On admission, Mrs. J had several systemic alterations of the baseline parameters. With a history of several comorbidities, a comprehensive systemic assessment was necessary. A cardiovascular evaluation revealed tachycardia, jugular vein distention, hypotension, and atrial fibrillation. These symptoms were due to the failing heart. Failing heart have reduced the ability to contract effectively; hence, there is fibrillation and racing heart to meet the systemic demand of blood. Reduced contractility also results in decreased cardiac output hence the presence of hypotension. Increased preload of the heart causing the veins to distend due to complete filling of the heart with blood hence the jugular vein distension. Tachypnea is a result of increased demand for oxygen by the tissues. Crackles is due to obstruction of airflow in the airway by secretion produced by the inflammatory process of COPD. Productive cough occurs due to the scaring of the airway and rapture of blood vessels lining the respiratory tract. Reduced oxygen saturation is the result of inadequate oxygen supply due to obstruction of the airway (Divo et al., 2015)

Appropriateness of Nursing Interventions.

Mrs. J is suffering from acute respiratory distress. It is evidenced by her complains of getting inadequate oxygen with the findings from the assessment, such as tachypnea, crackles, productive cough, and oxygen saturation of 82%. She has a decompensated heart failure that warranted critical care. Therefore, the priority nursing intervention was to promote sufficient oxygen supply to the tissues. Administration of 2L of oxygen via nasal cannula needed additional one liter to make three and positioning of the client to encourage airway patency. She is also required to be suction for secretion due to the productive cough to clear the airway. Administration of the drug to control symptoms of heart failure and COPD were appropriate.

Furosemide is a diuretic which promotes fluid loss through urine production, which results in the mobilization of fluids accumulated in the lungs to other organs. Enalapril promotes vasodilation of blood vessels resulting in reduced vascular resistance causing adequate cardiac output. Metoprolol is a beta-receptor blocker which inhibits vasoconstriction of muscles lining respiratory and cardiac system resulting in decreased heart rate and airway narrowing (Patterson & Felicilda-Reynaldo, 2018). Morphine reduces pain and anxiety on the patient hence reducing the rate of breathing. Bronchodilators dilate the airway promoting affecting airflow. Corticosteroids inhibit the inflammatory process resulting in the clearance of secretions from the airway (Page & Barnes, 2017).

Causes of Heart Failure and Nursing Interventions for Prevention

Heart failure is a complication of several cardiovascular diseases. Coronary artery disease is one of the conditions that can result in heart failure if not well managed. Nurses prevent heart failure from CAD by eliminating the risks its development by educating patients to quit smoking, avoid obesity, and diabetes mellitus (American Heart Association, 2018). Hypertension is another disease that can result in heart failure. Prevention of heart failure in hypertension involves strict adherence to medication and lifestyle modification such as weight management, dietary practice, smoking cessation, and physical activities (Hinkle & Cheever, 2017). Myocardial infarction results in heart failure if not well managed. Nurses prevent heart failure in patients with myocardial infraction through modification of lifestyle and controlling the incidence and prevalence of diabetes and hyperlipidemia. The fourth cause of heart failure is valvular heart disease. Defective valves result in impaired heart function resulting in cardiac muscle damage (Farmakis, Parissis, Lekakis & Filippatos, 2015). Prevention of heart failure in such patients involves proper management, including infection control and appropriate medication.

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Interventions to prevent Drug Interactions

Polypharmacy is a common practice among the elderly with multiple conditions. Nurses play a critical role in preventing health problems associated with polypharmacy, such as drug interactions. Educating clients to limit or avoid the use of over-the-counter medication is essential to avoid drug interactions with those prescribed on discharge. Teaching patient on drug management such as dosing and frequency is critical to prevent overdose or under dose of medication (Hinkle & Cheever, 2017). Timing of medication intake and meals is essential. It enables the patient to avoid food-drug and drug-drug interactions. Finally using one pharmacy for drug refill is essential for evaluating patient progress and response to medication therapy.

Health Promotion and Teaching Plan.

Successful treatment of COPD and heart failure requires a multidisciplinary approach to facilitate health promotion through health education. Lifestyle practices significantly impact these two diseases. Learning on the importance of proper dietary practice on cardiovascular health is essential for this client. She will be educated on the effects of smoking on her respiratory functions. Managing dietary intake and cessation of smoking helps the client to recover well from the two conditions hence promoting an easy transition to a better life. Teaching her on the strategies to manage weight will also feature in her health education (Hinkle & Cheever, 2017).

Health Promotion Method.

One of the effective methods for promoting the health of the client is the Health Belief Model. Health belief model works with the assumption that successful behavior change is achieved when the target population perceives the dangers or effects of the behavior, self-efficacy, and the barriers to change (Skinner, Tiro & Champion, 2015). In this case, Mrs. J will change her behavior and adhere to the prescribed medication if she understands the implications of her lifestyle and improper drug therapy to her health.

Triggers of OCPD

Several factors can trigger the worsening of OCPD symptoms. They include viral or bacterial infections that cause inflammation of the respiratory organs resulting in narrowed or blocked airways. Allergic reactions resulting from inhalation of irritants such as dust or chemicals can also trigger an inflammatory process that results in occlusion of the airways (Ko et al., 2016). Smoking behaviors is one of the factors attributed to cause OCPD for Mrs. J. therefore, cessation of smoking will be progressive and not abrupt to prevent withdrawal symptoms.

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Proper and comprehensive management of patient conditions is directly related to coming up with the accurate diagnosis. Having the exact diagnosis of the patient means that the clinicians should examine the patient for all the possible conditions that have similar clinical presentation. This is achieved through comprehensive physical examination of the signs and symptoms that the patient presents with. Laboratory services may also be utilized in order to come up with the correct diagnosis. With correct diagnosis, both pharmacological and non-pharmacological approaches are going to be employed in order to relieve the symptoms and prevent further systemic complications for the patient. For the present patient, he reports to have shortness of breath, easily fatigued evidenced by his inability to walk for a short distance. Reports to be having history of COPD, heart failure and an undiagnosed hypertension. The patient also reports to be currently on medications used to treat heart failure and COPD.

  Differential diagnosis

Asthma 

This is an upper respiratory condition that is usually characterized by shortness of breath. The shortness of breath is caused by the narrowing of the airway which is related to either inflammation of the airway or blockage of the airway by foreign objects such as secretions. Patient with asthma cannot engage in activities that require a lot of oxygen such as walking for a long distance. It is common in patients with history of cigarette smoking and cardiovascular diseases such as congestive heart failure (Divo et al., 2015).The current patient presented with exertion dyspnea and easy fatigue. He has a history of smoking cigarette, COPD, cardiac failure and present unmanaged hypertension. This symptoms can qualify the above patient to be asthmatic

Congestive heart Failure

Congestive heart failure is a cardiovascular disease in which the heart is not able to perfuse all the other systems due to inability of the heart muscles to pump blood out. Patient with heart failure usually present shortness of breath while exercising, coughing and inability to perform mild exercise.  The condition is commonly associated other cardiovascular disease such hypertension and lifestyle practices such smoking. Previous history of heart failure can also lead to recurrence of another episode. Currently, the patient has dyspnea, activity intolerance and history heart failure and present hypertension. These symptoms can be used to justify congestive heart failure in the patient.

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Tuberculosis 

This is an infectious bacterial disease of the lungs that may also spread to other part of the body. Patients with tuberculosis usually present with cough, shortness of breath as well inability to tolerate any form of mild to moderate physical exercise such as walking for a short distance. The present patient presents with shortness of breath while at rest and during exercise. The patient also reports to have no tolerance to activities such as walking due to dyspnea attacks. From these symptoms, tuberculosis should not be ruled out.

Bronchiolitis 

Bronchiolitis is another infectious disease that usually affects the lungs. It is common in children but can also be found in adults and causes acute symptoms among adults. The primary characteristic of this disease is shortness of breath and coughing. Fatigue is another symptoms that is usually observed in patients with bronchitis. The present patient presented with shortness of breath and getting easily fatigued. Therefore bronchitis should also be considered during final diagnosis.

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease is a condition where the airway is acutely reduced in size are completely blocked by foreign objects such as solids or fluids such as secretions like mucus, blood or food substances. Patients present with coughing, dyspnea and activity intolerance. History of previous COPD and heart failure are some of the risk factors of this disease (Divo et al., 2015). The patient in the case scenario meets all the symptoms requirements and therefore this disease should be considered during diagnosis.

Primary diagnosis

Chronic Obstructive Pulmonary Disease.

This disease is characterized by severely narrowed airway leading to inadequate air flow into the lungs. As a result, there signs of impaired gaseous exchange will be observed in the patient. They include dyspnea, coughing and activity intolerance in both mild and moderate occasions (Divo et al., 2015). This disease is associated with several factors. Previous history of the same disease and other cardiovascular conditions can result to emergence or re-emergence of such condition. Use of substance such as cigarettes increases the chances of a person getting such disease. For the above presented patient, his history of smoking, COPD, heart failure and hypertension points towards him developing another episode of COPD. His current symptoms of dyspnea and exercise intolerance further proves that he is suffering from COPD.

Diagnostic test.

Some of the diagnostic tests for the patient include radiological tests such as chest X-ray which will be done to visualize the extent of obstruction and determine the blocking agent. Pulse oximetry should be done to check for the level of oxygen saturation. A saturation of less than 90% should be intervened by oxygen therapy. Spirometry should be done to determine the EFV1 for the patient. The percentage of EFV1 is used to classify and stage COPD (Hillas, Perlikos, Tsiligianni, & Tzanakis, 2015).

Pharmacological and non-pharmacological treatment.

The goal of management in COPD is to eliminate symptoms and prevent further complications of the disease. Pharmacological treatment involves the use of a short-acting bronchodilators such albuterol and systemic corticosteroid such as fluticasone. The drugs are given together to the patient (Hillas, Perlikos, Tsiligianni, & Tzanakis, 2015).

Non-pharmacological management of COPD involves activities are aimed at enhancing quick recovery and preventing disease progression to worst stages. They involve suctioning the patient to remove secretions if they are the agents blocking the airway. Objects should be removed. Oxygen should be administered to the patient as necessary (Bradstreet, & Parkman, 2016).

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Several reasons informed the choice of the above three reproductive health condition among. One of the reasons is that these conditions affect all sexually active women regardless of age. Sexually transmitted infections including HIV/AIDS is prevalent among adolescents and young adults with multiple sexual partners. Secondly is that these three conditions are related to some extent where one condition increases the risk of another developing (Unemo et al., 2017). Sexually transmitted infection such as HIV and human papillomavirus (HPV) increases the risk of getting cervical cancer. Endometriosis has also been linked to the presence of both bacterial and viral sexually transmitted infection. Other gynecological diseases such as ovarian cancer have been associated with the presence of endometriosis among women (Servin et al., 2017).

Reproductive system disease significantly influences the health and the well-being of women globally. Morbidity is one of the effects of these conditions. The leading cause of hospitalization among the female population of reproductive age is gynecological diseases (Ward & Hisley, 2015). The disease affects the normal physiological, physical and social function among women. Sexually transmitted infection and cervical cancers are very painful (Servin et al., 2017). The physiological process such as urination and bodily functions such as sex are difficult to achieve due to pain associated with them.  Endometriosis results in painful and prolonged menstruation among women leading to psychological disturbances such as depression. Cervical cancer and endometriosis are characterized by bleeding which may result in anemia and its complications (Lees, Erickson, & Huh, 2016). Delayed diagnosis and treatment of these conditions result in complications such as pelvic inflammatory disease, urinary tract infections, infertility and even death among women (Berman & Koeniger-Donohue, 2018).

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Reproductive health nurses have significant roles to play in the prevention, identification, and treatment of these conditions among women. One of the critical element of addressing these conditions is through health education both to individual and group of women as an audience.  The aim of educating women concerning these condition is to create awareness, inform on early signs and symptoms, and, modify or change behavior to prevent lifestyle conditions such as sexually transmitted infection and cancer (Black et al., 2016).

For sexually transmitted infections such as HIV, HPV and other bacterial infections, the nurse should address the risk factors and preventive measures as well as the treatment options. Sexually active women should be encouraged to have one sexual partner as much as possible to reduce the chances of contracting the disease. Women should go for the screening of these conditions with their partners routinely (Berman & Koeniger-Donohue, 2018). Any unusual symptom in their reproductive system should prompt them to seek medical and gynecological care.

Nurses can also help a group of women on how to manage endometriosis. There is always a concern concerning endometriosis and fertility issues among women. The nurse should clarify that not all women with endometriosis are infertile. Nurses should educate women that infertility depends on disease progression and treatment (Black et al., 2016). Prevention of endometriosis through regular exercise, weight management and effective treatment of any gynecological disorder should be highlighted (Black et al., 2016). Gynecological malignancies such ovarian and cervical cancers can be prevented and treated effectively through comprehensive health education by the nurse. Nurses should encourage women of reproductive age and sexually to go for routine screening to promote early detection and treatment. Early signs and symptoms of the disease should also be highlighted (Black et al., 2016). The nurse is also responsible for educating the women on the importance of single sexual partner and initial treatment of sexually transmitted infections and other gynecological conditions to prevent the development of gynecological cancer (Berman & Koeniger-Donohue, 2018).

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Can coronavirus spread through sharing food? 

The question arises because the report by healthy Chinese authorities in December 2019 is that many people who contracted coronavirus had contact with seafood and the Wuhan animal market. Coronaviruses are zoonoses meaning that they infect particular animals and spread from an animal to another. The coronavirus spreading among animals can also infect humans when the virus develops certain mutations.  It means that animal products are more likely to have Coronaviruses as they need a host in an animal or human to grow. However, it cannot grow in foods. 

 Recent remarks by Singapore Food Agency are that there is no evidence to show novel coronavirus has any association with consuming food.  However, you need to take precautions to minimize the chances of contracting coronavirus through food, whether shared or not.  Coronavirus can spread through food in these situations. 

Preparation by a person with coronavirus symptoms  

 Someone with symptoms of coronavirus might have the infection even if the disease is at the incubation stage. Such a person can pass the virus to others when preparing, serving, or sharing food due to non-observance of hygiene when handling. Cough droplets on the hands can cause the spread of coronavirus.  Any food you eat should be after ensuring that the person handling or sharing food washes the hands before touching it. 

What if the droplets of an infected person fall onto food after washing hands?  It will cause a risk of infection for people who consume the food, but the chances of infection are low. The reason is that coronavirus infects cells along the respiratory tract but not in other body tissues like intestinal cells. 

Buffets  

Buffets can increase the transmission of coronavirus due to the communal environment. Diners during a buffet share ladles and also stand at proximity as they serve. Both increase the chances of transmission.  

Someone who coughs on to a hand then touches a spoon, or any utensil can contaminate it with coronavirus if infected. It is the same scenario if someone touches surfaces that a person with coronavirus had touched before then proceeds to touch a ladle at a buffet. All those who touch after can get into contact with nCoV.   

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The virus can survive on a surface for an hour, so it puts the people who touch the ladle a long moment after the infected person at risk of picking coronavirus.  The risk increases when people are in a large group, and everyone engages in self-serving. 

Sharing Of Utensils  

Sharing household items like glasses, cups, plates, spoons, and other utensils can cause infection. Droplets of body fluid like saliva disperse onto the surface of the utensil and can infect the person who uses the item after that without cleaning. The virus can survive for a moment outside the host. You can contract it even if you do not use a utensil soon after another person does it. 

Saliva can have a high viral load according to a study on specimens. A viral culture for 2019-nCoV saliva specimens detected the virus in 11 samples from the 12 patients in the study.  A viral culture found live viruses in the saliva of three patients, so sharing utensils and food can cause prompt spreading of Coronaviruses by saliva. 

Food can be a carrier of coronavirus if body fluids find a way in.  People should wash their hands properly with water and soap or sanitizer before handling food.  It is also safe to heat food above 60⁰C. Heat at this level destroys the coronavirus infection to eliminate infection ability. 

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Getting a nursing journal to publish articles might seem daunting, but it is possible for those who make sufficient effort.

Helpful tips for getting published in a nursing journal

Identify the right opportunity  

There are many nursing journals that all require articles, but you should begin by deciding those that fit the subject you want to write. Contemplate about these other factors together with the type of article you want to write:

• Your passionate area
• A burning clinical issue or question
• Target audience
• Timeliness of the subject

The subject of your article can be a reflection, research, best practice or opinion.  Assess the option that has much of your passion.

Analyze gaps in written material

Searching for a gap is like a diagnosis in nursing.  Search a variety of articles on the topic you intend to write to determine if there is an existing gap in the current literature. It is most likely that you will find something that other writers have not written about a nursing issue. Think about journals that focus on your chosen topic and determine the guidelines for authors. Most of the journals with websites have a guidelines page. Author guidelines include information submission process, word limit, and policies on issues such as language or images.

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Create an interesting topic

Choose a compelling topic for the subject that you choose to write to attract the attention of the editors as they know the taste of their readers. A good topic should be something that draws your passion as you will have a desire to research and write about it. Your enthusiasm will rub onto the readers as nobody like to read a dull article.

Make a formal query

One of the steps to getting published is to create a rapport with the editor.  Send a query letter to the journals that you zero in to gauge their interest in your topic.   Send a brief letter by email stating your topic, a summary of your background and qualifications enabling you to write on the matter.  Some people refer to this query as a pitch letter because it pitches the idea to an editor to determine interest in a particular interest.  

A pitch letter should articulate the goals and desired outcomes of the article. Most of the journal editors respond within a short moment. A response might include the general requirements and a submission deadline. It might also include guidelines on the things you might require to change.

Match the guideline

Your chances of publication are higher if you can write while adhering to author instructions. Many journals have managing and production editors to clarify instructions that are not clear to contributor such as referencing style.  Current lives are hasty, and you must write well and convey a message from the start as readers might not be patient to wait for the piece to progress. Avoid ambiguous concepts and terms or mistakes in the text. Communicate the ideas with precision, clarity in professional, authoritative voice while backing claims with statistics.

Proofread and edit your journal article before submission.  The quality will be higher if you ask someone knowledgeable to proofread your work. Journal editor might require for further editing, changes or clarification after reading your manuscript.  You should do it with enthusiasm as it is a sign that your contribution will not be rejected.

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Steps To Write a Nursing Research Paper

The basics of writing research assignment are the same, and there is no reason for nursing students to get a feeling of intimation.  This step by step process helps to write an excellent draft.

1. Choose the right topic

Find an interesting topic that gives you motivation to research and writing if you get the opportunity to make a choice.  A few professors decide to choose the topic for their students. The same subject will be broad, and it is helpful to narrow it till you get a specific focus with particular parameters.

For instance, if the topic is an addiction you can narrow it to the “management of addiction in adolescents.”

1. Find information from various sources.

A research paper as the name implies relies mostly on research.  It is essential to find the best sources of citing the writing before starting to write. Students often get a temptation to use similar sources in papers and news articles.  The best place to get information for this task is primary sources including:

• Journals
• Books and periodicals
• Encyclopedia, databases, and almanacs
• Newspapers
• Government reports and publications

Carefully read and evaluate the most valuable information while taking notes. Remember to keep track of the references materials as you will net them for citation and bibliography.

1. Create a thesis statement

A thesis statement is a sentence that informs the readers about the content to find in a research paper in a summarized form of the central and supporting points.

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1. Develop Outline

An outline is a framework within which to fit information that supports the thesis statement in the form of sub-headings.  Fix your points under each sub-topic.

An outline of a research paper comprises of the following:

• A title page
• Abstract
• Introduction
• A manuscript body of the paper comprising of:

1. materials and methods
2. Results of research
3. Discussion of the findings and conclusion

• Reference
• Tables, figures, appendix (optional)

1. Write A Nursing Research Paper Draft

A thesis statement and outline before this stage will help you to have a clear direction in presenting the ideas. When writing the body of your research paper ensures that you organize it in these three essential parts.

Introduction

Presents a background of the topic, general information on the subject and informs the topic to the reader in an engaging opening sentence. A thesis statement should close the introduction stating the main idea in a sentence or two.

Body

 Fill the body the body with statements that support the thesis statement while following the structure in the outline. You can change but only if it is essential.

Conclusion

A conclusion wraps up the research paper mostly by restating the thesis statement but in different wording. Summarize the points in the body, and few words explain the reason for believing that the support your claim on the matter.  Take a moment to point out the reason for believing that a topic requires more research if yours is inconclusive.

1. Write the reference page

This is the last page in a research paper listing all sources in the project for readers to find what an in-text citation quickly.

You can make a lot of mistakes when writing. Do not submit your paper before revising and editing. Go beyond fixing typos to check the clarity of the thesis statement, an organization of the paper, coherence, and credibility of the arguments in supporting the thesis. Also, check if the citation is in order and test plagiarism.

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Saudi Arabia has set a high standard for its healthcare. It has gone to the extent of hiring well educated and trained nurses from other countries who can offer high-quality care to patients.   Immigrant nurses earn a good salary and find a good working environment, but like in every place, indigenous and immigrant nurses encounter some challenges.

Adaptation challenges by immigrant nurses

Saudi Arabia hospitals hire many nurses from other countries. Many immigrant nurses have the challenge to settle in an unfamiliar environment with little or no support system.  New work in a place with different people, culture, and language can be a hard thing to adapt. Studies show that many immigrant nurses have trouble to adjust to a new environment.

Other difficulties lie in adjusting to different healthcare systems and hospital policies.  It is common for a nurse manager to allocate a single staff nurse to be in charge of patients and also do nursing report. Additionally, it is only the staff nurse in charge who can collect the medications that doctors prescribe.

It is different from hospital policies in western countries and Asian countries like Malaysia where nursing managers allocate two staff nurses to a cubicle.   One nurse will be responsible for nursing procedures while another is in charge of the report. It will take time for immigrant nurses to adapt to different systems and policies.

Staff challenges facing the nursing profession in Saudi Arabia

Nursing is a team career, but new nurses to Saudi Arabia have to deal with these challenges in relating to colleagues.

Forming a support system with new co-workers

The way people relate with other varies but it is slightly challenging to create a working relationship with nurses from different backgrounds.  Some nurses even experience emotional disturbances during adjustment including loneliness, confusion, frustration, low self-confidence and loss of self-esteem.

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Extremely high expectations from employers, managers, and colleagues

Saudi Arabia employers and colleagues have great expectations about capabilities and clinical performances. Hospitals have strict prerequisites and standards before they accept that someone is capable of serving patients well.  Some conduct frequent strict job evaluations making it tougher to work than most nurses thought.

Staff shortages

Saudi Arabia like many other countries has a problem of nursing shortage. Staff at many hospitals work for long hours and attend to an extra load of patients.  Disapproval against gender mixing with rotating shifts and long working hours makes nursing to be seen as a socially unacceptable choice in this country. This negativity about nursing deters many Saudi women from enrolling to nursing schools. It makes the problem of shortage to escalate leading to heavier workloads and longer shits.  

Being short staffed causes personal and professional issues. Nurses do not have other options except taking on more shifts when a hospital has lesser staff. Covering for absences of co-nurses and sacrificing on important life occasions also becomes a frequent happening. Short staffing is a common reason for nurses to experience burnout and frustration.

Meeting patient expectations

Many patients have higher expectations than the level that nurses can achieve. Their expectations are not in consideration of staffing shortages and hospital budgets. It puts much strain on the nurses who have a lot to do in achieving patient care. The morale of nurses brings down the morale of nurses and gives them much stress when they hear that the patients are unhappy with the level of service.

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