Provide an example on how decision support is embedded in the EHR?

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Question Answered step-by-step Provide an example on how decision support is embedded in the EHR?Please include referencesThank You Health Science Science Nursing HCI 655 Share QuestionEmailCopy link Comments (0)

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Question can you draw concept map  Case Study #2Mr. ScottalineHistory of Presenting Illness (HPI)Health HistoryNon- smokerMr. Scottaline is a 58-year-old male who was brought in to the emergency department by EMS. His neighbor called EMS on his behalf because he looked generally unwell, jaundiced, lethargic, and was behaving in a confused manner.AUD (alcohol use disorder)Known Liver Cirrhosis with portal hypertensionDepressionFamily history is unremarkable  Home MedicationsCarvedilol 6.25mg PO dailyFolic Acid 5 mg PO dailyMultivitamins 1 Tab PO daily Paroxetine 40 mg PO daily Spironolactone 25 mg PO daily Thiamine 100 mg PO daily Physical Assessment on Admission Day 1General Appearance: disheveled, slow and unsteady gaitNeurological: lethargic, oriented to person, inconsistent with date and timeRespiratory:  clear air entry to all lung fields, no SOB, no cyanosis, respirations unlabouredCardiovascular: S1 S2 heard, no murmur, pulses moderate, regular and palpable, skin warm, dry. Cap refill <3 seconds, +2 edema to lower legs bilaterallyGastrointestinal: Abdomen large, softly distended, mild diffuse tenderness, BS x4, loose BM x2 today looseGenitourinary:  Voiding without difficulty, urine clear yellow. No bladder distention notedIntegumentary/ Musculoskeletal:  Skin intact, jaundiced skin & sclera, a few scattered bruises to arms and legs. Motor power moderate and equal x4.Psychosocial:  Lives alone, no kids, divorced. Retired factory worker. Poor management of cirrhosis and portal hypertension. Currently has ETOH consumption ~8beers/day. Vital Signs:  T.  37.8, HR 96 regular, RR 18, 96% RA, BP 94/60DiagnosticsCT scan demonstrates worsening liver cirrhosis Abdominal U/S demonstrates significant Ascites Ascites fluid diagnostics demonstrate spontaneous bacterial peritonitisEndoscopy demonstrates increased portal hypertension  Blood Work on AdmissionCBC:  Hemoglobin 130 g/L (120-160), Platelets 90 (130-380), WBC 13.2  (3.5-10.5)Electrolytes:  Sodium 136 mEq/L (135-145), Potassium 3.8 mEq/L (3.5-5.0), Chloride 100 mEq/L (98-107), magnesium 0.82mmol/L (0.74-1.07) Renal panel:  Creatine 187 (53-106mcmol/L) , eGFR 26  ml/min (>60 ml/min)Liver panel:  AST 68 U/L (0-35), ALT 55  (4-36), ALP 225 (35-120 U/L),   Total Bilirubin 32  mcmol/L(5.1-17)  Miscellaneous:  ammonia 77 mcmol/L (6-47 mcmol/L), albumin 22 g/L (35-50 g/L),  INR 1.9 (0.9-1.1) Working DiagnosisHepatic encephalopathySpontaneous bacterial peritonitis (SPB)Query onset of Hepatorenal syndrome Significant progression of liver cirrhosis and portal hypertensionAlcohol withdrawalIn-Hospital Treatment & Orders Paracentesis drained 3L fluid CIWA protocolDelirium and CAM (confused assessment method) monitoringMonitoring and replacement of electrolytes Monitoring of refeeding syndrome In-Hospital Medication Orders Albumin IV 25% x3 doses Baclofen 5mg TID (*new)Ceftriaxone 2g daily x5 days for SPB Carvedilol 6.25 mg PO daily   (discontinued)Diazepam 10mg IV/PO Q1H PRN  for CIWA scores 10-19 until scores less than 10.Folic Acid 5 mg PO dailyKCL 10mmol IVPB x3 dosesLactulose 30ml QID- titrate to 3-4 BM's /day (*New)Multivitamins 1 Tab PO daily Paroxetine 40 mg PO daily  Rifaximin 55mg PO BID (*new) Spironolactone 50 mg PO daily (*New dose) Thiamine 100 mg PO daily Day 2 Vitals and Blood WorkCBC:  Hemoglobin 126 g/L (120-160), Platelets 90 (130-380), WBC 12.4  (3.5-10.5)Electrolytes:  Sodium 132 mEq/L (135-145), Potassium 3.3 mEq/L (3.5-5.0), Chloride 100 mEq/L (98-107), magnesium 0.69mmol/L (0.74-1.07) Renal panel:  Creatine 190 (53-106mcmol/L) , eGFR 25  ml/min (>60 ml/min)Vital Signs:  T.  36.8, HR 92 regular, RR 18, 96% RA, BP 102/74Mr. Scottaline is having a complicated and likely an extended hospital stay for end-stage liver cirrhosis. His complications have included moderate alcohol withdrawal, electrolyte imbalances, refeeding syndrome, delirium, skin breakdown from edema and frequent diarrhea, hypotension, and deconditioned mobility. As his nurse on day 2, you need to prioritize his needs, create a plan of care, and demonstrate understanding of how all of these health concepts are related. Concept Map and Nursing Care PlanFor assignment 2 concept map and case analysis you are the RN in charge of Mr. Scottaline's care and you want to develop a nursing care plan to provide direction for his acute priority needs. Use the assessment data and information in the case scenario to guide your development of the one-page only concept map visual diagram. Identify and outline 6-10 nursing care priorities related to this case scenario and number the care priorities in level of importance.  Include lines and arrows to visually display relationships and connections among concepts. Include linking words with the lines to indicate the nature of the connection or relationship (for example: leads to, influences, contributes to, results in, etc.) Include a full nursing care plan (nursing diagnosis, SMART goals, nursing interventions supported with credible and current sources of evidence, and evaluation statements) with the first nursing care priority you have identified. This can be completed as an appendix attached to the paper portion of the assignment. Refer to the Assignment 1 and 2 marking guide in the Assessment Overview for further direction of the requirements of the concept map as well as case analysis. You may also find it useful to go back to Unit 1 and review the content related to Concept Mapping. Keep in mind the concept map in Unit 1 is not as fully detailed as we expect your concept map to be. The concept map is worth 65% of your entire mark for this assignment, so spend your time constructing this. 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Question 41, during anaphylactic shock, the body reacts by rapidly... 41, during anaphylactic shock, the body reacts by rapidly vasodilating blood vessels , the body's response also includes an airway reaction to histamine. What is the expected airway response during anaphylaxis?A, bronchophony B, bronchodilation 42. A nurse is assisting with the care of a client immediately following a lumbar puncture. Which of the actions should the nurse take? Select all that applyA. Elevate the client's head of bedB. Insert a urinary catheterC.Apply a cervical collar to the client.D Monitor the puncture site for hematomaE. Encourage fluid intake.43. A client is admitted to the medical surgical unit with a diagnosis of gastrointestinal bleeding. The nurse noted that the client's hourly urine output is decreasing. What is the normal output of urine per hour?A. 30ml/hrB. 100 ml/hr  44, a client in hypovolemic shock , the nurse knows that with any type of shock , there will be a decrease in circulating blood volume resulting in decreased tissue perfusion. The inadequate tissue causes what observable sign in the client evaluation?Flushed skinVasodilationIncreased urine outputDelayed capillary refill45.A nurse is collecting data on a client who has a major burn injury. The nurse should recognize which of the following findings as a priority.A.      the client has a heart rate of 122 beats per minuteB.      The client reports immediately discomfort at the burn siteC.      The client has a cough productive of black colored sputumD.      The client has a first degree burn on their hands46, nursing care for a client who is admitted with frostbite of the includes which of the following A, giving the client hot fluids to drinkB, applying a heating pad to the frostbitten area C, immersing the foot in warm water D, wrapping the foot unwarmed blankets  47, the client receiving mechanical ventilation has became more restless throughout the shift which is the nurse's first action/A , call the health care provider B, sedate the client  C, evaluate the client for pain D, evaluate the clients oxygenation  49. A client presents to the outpatient clinic with a two-day history of fever, fatigue, coughing and difficulty breathing. She is short of breath and unable to speak in complete sentences. What is the priority action?A. Review the physician orders and implement.B Obtain blood pressureC. Obtain oxygen saturation. 51, what is the priority action for the nurse to take if phlebitis infection at iv site is suspected?A, elevate the extremity B,remove the catheter C, apply continuous heat D, continue to monitor site  52. Which of the following interventions should the nurse identify as the priority for a long-term care client who is receiving mechanical ventilation?A. Suction the airway as needed.B.Providing a communication board for the clientC.Begin continues the feeding through a nasogastric tube.D.Application of antiembolism stockings.53.Which client needs to be placed immediately in isolation?A. A probable cause of inhalation anthraxB.suspected smallpox, but probable chickenpoxC.A client diagnosed with botulism poisoning54, a nurse is caring for a client in a rehab center who is being treated for partial -thickness and full-thickness bums of his head , neck, and chest. A client who sustains bums on their face, neck , and chest is most at risk for which of the following?A, infection B, airway obstruction C, fluid and electrolyte imbalance D, loss of motor function 55, older adult clients often have fragic skin. To help prevent skin tears , which of the following interventions would be the best option when initiating a peripheral iv?A, slap the skin vigorously to cause the vein to riseB, avoid the use of a tourniquet if the vein is arady hard C, use a blood pressure cuff to cause the vein to distend D, place a gauze pad under the tourniquet before tightening  56, in a disaster triage situation, which of the following is an example of the emergent (red tag) category?A , a client who has a punctured temporal artery B, a client who exhibits manifestations of multiple organ failure C, a client who has several closed fractures with bruising D, a client who has an open fracture  57, a client has suffered a deep laceration to the femoral artery. Which type of sock would the nurse anticipate?A, hypovolemic B, neurogenicC, cardiogenic D, septic 59. Clients who are receiving mechanical ventilation are at risk for pneumonia. Which of the following actions will help decrease the risk of pneumonia? Select all that apply.A. Handwashing before and after contact with the client.B. Administering antibiotic prophylaxisc. Placing the clients in a negative airflow room. 60,the plague was caused by bacteria found in rodents and fleas. The plague is on the list of bioterrorism agents , as a part of the disaster preparedness team the nurse is required to know the signs and symptoms of the plague , what are the signs and symptoms of the plague?A, hemoptysis , high fever, headache , respiratory failure B, nausea, vomiting , anorexia C, fever, backache, pustular lesionsD, swollen lymph nodes, edema 62. The CDC has identified an outbreak of cholera in a small remote village. The nurse volunteers to treat victims and educate the village on preventative measures. What would the nurse focus on in teaching the people that live in the village? Select all that apply.A. Boil water before drinkingB. Prevent raw sewage from entering water sources.C. Cook food well before eating.D. Handwashing.E. Proper wound care 63.A client receiving gentamicin intravenously reports that she is itching and has a rash on her arms. What is the priority action in this situation?A, change the iv insertion site to a new location B, stop the infusion of the drug immediately C, report the clients problem to the primary health care provider D, document findings anti actions in the electronic record 64, To evaluate effectiveness of lasix and morphine for treatment of pulmonary edema the nurse would do which of the following A, assess for decreased painB, check the strength of peripheral pulses C, monitor intake and outputD, assess respiratory status   65) A nurse is working in an ambulatory clinic. A client enters the room and is bleeding profusely from a deep laceration of his left lower forearm. After donning gloves what is the priority actionA. Sit the client in the chair with the legs elevatedB. Application of tourniquet to the left armC. Elevate the extremities above the heartD. Application of direct pressure to the wound  66) Which of the following is the early symptoms of shockA. HypotensionB. BradycardiaC, bradypnea D, irregular heart rhythm  67) Which of the following is a high priority in the immediate treatment of chemical the burns of the handsA. In all cases apply water to cool the burnB. In most cases except for dry lime, flush with large amount of water to remove the chemicalC. Use alcohol to clean the chemical off the skinD. Cover the burn with the dressing but do not flush the chemical from the skin 68) Which of the following is the responsibility of the nurse during the disaster?A. Maintain the appropriate stock in the unitB. Reinforce discharge teaching to clientsC. Focus on client with life threatening emergenciesD. Delegate the Aps to focus on the client's ADLs 69. A client who has taken their first dose of penicillin reports shortness of breath and a red rash on their chest and abdomen. Which of the following medications would be administered first?A. DiphenhydramineB. Hydrocortisone sodium succinateC. AlbuterolD. Epinephrine 70. A client is in cardiogenic shock with significant hypotension. What position would increase the blood flow to the brain? A. Supine with legs elevated.B. High fowlers  C, semi-fowlers D, side-lying 71. Smallpox was eradicated in the US in 1971 due to the development of a vaccine. Smallpox is listed in the category of bioterrorism agents. How is smallpox transmitted as a biologic agent?A Contamination watersB ContactC AirborneD Indirectly in food sources 72. A nurse is observing the care of a client in the emergency department. The client reports severe radiating chest pain and shortness of breath. The client is restless. Slightly cyanotic and reports being frightened. The provider prescribes oxygen by nasal cannula at 4l/min stat. cardiac enzyme levels. IV fluids. And a 12 lead ECG. Which of the following actions will be taken first?A. Application of oxygen at 4l/minB. Inserting the peripheral.C. Semi Fowlers.D. Side lying 73) A nurse is attending a yearly training about triaging after a mass casualty event. Which of the following clients would receive priority care?A. A client who has a circular partial thickness of their handB. A client who has an open fracture of the humerus.C. A client with a large head lacerationD. A client who has severe respiratory distress 74. A Nurse is preparing to exit an isolation room. Which of the following pieces of personal protection equipment (PPE) should the nurse remove last?A EyewearB GownC GlovesD Mask  Health Science Science Nursing NURSING 155 Share QuestionEmailCopy link Comments (0)
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