Mrs. Brady is a 58 year old woman who is admitted to your unit post op from an ORIF (open reduction internal fixation) of the left hip. She is now three days post-op and has started physiotherapy. Her pain has been manageable since her surgery and she is keen to go home. Her Foley catheter was removed yesterday evening.
You arrive for your day shift and find Mrs. Brady in the bathroom. She tells you that she feels as though she needs to void, but that she has tried multiple times overnight and nothing has happened. She reports 6/10 pain to the pelvic region and appears to be in discomfort as she is unable to stay still and is diaphoretic.
You assist Mrs. Brady back to her bed and perform your head to toe assessment. Her vital signs are as follows: T- 36.8 C, P- 110 bpm and regular, BP 145/80, Sp02- 95% on room air and RR- 16 per minute, easy and regular. Her cardiovascular and neurological assessments show no abnormalities. She denies any gastrointestinal symptoms. On inspection you see a mass in the pelvic area, which is palpable. Mrs. Brady states it is painful on palpation and it makes her feel as though she needs to void again. You decide to ask the clinical instructor to assist you in bladder scanning the patient. The bladder scan shows 450 ml of urine in the bladder. Mrs. Brady tries once again to void and is unable to.
1. What would your priority action be?
2. Please discuss the risks of urinary catheterization in the hospital setting, specifically related to urinary tract infections. Please use current evidence-based research.
3. Which type of urinary catheter insertion would you anticipate for this situation and why?
4. Identify three potential causes for urinary retention in the post-op population and discuss whether these apply to Mrs. Brady.
5. Describe how you would provide patient education to Mrs. Brady. Include at least three teaching points with rationale.
Mrs. Brady has now had her urinary retention relieved and is reporting 5/10 pain to her surgical incision area of the hip after all of the moving back and forth to the bathroom. She has the following medications ordered on her MAR.
Acetaminophen 1000mg PO q6h PRN
Metoclopramide 10mg PO q8h PRN
Ketorolac 10 mg PO q8h PRN
Hydromorphone 1mg PO q4h PRN
6. Identify which of the above medications you would administer to Mrs. Brady for her pain.
7. Discuss why you chose the medication you did, the medication class and any side effects of the medication
8. Discuss if there are any follow up assessments that would be required based on your medication choice
9. Describe three alternate pain relieving interventions that the nurse could initiate without a physician’s order and rationale for their use
You remember that Mrs. Brady’s dressing is due to be changed today. The order in the chart reads:
Dressing change, q 3 days and PRN.
10. Please describe six points that you would assess and document about Mrs. Brady’s dressing change/incision
11. Mrs. Brady asks you if there is anything she could be doing to help her incision heal faster. Using current evidence based literature, please provide at least three suggestions for Mrs. Brady.
In the past section, optional information, for example, books, diaries and online diaries are utilized to direct the writing survey. In this part, essential information is gathered through the contextual investigation. This part will cover the examination system comprises of research reason, inquire about technique, testing strategy, look into instrument and data gathered from the contextual investigation. The investigation of the information is talked about in the following section. This contextual analysis is led to investigate the level of consumer loyalty of the neighborhood clients towards the execution of a strip mall. Mid valley megamall is picked as the subject on the off chance that review. The time allotment for the entire research is multi month. RESEARCH FRAMEWORK: As a matter of first importance, the estimation targets must be indicated to improve the exploration procedure. Essentially, there are four sorts of consumer loyalty overview which depends on the estimation destinations of the examination (Vavra, 2002). Since this exploration is utilized to research the level of execution of a strip mall from the consumer loyalty's as a rule, consequently, it is known as by and large status overview. As indicated by Vavra, by and large status overview is underscored more on the general issues, by and large execution, and by and large clients' fulfillment. (2002). RESEARCH METHOD AND PURPOSE: This exploration is directed utilizing quantitative research strategy. From the consumer loyalty overview, the exploration data gathered from the example is the essential information. The point of this examination is to explore the level of clients' fulfillment in a strip mall, to distinguish the genuine need of clients through the conveyance of surveys to the example and to illuminate whether the execution meet the clients' desires. Populace AND SAMPLING METHOD: Examining strategy is a technique for picking a gathering of people groups from the whole target populace with a specific end goal to acquire the required data. Essentially, there are two sorts of inspecting outlines: likelihood and non-likelihood. This exploration has received non likelihood examining procedure which is most reasonable for a generally scattered populace, for example, the clients of Mid Valley Megamall. It is difficult to utilize the likelihood examining strategy for this exploration because of the trouble in distinguishes the objective populaces as it is too huge for look into. The example is chosen to assess the gross outcomes in light of the fact that less cost and time required and the example is effortlessly gotten while contrasted and the likelihood examining strategy. The objective populaces for this exploration are the Malaysian clients of Mid Valley Megamall and the example is restricted to grown-up from 18 to 50 years of age. This example is picked on the grounds that these gatherings of individual visit the shopping center more every now and again than other statistic profile. The example size of 100 clients extended from 18 to 50 years of age is considered as illustrative of Malaysian clients of Mid Valley Megamall. Outline OF QUESTIONNAIRE: Poll is utilized as research instrument for this examination. The polls are set up as per the goals which set up toward the start. Keeping in mind the end goal to get better reaction from the example, the surveys are intended to be straightforward and simple to be comprehended. On the off chance that the length of the surveys is too long, it will influence the rate of reaction. As per Vavra, there are four sorts of question can be gathered, in particular actualities, demeanors, forecast conduct and socioeconomics. (2002). Expanded kinds of question are all the more fascinating for the clients. The poll comprises of three segments. The primary segment is about the statistic profile of the respondent. The goal is to know the respondents' experience. The second segment is about the general data with respect to the connection between the respondents and the shopping center. Additionally, it is utilized to recognize the genuine need of the clients. The third area is about the examination on the level of fulfillment of the clients from the example picked towards the area, item execution, staff, building design, framework and offices gave in the shopping center. This area is critical in decide if the shopping center meet the necessities of the clients. Moreover, it incorporates the proposals from the clients so as to help the shopping center to upgrade their execution later on. SCALE: For the poll, each inquiry has its own reaction choices, for example, open-finished reaction and close-finished reaction. Open-finished inquiries require the assessments of the clients with respect to the general execution of the shopping center. Close-finished inquiries are more productive and quantifiable in light of the fact that it comprises of numeric scales which utilized by the clients to express their sentiments essentially. The scale is known as Likert Scale. The 5-point numerical scale is received which running from 1 to 5, 1 speaks to not fulfilled, 2 speaks to some degree disappointed, 3 speaks to neither fulfilled or disappointed, 4 speaks to some degree fulfilled and 5 speaks to unequivocally fulfilled. The scale assist the respondents with making an unmistakable choice in view of their level of fulfillment. Conveyance METHOD: Conveyance strategy otherwise called field technique and it characterized as the route utilized by the questioner to disperse the polls to the example. The polls in look into are appropriated to the clients actually at the Mid Valley Megamall and in the meantime they restore the surveys. Contextual investigation: MID VALLEY MEGAMALL: Foundation: Mid Valley Megamall is one of the Malaysia's biggest urban advancement extends on the planet. It was one of the ventures inside the Mid Valley City. Mid Valley City wants to be the most current and coordinated blended utilize improvements on the planet. The development begins in year 1995. At present, it includes Mid Valley Megamall, Cititel Hotel, Menara IGB, Boulevard Offices, Boulevard Hotel, Northpoint Mid Valley City, Centrepoint North and South Towers, The Gardens Retail Gallery, The Gardens Hotel, The Gardens Residences and two historic point office towers. IGB Corporation Berhad, a property and speculation holding organization recorded on Bursa Malaysia Securities Berhad is the engineer of Mid Valley City while the Mid Valley Megamall is possessed and worked by Kris Assets Holdings Berhad, a recorded IGB backup organization. A two measurement ground breaking strategy of Mid Valley City is encased in informative supplement. Depictions OF MID VALLEY MEGAMALL: Mid Valley Megamall is chosen for the contextual analysis. Mid Valley Megamall is propelled in year 1995 and it was opened in November 1999. Mid Valley Megamall is a mind boggling comprises of a shopping center, an office tower square, 30 signature workplaces and two inns. It is the primary shopping center involves four fruitful grapple occupants, specifically Jaya Jusco, Metrojaya, Carrefour and Golden Screen Cinemas. Additionally, it involves 13 junior and smaller than usual grapples and 403 claim to fame shops. Mid Valley Megamall has a gross floor territory of 4.5 million square feet and net lettable zone surpasses 1.7 million square feet. Mid Valley City is arranged and created as a "City in a City"Mid Valley Megamall is a key piece of Mid Valley City. It was granted the Best Shopping Complex Award 2000 by Tourism Malaysia and Best Retail Development Award 2001 by FIABCI Malaysia (International Real Estate Federation). Mid Valley Megamall is a decent decision for the nearby occupants and outside travelers. MISSION AND VISION: Mid Valley Megamall is meant to satisfying everybody's needs. So as to accomplish the mission, the profoundly lively and capable experts are selected in offices. Indeed, Mid Valley Megamall accentuates on their administration standard and it wishes to make a cutting edge and snazzy shopping heaven for their clients. For whatever length of time that the clients are in the Mid Valley Megamall, they will ensure everybody appreciate the administrations and items gave. In addition, Mid Valley Megamall intends to keep up the development of the shopping center in the focused retail industry. Elements INFLUENCE THE CUSTOMER SATISFACTION: Area AND ACCESSIBILITY: Mid Valley Megamall is deliberately situated between Kuala Lumpur Central Business District and Petaling Jaya. It is situated in an advantageous area that can be effectively open from all corners on the Klang Valley. Other than it is encompassed by Petaling Jaya, Bangsar and Damansara. There is a KTM Komuter prepare stop and a LRT Station adjacent while taxis are accessible at the passageways of Center, North and South Courts. The KTM suburbanite station can be gotten to through a secured person on foot scaffold to the Megamall. It's accepted to bring a normal of 10,000 travelers every day. The station is handicap inviting, and offices include toilets, lifts, secured stages, ticket and data counters and ticket candy machines. Besides, Mid Valley has offers free complimentary screen transport administrations (Trinton Bus) at an interim of 30 minutes to 1 hour that movement between Bangsar LRT Station and Mid Valley South Court. Other choice of transportation is people in general transport accessible. Mid Valley Megamall can be gotten to through five noteworthy expressways and two railroad lines. Later on, the change of street and open transportation will be finished. It incorporates an assigned monorail station, a connection scaffold to the Putra LRT Station and the updating of interior activity stream. Being situated in the middle of Kuala Lumpur and Petaling Jaya, a measure of RM250 million was put resources into building a flyover and upgrade the system of street for the reason to associate the Federal Highway and all the real catchment and private rural areas or organizations premises inside Klang Valley to Mid Valley Megamall. The area plan is encased in addendum X. In the interim, the area of the retail chains is likewise vital for the helpful of the clients. NFRASTRUCTURES AND FACILITIES: Mid Valley c>GET ANSWER