General Survey/Skin/Nutrition Assignment

This week’s graded discussion topic relates to the following Course Outcomes (COs).

CO1 Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)

CO3 Utilize effective communication when performing a health assessment. (PO 3)

Your home health agency has received an order from a local hospital to evaluate and treat an elderly woman being discharged from its medical surgical unit.General Survey/Skin/Nutrition Assignment

Millie Gardner, an 83-year-old female patient, is being discharged home today to the care of her husband Fred (87 years old) following a 9-day hospitalization for pneumonia, dehydration, and failure to thrive. She has a history of hypertension (HTN), Type II Diabetes, and cerebral vascular accident (CVA) with left-sided weakness. Patient is alert and oriented but does have periods of forgetfulness during the overnight hours. Patient has intermittent incontinence of bowel and bladder and requires assistance with all activities of daily living (ADLs).

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Medications:

Lopressor

Lisinopril

Plavix

Metformin

Novolin R per sliding scale *NEW*

Multivitamin

Colace

Zithromax *NEW*

Upon arrival you are greeted by Champ, the couple’s rambunctious miniature Doberman pinscher dog. Millie is in her wheelchair staring blankly out the window, and Fred is busy in the kitchen preparing the couple’s lunch.General Survey/Skin/Nutrition Assignment

Based on the scenario above, please use the general survey process to describe the areas that you would be observing immediately upon entry to the home.

What, if any, concerns related to Millie’s skin and nutritional status do you have?

What nursing interventions will you include in the plan of care to address these concerns?

What teaching strategies will you use to educate Millie and Fred on the new medications?

Using the SBAR, please include the information that you will communicate to the physician’s office at the completion of the visit.

FANCL established in 1980, had the world acme scientific research and the production technology, developed in different way with the general skin appliances and does not originate including the antiseptic, the chemical additive cosmetology and the health food, ceased generally the skin question which caused including the antiseptic skin appliances, occupied the world “not to have the increase” steadily the leading positions.General Survey/Skin/Nutrition Assignment

Fancl House’s supplement health products offers a relatively ladies run off nutrition day to day situation for manager to present their product to a captive audience. However, little is known about its effectiveness, especially in countries such as Hong Kong. In this way, Fancl House nutritional supplements have some product lines, focus on different customers needs thus provide relative supplement products for them.

Fancl House’s marketing strategy is holding a major of ladies wants to become more beautiful and healthy for marketer to sale diverse lineup items to them. Fancl House unceasingly innovate nutritional supplements quality to cater consumers’ needs. If so, some of the products would be exists or not depends on the market trend.

The aim of this project study is to know the reasons of supplement products stay or loss and how can a product success to exist or eliminate in the market, and aim at the weakness to improve. In this research, I would like to find out necessities, current trends of supplement products and customers long-term relationship and also want to focus on studying the Fancl House marketing strategy of supplement products and why the products would be eliminate or exist in the market. At other times, from the Market Research Center, it can know that the health-supplement market which includes vitamins, mineral supplements, and other Western health supplements, has enjoyed steady growth in Hong Kong rising from $148 million in 1997 to $202 million in 2003. Therefore, in this study, the surreys have been adopted face to face interview to collect data. For the research questions it may include why health food are important in Hong Kong market, or this products really can improve good health and beauty face etc.General Survey/Skin/Nutrition Assignment

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According to NHS report, 1998, ‘Wound care has, in the past, not been well managed because of the limited understanding of the healing process and the inadequate range of dressing materials available. Wound management has now come full circle, back to Hippocrates’ principle and dressings are being developed to provide the ideal environment for nature to do its work’.

The primary function of normal intact skin is that it can control microbial populations living on skin surface from entering underlying layers or organs and thus protects the body from pathogens. Exposure of subcutaneous tissue with a wound provides a moist and warm environment for microbial organisms. However factors such as wound type, depth, and location, quality, level of tissue perfusion and anti-microbial efficacy or resistance is important for examining microbial effects on wounds. Wounds are broadly categorized as either acute or chronic. Acute wounds are caused by external damage to intact skin and include surgical wounds, bites, burns, minor cuts and abrasions, and more severe traumatic wounds such as lacerations and those caused by crush or gunshot injuries (in Bowler et al, 2001, p.245). Acute wounds are expected to heal within a predictable and specified time frame and with minimal intervention although in severe cases such as gunshot wounds, anti-microbial therapy or surgical intervention may be necessary. In contrast, chronic wounds are most frequently caused by endogenous mechanisms associated with a predisposing condition that ultimately compromises the integrity of dermal and epidermal tissue (Bowler et al, 2001, p.245). Pathophysiological abnormalities that may predispose to the formation of chronic wounds such as leg ulcers, foot ulcers, and pressure sores include compromised tissue perfusion as a consequence of impaired arterial supply (peripheral vascular disease) or impaired venous drainage (venous hypertension) and metabolic diseases such as diabetes mellitus.General Survey/Skin/Nutrition Assignment

Tissue viability is considered as a growing specialty that primarily addresses all aspects of skin and soft tissue wounds including acute surgical wounds, pressure ulcers, and leg wounds and ulceration. Tissue viability includes but not just restricted to wound management and covers professional aspects of wound care, nursing and also a wide range of organizational, political and socioeconomic issues.

Wound management and tissue viability are intricately related and Schultz et al (2003) indicate that the healing process in acute wounds has been extensively studied and the knowledge obtained from these studies have been used for the care of chronic wounds with the assumption that non healing chronic wounds suggest an aberration of the normal tissue repair process. However the healing process associated with chronic wounds is quite different from that of acute wounds. As Schultz et al discuss, usually in chronic wounds, the sequence of events which lead to repair in acute cases becomes stuck or disrupted at different stages of the healing process and before the normal healing process could be resumed, the barrier to the healing process has to be recognized and correct techniques have to be applied. Thus for appropriate understanding of the healing process and the interventions necessary to speed up healing and to repair chronic wounds, it is necessary to understand the underlying molecular events. Wound bed preparation is the management of wound that accelerates endogenous healing and facilitates the effectiveness of therapeutic measures and is an important concept in wound management. Wound bed preparation is an educational tool in wound management and several key issues form part of wound management and tissue viability. These include status of wound bed preparation, analysis of acute and chronic wound environment, wound bed preparation in the clinic, cellular components of the wound bed preparation concept, and analysis of the components of wound bed preparation.General Survey/Skin/Nutrition Assignment

An important part of wound management is realizing the potential dangers of wound infection. Surgery itself carries a 1 to 5% risk of wound infection and if proper care is not taken, there is a 27% chance of endogenous contamination. Bowler et al (2001) write, ‘Infection occurs when virulence factors expressed by one or more microorganisms in a wound out compete the host natural immune system and subsequent invasion and dissemination of microorganisms in viable tissue provokes a series of local and systemic host responses’ (p.247). Wound infection and presence of pathogens in the skin and body are primarily responsible for delayed wound healing although host immune response and local environmental factors such as tissue necrosis, hypoxia and ischemia impair immune cell activity. Antiseptics, antibiotics, antimicrobial therapy, vacuum assisted wound closure, enzymatic and surgical debridement, pressure reduction in wounds and complementary and alternative therapies are the common techniques of wound management.General Survey/Skin/Nutrition Assignment