what are the three components of the DRI? 

describe how RDA. AI, AND UL influence health

after reviewing your results on the interactive DRI, how well are you meeting the RDAs suggested 

what two changes can you make to improve

 Avsar, P., Budri, A., Patton, D.,  Walsh, S., & Moore, Z. (2022). Developing algorithm based on  activity and mobility for pressure ulcer risk among older adult  residents: Implications for evidence‐based practice. Worldviews on Evidence-Based Nursing, 19, 112–120. https://doi.org/10.1111/wvn.12545 

 RESPOND TO PEERS WITH APA REFERRENCE    

 Tony    

  Healthcare technology trends are essential to healthcare and providing optimal care to patients. The use of technology will only become advanced for many years to come in healthcare. Technology is playing more of a role in patient care and experience to achieve the best possible outcomes for patients (PR Newswire, 2019). The healthcare technology seen in my facility is the most recent change over to electronic medical record (EMR), the implementation of a robot to transport medications for pharmacy, and the patient access portal. The EMR serves many purposes in daily patients care and it is utilized by almost every individual in the facility. As new nurses start in the field, it is important to have a basic understanding of EMR and informatics and for it to be part of nursing competencies (McGonigle & Mastrian, 2017). The EMR has also served as a gateway for my facility because it has introduced more technology since its implementation, such as the pharmacy robot and the patient access portal. The pharmacy robot is connected through the EMR and is triggered to send medication up to nurse when requested through the patient's medication chart in the EMR. The robot has been substantial in assisting the pharmacy in delivering medication at any specific time. The downside to the pharmacy robot has been that at times it gets stuck, and the nurse receives the medication late. The other important technological trend is the patient access portal. The portal is viewed by the patient and their medical information and physician providing care is available to view. The portal assists the patients in viewing medications, educational videos pertaining to their medical conditions, and communicating with providers. The negative to the portal is the medical information seen by the patient may be misconstrued if the patient lacks the education of their condition.

            Healthcare technology trends are vital for quality-of-care improvements and also managing cost of facilities (Fichman, Kohli, & Krishnan, 2011). Cybersecurity is going to be a more prominent part of healthcare and providing patients with privacy. Healthcare providers need to be mindful of cyber security to keep patient’s information safe (Kruse, Ffrederick, Jacobson, & Monticone, 2017). Patients will be more willing to participate in the use of the emerging technologies if they know their information is protected.

Florence A

In my experience as a nurse, I have witnessed various healthcare technology trends that have gained prominence in recent years. One of the most remarkable trends is the growing use of Electronic Health Records (EHRs) to manage patient data. EHRs allow healthcare providers to obtain patient data swiftly, encouraging effective and synchronized care. However, one potential obstacle associated with EHRs is the threat of data breaches, which can jeopardize patient privacy.

 Another notable trend is the use of telehealth services. Telehealth allows healthcare experts to provide care from a distance, improving the availability of healthcare for individuals in remote areas or those with restrictions on movement. However, a potential risk lies in the safety of telehealth platforms, as breaches could expose sensitive patient data (Benda et al., 2020). In terms of data safety and legislation, the benefit is that laws such as the Health Insurance Portability and Accountability Act (HIPAA) guarantee the protection of client information. Nevertheless, the risk lies in the intricacy of conformity, which can result in administrative burdens for healthcare institutions.

In my perspective, the most promising trend in healthcare technology for nursing practice is the smooth incorporation of artificial intelligence (AI) and machine learning (ML) into clinical decision support systems. This advancement holds vast potential to change nursing care. Artificial intelligence and machine learning algorithms can manage vast patient information rapidly, providing nurses with valuable understandings that help in making informed decisions promptly (Rubinger et al., 2023). This promise of AI and ML can significantly improve patient care outcomes by reducing errors and optimizing the overall effectiveness of healthcare delivery. By harnessing these technologies, nurses can offer more precise diagnoses, formulate customized treatment plans, and allocate resources efficiently, ultimately contributing to enhanced patient experiences and better healthcare outcomes.

These healthcare technology trends present the potential for significant enhancements in patient care outcomes, efficiencies, and data management. Nevertheless, healthcare organizations must manage the associated obstacles and risks, such as data security and regulatory compliance, to ensure these technologies' safe and efficient application in nursing practice.

 

Answer the questions in both scenarios in your own words. Answer these questions as if you were talking to a peer, unless otherwise indicated.

Shock Case Studies

Scenario #1

K.L., a 25-yr-old Korean American, was not wearing his seat belt when he was the driver involved in a motor vehicle crash. The windshield was broken and K.L. was found 10 ft from his car. He was face down, conscious, and moaning. His wife and daughter were found in the car with their seat belts on. They sustained minor injuries and were very frightened and upset. All passengers were taken to the emergency department (ED). The following information pertains to K.L.

Subjective Data

• States, “I can’t breathe”
• Cries out when abdomen is palpated

Objective Data

Physical Examination:

• Cardiovascular: BP 80/56 mm Hg; apical pulse 138 but no palpable radial or pedal pulses; carotid pulse present but weak
• Respiratory: respiratory rate 35 breaths/minute; labored breathing with shallow respirations; asymmetric chestwall movement; absence of breath sounds on left side
• Trachea deviated slightly to the right
• Abdomen: slightly distended and left upper quadrant painful on palpation
• Musculoskeletal: open compound fracture of the lower left leg

Diagnostic Studies

• Chest x-ray: Hemothorax and six rib fractures on left side
• Hematocrit: 28%

Interprofessional Care in the ED

• Intraosseous access in right proximal tibia placed prehospital
• Left chest tube placed, draining bright red blood
• Fluid resuscitation started with crystalloids
• High-flow O2via non-rebreather mask

Emergency Surgical Procedures

• Splenectomy
• Repair of torn intercostal artery
• Repair of compound fracture

Discussion Questions

1. What types of shock is K.L. experiencing? What clinical manifestations did he display that support your answer?
2. What were the causes of K.L.’s shock states? What are other causes of these types of shock?
3. Priority Decision: What are the priority nursing responsibilities for K.L.?
4. Priority Decision: What ongoing nursing assessment parameters are essential for this patient?
5. What are his potential complications?
6. Patient-Centered Care: K.L.’s parents arrive. English is their second language. They are very anxious and asking about their son. What can you do to provide culturally competent family-centered care?
7. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses?
8. Teamwork and Collaboration: Identify the tasks that could be delegated to unlicensed assistive personnel (UAP).
9. Evidence-Based Practice: You are orienting a new graduate RN. He asks you why crystalloids are used instead of colloids for fluid resuscitation. What is your response?
10. Examine therapeutic nursing interventions associated end-of-life decision-making.

 The following is information that will assist you in answering the question associated with scenario #2

Septic shock is

“A life-threatening organ dysfunction caused by a dysregulated host response to infection” (McCance & Huether, 2019, p. 1550).

The infectious process starts with an infectious agent entering the bloodstream and causing bacteremia either directly from the site of infection or indirectly by releasing toxic substances into the bloodstream. Some of the most common causes of septic shock are gram-negative or gram-positive bacteria, viruses, and fungi. The most common sites of infection are the lungs, bloodstream, intravascular catheters, intra-abdominal, urinary tract, and surgical wounds (McCance & Huether, 2019).

Normal Physiology

In normal physiology, when a pathogen invades the body, the body will react with local and systemic responses.

• Our first line of defense is the body’s natural physical, mechanical, and biochemical barriers such as the epithelial cells and surfaces of the skin. These defenses prevent microorganisms from getting into tissues and also have the ability to remove infectious microorganisms. The surfaces of the skin and mucous membranes of the body also contain normal microbiomes (“normal flora”) that also protects the body by releasing chemicals to prevent pathogens from being colonized (McCance & Huether, 2019).
• The body’s second line of defense is the inflammatory response. Inflammation causes a vascular response that makes vessel walls become leaky and more permeable and makes white blood cells adhere to vessel walls and migrate out into the tissues. Symptoms usually produced by inflammation are the heat, redness, edema and pain. The goal of inflammation is to prevent and limit infection and interact with components of the adaptive immune system as well as prepare the body for healing (McCance & Huether, 2019). 

There are three important plasma protein systems involved to provide an active barrier against invading pathogens in the inflammatory response.

• One is a complement system which destroys pathogens directly and work with other components of the immune responses by three pathways: (1) classic, (2) lectin and (3) alternative. The main functions of these are to induce rapid mast cell degranulation, attract white blood cells to pathogens, and “tag” pathogens for destruction (McCance & Huether, 2019).
• Second is the clotting or coagulation system which forms blood clots that include a meshwork of protein strands at the injured or inflamed site to stop bleeding, trap pathogens to prevent the spread of infection, and provide a framework for repair and healing (McCance & Huether, 2019).
• The last important inflammatory response is from the kinin system which activates and assists inflammatory cells by the release of mainly bradykinin which causes dilation of blood vessels, pain, smooth muscle contraction, increase vascular permeability and leukocyte chemotaxis (McCance & Huether, 2019). 

There are also many biochemical mediators of the innate immune system that secrete cytokines responsible for activating other cells such as interleukins, chemokines, interferons, and other molecules. These chemicals are important to the vascular changes that occur during the inflammatory process (McCance & Huether, 2019).

Along with the cellular mediators are the cellular components such as platelets, phagocytes (neutrophils, eosinophils, monocytes, macrophages, and dendritic cells), natural killer cells, and lymphocytes. The components respond to the site of the injury together to limit the tissue injury, kill pathogens, remove the debris, and prepare for healing and tissue repair (McCance & Huether, 2019). 

Septic shock begins when the pathogen enters the bloodstream. This stimulates the release toxic substances called the triggering molecules, which triggers the body to activate the proinflammatory responses and release proinflammatory cells such as leukocytes, macrophages, monocytes and platelets as well as proinflammatory mediators such as cytokines (interleukins, tumor necrosis factor alpha and other mediators). Cytokines along with the vasoactive peptides cause vasodilation causing hypotension, relative hypovolemia, and decreased in oxygen delivery to the tissues. The release of proinflammatory cytokines also activate plasma protein systems of the complement, coagulation and kinin systems (McCance & Huether, 2019).

Dysfunction of epithelial cells cause further capillary leaking and microvascular thrombus, tissue hypoxia and apoptosis. Due to tissue hypoxia, the body will start breaking down carbohydrates to make ATP or energy for the body. As more anaerobic cells are being used for energy, the more lactic acid is produced. Without correction, the accumulation will lead to metabolic acidosis causing further damage to the tissues (McCance & Huether, 2019).  

As the responses of proinflammatory and anti-inflammatory mediators intensify the body experiences persistent low arterial pressure, low tissue perfusion, low systemic vascular resistance which will profoundly affect the circulatory, cellular, and metabolic systems. These responses will lead to multiple organ dysfunction syndrome (MODS) due to dysfunction of the kidneys, liver, intestines, lungs, and brain as a result of tissue hypoxia and lack of tissue perfusion (McCance & Huether, 2019). 

Tools

Septic shock is measured by the SOFA score and assessing different systems in relation to the severity of the organ failure. The quick SOFA criteria include a respiratory rate equal or greater than 22 per minutes, altered mentation and systolic blood pressure less than 100 mmHg. The standard SOFA scoring includes respiration, coagulation of platelets, bilirubin level of the liver, mean arterial pressure, Glasgow coma scale score, creatinine level, and urine output.

Clinical manifestations

Clinical manifestations of septic shock usually include fever, chills, sweating, warm progressing to cool skin, respiratory distress, altered mentation, decreased urine output, hypotension, elevated liver enzymes, and decreased platelet counts (McCance & Huether, 2019). 

Scenario #2

Mr. S. S. is a 56-year-old, white male with a right diabetic foot ulcer. He was at his podiatrist’s office for a wound check and was referred to the emergency department (ED) due to increasing purulent drainage and necrotic tissue in the wound. Mr. S.S. noticed the drainage getting worse over the last week and has experienced fevers up to 102 degrees F for two days. He also complains of diaphoresis, fatigue, abdominal pain, and general malaise. He states he just does not feel like himself.  

Past Medical History:

Allergic to Penicillin and shellfish

Uncontrolled Type 2 Diabetes Mellitus 

Hyperlipidemia

Hypertension [baseline 140/90]

Obesity [BMI=32]

Cholecystectomy, age 32 years

Left Above the Knee Amputation (AKA), age 54 years

Pertinent Family History:

Mother- Hyperlipidemia, Hypertension, CABG x2 vessels

Father- Prostate Cancer, age 63 years

Pertinent Social History:

Active Smoker (2 packs/day)

History of Alcoholism

Previous history of homelessness

Emergency Department

In the ED, assessment reveals moderate foul odor, purulent drainage from right foot ulcer, and capillary refill of four seconds on upper and lower extremities. Patient is alert and oriented but short-term memory appears to be impaired and the patient is asking abnormal questions. Two peripheral IVs and an indwelling foley catheter are placed, a 1000mL bolus of IVF is initiated, wound and blood cultures are obtained, and the patient is started on broad spectrum antibiotics. An x-ray of his right foot demonstrates soft tissue inflammation and concern for osteomyelitis, so an MRI was completed of his foot. The patient is transferred to MICU for further management. 

ED Vitals:

Temperature: 101.6 degrees F

Heart Rate: 117 bpm

Respiration Rate: 24 breaths/min

Blood Pressure: 92/45 mm Hg (MAP 61)

Blood glucose: 315 mg/dL

SpO2: 91% on 2L NC

ED Labs:

WBC: 26,000

Lactate: 6.0 mmol/L

C-reactive Protein: 11mg/L

Creatinine: 1.4 mg/dL

pH: 7.32

Medical Intensive Care Unit

Upon admission to MICU, Mr. S.S. is lethargic and flushed. Further assessment demonstrates bounding pulses and right lower extremity edema. His heart rate increased and blood pressure dropped despite the liter bolus. The patient is started on vasopressors to maintain his blood pressure and intubated to protect his airway.

Pertinent Vitals:

Temperature: 101.4 degrees

Heart Rate: 154 bpm

Respiration Rate: 30 breaths/min

Blood Pressure: 72/34 (MAP 47)

SpO2: 86% on 2L NC

1. All of the options below are the most common causes of septic shock except for: 
   1. Gram-negative bacteria
   2. Gram-positive bacteria
   3. Viruses
   4. Cancer
2. Which of the following criteria would you expect to see from a patient with septic shock?
   1. Elevated lactate level
   2. 30 ml/hr of urine output
   3. Respiration of 18 rate per minute
   4. Patient is alert and oriented 
3. Which of the following are measurable components of the quick SOFA? Select all that apply.
   1. Respiration rate
   2. Temperature
   3. Heart rate
   4. Systolic blood pressure 
   5. Mentation
4. The patient wants to know more about sepsis asking if he or any of his family members would be at higher risk for sepsis. You tell the patient that most vulnerable patients for this problem would be: (Select all that apply)
   1. Children younger than one
   2. Patients who have received recommended vaccinations
   3. Adults 65 years old and older
   4. People with weakened immune systems
   5. People with chronic diseases
   6. People have been traveled outside of the United States
5. Discuss why septic shock is one of the leading causes of death in the intensive care units.
6. Examine therapeutic nursing interventions associated end-of-life decision-making.