a) Upon what financial goal does Stanley seem to be focusing? Is it the correct goal? Why or Why not? The financial goal that Stanley seems to be focusing on is maximizing the profitability of Track Software Inc. which is apparent in years 1997 to 2003 increases in net profit from ($50,000) to $48,000 respectively. His financial goal of profit maximization was also evident in his hesitance to hire a software developer because this would result in a salary cash outflow of $80,000 per year and lower the Earnings Per Share(EPS) in years to come. Par:(1)Stanley is focusing on maximizing profit, as shown by the increase in net profits over theperiod1997 to 2003. His dilemma about adding the software designer, which would depress earnings for the near term, also demonstrates his emphasis on this goal .Maximizing wealth should be the correct goal for a financial manager. Wealth maximization takes a long-term perspective and also considers risk and cash flows .Profits maximization does not integrate these three factors (cash flow, timing, risk) in the decision process (2) An agency problem exists when managers place personal goals ahead of corporate goals. Since Stanley owns 40% of the outstanding equity, it is unlikely that an agency problem would arise at Track Software A. Maximization of shareholder wealth, which means maximization of share price,should be theprimary goal of the firm. Unlike profit maximization, this goalconsiders timing, cash flows, andrisk. It also reflects the worth of the owners’investment in the firm at any time. It is the value theycan realize should theydecide to sell their shares. B. Yes, there appears to be an agency problem. Although compensation for management is tied toprofits, it is not directly linked to share price. In addition,management’s actions with regard topollution controls suggest a  profitmaximization focus, which would maximize their earnings,rather than an attemptto maximize share price Eco Plastics Company ECO Plastics Established in 2000, ECO Plastics Ltd is the UK’s leading and highest quality plastic bottle recycler producing plastics for soft drinks and milk bottles. Challenge In March 2011, the company signed a ten-year joint venture deal, a first in the UK drinks manufacturing industry, to supply the global enterprise with high quality food-grade recycled material (rPET). In order to achieve Coca-Cola’s target of including 25% rPET in all plastic packaging within Great Britain by 2012, ECO Plastics needed to expand their premises. Jonathan Short, Managing Director of ECO Plastics Ltd said, â€Å"We were thrilled to sign the joint venture deal with a company of the calibre of Coca-Cola and begin the next important step for our business. All we needed to do was secure the additional capital required to expand our premises and fund our operations.† Solution ECO Plastics approached a number of finance providers but found that due to the economic climate, lending was restricted. â€Å"It was difficult at first to find the financial backing we needed to expand our business and meet the needs of our exciting venture with Coca-Cola,† said Mr. Short. â€Å"We approached Close Brothers and discussed a structured finance solution, tailored to meet our specific business requirements. The deal was primarily a leasing contract, secured against our existing assets which incorporated invoice finance to fund our operations during the expansion.† Result The combined asset-based financial platform of  £18million provided by Close Brothers Invoice Finance and Close Brothers Leasing supported the construction and operation of the expansion to ECO Plastics’ processing plant, which completed in 2012. â€Å"Without Close Brothers, we would have been unable to fulfil our agreement with Coca-Cola which would have not only been devastating to our business, but to the industry as a whole,† said Mr. Short. â€Å"Working with Close Brothers has afforded us with the opportunity to expand our business and realise our true growth potential as we continue to  work toward becoming the world-leader in sustainable packaging.†

Life In The U.S

It took me eighteen years to realize what an extraordinary Influence both of my parents are to my life. As well as me, they were both born in Mexico. I come from a family that takes risks in order to achieve something in life. ThatS exactly what they did once my mother Maria gave birth tome in Mexico. It only took a short amount of time to realize they didn't want me or my sibling to go through everything they went through when they were younger. They changed their whole lives around just for their family. Knowing they had to go through a lot to get where they are right now.I admire the person they have become and they influence me because I want to be able to achieve my goals and become someone in life Just for them. My name is Deyanira Cerriteno. I was born in September 13, 1995. This is my last year attending at Benson Polytechnic High School. At the age of 4 months until four years old I lived with my Grandparents ; my Aunts and uncles when my mom came here to the united States. Let me tell you a little something about my mother Maria. She was born in Michoac?n, Mexico. She was a mommy's girl and not so much of a daddy's girl.She had eight brothers and sisters. She Is the 4th oldest out of all and she was one of the most caring ones. She would always take care of her younger siblings. She would talk about boys Just like any other teenager in the world. But just like any other family, her family had struggles. They had financial struggles. At one point they were a moderate family but everything went down the hill. They couldn't keep up with all of their children's school pays, house rent, water payment, food to feed the whole family, and money for necessary things like clothes, etc†¦ en she knew she was pregnant of me that's when she realized she didn't want me to go through the struggles that they were going through. They wanted me to have a good life and actually be someone in life so that their grandsons/daughters would not go through the struggles a s well. Her and my father were closer than they were before and they both took the decision to immigrate here to the Unites States. Unlike my father, my mother was scared to get caught by immigration and get sent back to Mexico. They had to go through the dessert where they found scorpions, and cactus.Not the safest environment. It's awesome to know they did it for me. My father Enrique on the other hand was born in M ©xico as well. My father had 5 brothers and sisters. Both of his parents got separated and went their own way. But his father was an alcoholic and only decided to take both of the oldest kids that were working at the time. After his father left his mother with the other 4 kids, everything got worse. My dad felt useless and felt Ilke his dad never felt love for him. Not long after my grandfather left, my grandmother got sick and that's when she as diagnosed with cancer.My dad didn't know what to do. They were all alone. No one had a Job. My grandmother wasn't able to take care of her kids because she was weak most of the time. My father being the oldest that was left was going out in the streets and begging for money, looking out for any jobs that were available. He was only 8 years old. He left school and supported his mother because she couldnt do 1 OF2 tne same tnlngs sne usea to. He naa turned Into tne Tatner Tlgure Tor nls Drotners and sisters. He found a Job and was able to feed 5 mouths and his own.People round didn't like my grandmother because they thought she was the reason why her husband left but in reality, it was all of my grandfather's fault. he was the one that was never there to help my grandfather with all I've the kids, he wasn't being responsible . I know I don't have the right to Judge anyone. My parents taught me better. Behind everything there is always a reason. My parents did something illegal. But they took the risk to cross the border and also risks their lives Just so that me and my future siblings could have a better life then they did.I understand what they went hrough. I honestly appreciate their hard work. That's why, in my future as a nurse I am going to help out the ill and also make my parents proud of me because that's why they came here in the first place. I am not ashamed to tell people I once came from a place where we had no house or were poor and hardly had money to feed ourselves. That's where everyone begin. They begin from the bottom and take their selves up high. Both of my my parents were the strong ones and came from a family were they take risks and l, once again , am the person I am. Thanks to them.

The Madwoman in the Attic by Sandra Gilbert and Susan Gubar

Oftentimes literature can have a profound impact on not only individuals, but on the entirety of the society in question. The written word has more than proven to be an important tool used to challenge societal norms as well as cultural expectations, to shake the framework of society and act as a harbinger of changes that trickle through and flood the socio-political orders that be. This was particularly true for the nineteenth-century female writer who was â€Å"enclosed in the architecture of an overwhelmingly male-dominated society† (Gilbert and Gubar). As the authors of The Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination Sandra Gilbert and Susan Gubar point out, there existed at the time â€Å"a common, female impulse to struggle free from social and literary confinement through strategic redefinitions of self, art, and society† (Gilbert and Gubar). One would have difficulty fully understanding social facets of the Victorian e ra without making an effort to first understand the plight of emerging female writers during this time period, especially noting that some sought male-sounding pseudonyms in order to secure their publications, and to be taken seriously as novelists and authors. Charlotte Bronte and Elizabeth Barrett Browning are two such female writers who actively sought to redefine society through their work—in particular, the expectations women were meant to make realities. Bronte’s 1847 novel entitled Jane Eyre and Browning’s 1856Show MoreRelated Exposing the Role of Women in The Madwoman in the Attic Essay1701 Words   |  7 PagesExposing the Role of Women in The Madwoman in the Attic  Ã‚  Ã‚     Ã‚   In their book The Madwoman in the Attic, Sandra Gilbert and Susan Gubar address the issue of literary potential for women in a world shaped by and for men. Specifically, Gilbert and Gubar are concerned with the nineteenth century woman and how her role was based on her association with the symbols of angels, monsters, or sometimes both. Because the role of angel was ideally passive and the role of monster was naturally evil, bothRead MoreEssay on Feminist Theory in Heart of Darkness1199 Words   |  5 Pagesargue the novel is gendered feminine. Sandra Gilbert and Susan Gubar claim â€Å"Conrad’s Heart of Darkness†¦penetrates more ironically and thus more inquiringly into the dark core of otherness that had so disturbed the patriarchal, the imperialist, and the psychoanalytic imaginations†¦Conrad designs for Marlow a pilgrimage whose guides and goal are†¦eerily female† (DeKoven 233). This short essay will use Joseph Conrad’s novel Heart of Darkness to highlight Gilbert and Gubar’s theory of angel/monster dichotomyRead MoreThe Madwoman in the Attic4718 Words   |  19 Pages23-41 OPEN ACCESS ISSN 2220-4504 www.ieit-web.org/apscj Women’s Secret Language: the Madwoman in the Attic in a Cultural and Psychological Context JIA Shi 1 1 The University of Iowa E-Mails: daisy-wreath@hotmail.com Received: Apr. 2011 / Accepted: May 2011 / In Press: May 2011 / Published: Jun. 2011 Abstract: As an outstanding representative of the second-wave feminism, The Madwoman in the Attic is still useful in handling the relationship between women and language, especially whenRead MoreRelationship Between Emma Woodhouse And George Knightley1089 Words   |  5 Pagessame rank as his own, with a little money, it might be very desirable†. (Austen 30). Marriage doesn’t serve as the only expectation for women. 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Bertha then, is a reflection of Jane’sRead MoreJane Eyre By Charlotte Bronte1601 Words   |  7 Pagesrepresentation of the fem ale Victorian writer, trapped in the â€Å"attic† of societal conventions and labeled as a madwoman for her passionate display of emotion (Gilbert and Gubar 7). The only way that Bertha was able to show her power is through unacceptable displays of emotion and arson. Female writers who wrote about unacceptable and taboo ideas, or anything at all, were often labeled as inferior and too passionate, like Bertha (Gilbert and Gubar 12). Rochester called her  intemperate and unchaste (Brontà «Read More Mothers in Jane Austens Sense and Sensibility Essay1517 Words   |  7 Pagescompliments and attention, Fanny Dashwood desires money. Their poor mothering skills, however, are not surprising, but merely reflect Austens clear portrayal of them as shallow individuals with unbalanced values. In Sandra M. Gilbert and Susan Gubars now-classic The Madwoman in the Attic, they discuss a strange breed of women in Austen novels that, unlike the heroines, are angry, ruthless, and powerful. Often, they are mothers or surrogate mothers who seek to destroy their docile children (170).