Prevention of Central Line Associated Blood Stream Infections Through Research Paper

Prevention of Central Line Associated Blood Stream Infections Through Education - Research Paper Example CLABSIs have been estimated to occur in the United States hospitals in the range of 250, 000-500, 000 cases annually. This has resulted in high costs of care for patients who have been hospitalized. The need to cut down the costs associated with CLABSIs resulted in research aimed at developing a feasible solution. Research has yielded a mechanism that will see nurses educated on best practices that will them take an active role in the prevention of CLABSIs. This paper will focus on implementation of a plan to prevent central line associated blood stream infections by way of educating nurses. Problem Identification and Importance According to the Center for Disease Control (CDC), every year an estimated 41,000 Central line associated blood stream infections occur in hospitals in U.S. The infections are typically serious and result in protracted stay in hospitals with increased costs. These infections also come with an increased risk of mortality (CDC, 2012). CLABSI (central line assoc iated blood stream infections) are typically prevented by proper management of the central line. CLABSIs are considered to be part of healthcare associated infections (HAIs) and have been reported to responsible for mortality ranging from 12-15%. In a study conducted by CDC, the findings revealed that approximately 43,000 CLABSIs occurred in hospitalized patients in ICU in U.S hospitals. There was a reduction in the number of CLABSIs by approximately 18000 in the year 2009. CLABSIs resulting from Staphyloccocus aureus represented the greatest decrease than even the gram negative rods like Candida spp and Enterococcus spp. In the same year, 23,000 CLABSIs occurred among inpatient individuals in the inpatient wards of U.S hospitals. In the year 2008, approximately 37, 000 CLABSIs occurred in outpatient clients receiving outpatient hemodialysis (CDC, 2011). These statistics serve to underscore the importance of CLABSIs in U.S hospitals. CLABSIs have resulted in an increased cost of med ical treatment. Hospitalized persons are paying huge amounts of money for their medical costs (Moe, 2012). It is this CLABSI associated costs that created a need for research activities that would see the CLABSIs kept to a minimum. The research activities have resulted in current evidence based guidelines that when executed, the incidence of CLABSIs will reduce. The mechanism requires that nurses be educated on prevention of CLABSIs. CLABSIs are not only responsible for high medical cost but are also responsible for morbidity and mortality in pediatric and neonatal intensive care units (Bizzarro, 2011). According to Bizzaro (2011), although implementation of evidence based catheter care bundles has reduced the infection rates, CLABSIs remain a fundamental problem in the pediatric and neonatal critical care units. CLABSIs are responsible for both pediatric, neonatal and adult morbidity and mortality in U.S citizens. Costs According to a study conducted by Shannon, et al (2006), the i nfections that are acquired while in hospital add considerable mortality and morbidity to patient care. A detailed economic analysis of the hospital expenses and revenues in 54 patient cases who had contracted central line associated blood stream infections over a period of three years in two intensive care units was conducted. The financial data was compared to data of other patients who were of

Free Essays - Adventures Of Huckleberry Finn :: Adventures Huckleberry Huck Finn Essays

Adventures Of Huckleberry Finn Essays In the Style of Twain The Adventures of Huckleberry Finn, is said to be " the source from which all great American literature has stemmed" (Smith 127). This is in part attributed to Mark Twain's ability to use humor and satire, as well as incorporating serious subject matter into his work. Throughout the novel Twain takes on the serious issue of Huck's moral dilemma. One such issue which is particularly important in the novel is pointed out by Smith: He swears and smokes, but he has a set of ethics all his own. He believes that slaves belong to their rightful owners, yet in his honest gratitude toward his friend Jim, he helps him to escape the bonds of slavery. (181) This is something that tears at Huck throughout the novel and helps Twain show how complex Huck's character really is. "The recognition of complexity in Huck's character enabled Twain to do full justice to the conflict of vernacular values and the dominant culture" (Smith 125). Throughout Huck and Jim's adventures Huck is constantly playing practical jokes on Jim who seems to take them all in stride. But unknown to the reader Twain uses this aspect as another notch in Huck's moral 2 growth. Critic Frank McGill points this out: Huck's humble apology for the prank he plays on Jim in the fog is striking evidence of growth in Huck's moral insight. It leads naturally to the next chapter in which Twain causes Huck to face up for the first time to the fact he is helping a slave escape.(119) Another serious issue addressed by Twain is the abuse that was given to Huck by his father. Huck was kidnaped from the Widow Douglas by his father who had heard of his inheritance. Huck's father then took him to a cabin far away in the woods where he kept the boy a prisoner, beating him and half starving him. Twain tells us how Huck felt about life with his father: Before long Huck began to wonder why he had even liked living with the widow. With his father he could smoke and swear all he wanted, and his life would have been quiet pleasant if it had not been for all of the constant beatings.

The Ultimate Model City

We all want to live in the best city in the world. A high standard and quality of living is, after all, a very desirable thing. We have hopes and dreams and aspirations for what an ideal city should be. Magazines even routinely publish their own lists of the best cities in the world, so we can all have an idea of just what a great city should constitute. With that in mind, the following constitutes the ultimate model city. The model city is small, as larger cities have larger problems like pollution and crime. Yet it is not so small as to have nothing to offer its residents. The model city covers ten square miles or less and has a population of between 5,000 and 10,000. That makes it large enough to attract certain amenities and small enough that it maintains its â€Å"hometown† feel and charm; it is also small enough that most of the residents will have the opportunity to know each other. The model city is a direct democracy. Its citizens all have a direct say in what goes on in the town, thus giving them a true feeling of ownership of the town. The direct democracy is facilitated through regularly scheduled monthly town meetings (with an option to have extra meetings in cases or emergencies or extremely important and urgent topics). Town members can go to the meetings personally or appoint a proxy to vote in their place on issues. The town meetings are run by a town chairman, whose main function is organizing, holding, and acting as facilitator at town meetings. This chairman is elected by secret ballot by town citizens once a year to a year-long term with no term limits. Any issue that comes before the town is voted on in town meetings. For certain functions that would require too frequent voting to be practicable, the town elects every other year to terms of two years with no term limits, committee members to oversee functions such as roads and parks, etc. The town has its own Constitution. It is a document drawn up at the founding of the town and amended throughout the years by town citizens as times and needs change. It lays out the rights and responsibilities of being a citizen of the town. The town Constitution gives each citizen all of their basic freedoms found in the U. S. Constitution, plus describes the organization of their system of direct democratic government. The Constitution also guarantees non-discrimination in the town in all areas of town life. This non-discrimination policy extends to all races, genders, nationalities, and sexual orientations (and just to make sure the policy is followed, there is a committee of Equal Opportunity volunteers to look into allegations of discrimination and then report back to the town for votes on resolution). The town Constitution is displayed at the town hall for all to see. The town has all of the basic necessities one would need in a town. These necessities include a fire department, a hospital, an elementary/middle school (grades K through 8) and a high school, a water department, an ambulance, a train station and a bus station. The town also has electric and phone service, is within range for cell phone service, and has cable and high speed internet capabilities. The water and fire departments are run by volunteer committees whose terms are for two years, when they can re-volunteer or allow others to do so. There is no police department per se, but there is a volunteer citizens patrol, unarmed but with the power to make citizens' arrests, and these volunteers take shifts patrolling the streets either on foot or in their cars. These patrol volunteers have terms of one year, renewable at will. All volunteers on all committees and departments, as well as all people in elected positions, can be removed by for cause by vote of the town. The town has an extensive system of parks and open spaces where children, families, and pet-owners can go. These parks are landscaped, well-kept, and rely heavily on natural influences, meaning there are many trails, trees, and streams. Some parks have playground equipment, some have sports equipment, others do not. Each park has a theme, and attracts people who want to indulge in that theme (dog-walking, Frisbee, nature observation, etc. ). The town also has attracted several different ethnic restaurants, giving the town a variety of food from which to choose. The town has Chinese, Japanese, Indian, Vietnamese, Mexican, Ethiopian, Middle Eastern, French, Greek, Italian, and vegetarian restaurants available. There is also a thriving community theater, which actively encourages community participants in its productions, and which has its own playhouse. For those who prefer the silver screen to the stage, there is a 4-screen movie theater. There are also three dance clubs in town, a contemporary club for the young adults, a ballroom/swing club for seniors, a line-dancing/karaoke club for families, and a club just for teenagers. The town also has several thriving civic organizations, including the Lions, Kiwanis, Daughters of the American Revolution, and a Garden club, to name a few. In addition, there is always some sort of program or production going on at the elementary/middle school and high school, including sporting events with neighboring towns. There is always plenty to do and plenty to get involved with in the town. The residents do not lack for recreation. The town is very environmentally conscious. It has a curbside recycling program that picks up any sort of recyclable material and provides residents with color-coded bins for dividing recyclables. The town makes sure its water is not fluoridated and has a complex filtration system to make sure the water is pure. All wires and cables are buried rather than on poles. Steps are taken through an environmental protection committee run by a committee of volunteers of those with knowledge in the field to make sure that any unavoidable pollution, such as through sanitation systems, has the minimal possible impact on the environment. None of the businesses in town is allowed to have any toxic emissions. Firearms are not allowed to be discharged within town limits, thus eliminating the needless killing of animals and resultant disruption of the ecological balance within the town. The town, as a result, has some of the cleanest air and water in the nation and has attracted many natural and health foods stores. In the area of business and industry, most of the people who live in the town also work in it. The small area of the town has the added benefit of making it quick and easy to get to work, and carpooling and biking is encouraged through company car pool incentive programs and well-kept bike paths within the city. Most of the businesses in the town are locally owned and operated. The town places a high value on independently owned stores, and has more than once successfully voted down proposals from big chains like Wal-Mart and Target to build there. The schools in town employ many town residents, as do the restaurants and grocery stores, the movie theater, and a wide array of specialty retail shops. The town is also home to several banks, bookstores, attorneys' offices, salons/day spas, and even has a few family-run farms on the outskirts that employ some residents. The town itself is an employer of those who work on sanitation crews and recycling trucks and at the public library. There are not any big companies or corporations in the town, as that would detract from the local, small-town atmosphere and may lead to an increase in pollution and could attract undesirable companies to the town. However, the town has enough local businesses and town departments to employ nearly everyone who needs employment. The town does levy a property tax and a school tax in order to create revenue for things it needs. However, these taxes were voted on by the town members, and every five years, the taxes are re-evaluated at town meetings in order to determine if they should continue, and if so, if they should be increased, decreased, or remain the same. A town treasurer is elected every two years to handle the money from these revenues, to create a town budget that is then voted on by the townspeople for approval, and to make sure all the money goes to the appropriate places. The town treasurer is allotted two volunteers to assist him or her in his or her duties, and these volunteers are selected at the times the town treasurer elections are held. The town is also home to a chapter of the Red Cross, and many people in the town are volunteers, and have learned how to be prepared for and handle disasters. These townspeople regularly give lectures and hold classes for other townspeople pertaining to these things, including giving a regularly scheduled adult and child CPR class and organizing and holding blood drives. If a natural disaster were to occur in the town, the citizens would be prepared and know what to do. The town is not built in an area prone to earthquakes or floods, and there are no volcanoes nearby, so the chances of these disasters happening are remote. However, the chance of a violent storm, tornado, or blizzard is a possibility, and the residents are well-prepared for these events. The town also has 911 service for their local fire trucks and ambulances, and a connection at the town hall to the Federal Emergency Management System in case of larger emergencies. So far, this connection has not had to be used.

Critical Essay on Shakespeares Macbeth

Critical Essay on Shakespeares Macbeth Macbeth is considered to be one of the most unusual and mysterious tragedies of Shakespeare. Being one of the very few plays, which was never performed while Shakespeare was alive, and the shortest of his plays, it is notorious among actors as the most unlucky theatrical works. Another peculiarity of Macbeth is that it focuses on the theme of the evil, but with a peculiar difference. The main character, Macbeth, is wicked, no question, but he is not an ordinary villain. He knows too well the difference between the good and the evil. He realizes that having killed Duncan he violates moral laws, which he deeply respects. Not having committed the crime yet, he knows what horrible pains of remorse he is doomed to experience. But still he decides to commit a crime. His longing for power appears to be stronger than conscience and fear of moral scruples. Having committed the crime, Macbeth loses his inner peace completely. He stops believing in friendship, his soul is tortured by suspicions. As he feels that everyone around him is his enemy, he becomes cruel and meticulous. Macbeth achieves the long desired power, but he cannot feel satisfied with it. The people and the aristocracy hate him and he has to fight them. Although he knows that his life is his worst nightmare and a meaningless massacre, he does not surrender, deep down being a hero. Macbeth is an unusual story of a good, moral person committing a

Animal Totems and Guides - 672 Words

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The time frame in which a particular animal totem is in your life directly correlates with how well you recognize, learn and then incorporate the knowl edge into your life. Be mindful that your animal totem/s (and we do have more than one) have chosen you! They will present when you are fully and completely ready to accept and realize the lessons in their coming. Most often, your animal totems are wild animals as opposed to domesticated. This is not always the case but often is. Use your gift of Claircognizance (clear knowing) to discern this. Your will know there is a higher knowing message for you when the animalShow MoreRelatedWhat I Learned About The Flute Was So Special1154 Words   |  5 Pagestell stories using animals as the main character. I made this assumption before even looking up the actual reasoning. I then found a quote from Sitting Bull explaining that â€Å"every seed is awakened and so is all animal life. 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Identification And Description Of Authentication...

GAI is a financial institute located in Canada, the United States, and Mexico. It is specialized in financial management, loan application approval, wholesale loan processing, and investment of money for their customers. The GAI employs over 1,600 employees and has been growing consistently for nearly six years because, its management strategy has been built on scaling operational performance through automation and technological innovation. However, the GIA has experienced several cyber-attacks from outsiders over the past a few years ago. This attack has conducted the loss of its confidentiality, integrity, and availability for several days, the loss of its reputations, and mostly the loss of its customer data confidentiality. To secure the GAI’s network system, a lot of issues have to be addressed. This paper will cover the identification and description of authentication technology and network security issues, list all access points, it will design a secure authentication t echnology and network security, list all known vulnerabilities, address concern over the mobile security and design a secure mobile computing, identify wireless vulnerabilities and recommend what safeguards, and finally, design a cloud computing environment for GAI. Because GAI is a financial institution, to secure its facility, a top secret clearance have to be required for everyone who enter its network or facility. 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Cholecystits/Cholelithiasis Free Essays

PATHOPHYSIOLOGY Medical Diagnosis: Cholecystitis/Cholelithiasis Nursing Diagnosis: Activity intolerance r/t laparoscopic abdominal incisions AEB SOB during ambulation, increased respirations at 38, O2 sat 80% room air after walking 50 ft. Normal Physiology: The gallbladder is situated inferior to the liver. The gallbladder is a structure that functions as a storage space for bile that is produced in the liver. We will write a custom essay sample on Cholecystits/Cholelithiasis or any similar topic only for you Order Now The liver produces and secretes bile into the gallbladder from the right and left hepatic duct join together to become the common hepatic duct then into the gallbladder via the cystic duct. During the digestion of fatty food, the gallbladder releases bile that passes through the common bile duct and into the duodenum through the Sphincter of Oddi to break down fat into fatty acids to be absorbed by the small intestine to be used as energy and storage of energy for metabolic needs of the body. Pathophysiology: Cholecystitis, and inflammation of the gallbladder, is a condition which can be caused by cholelithiasis, the formation of gallstones. Most stones are formed of cholesterol. Excess cholesterol in bile is associated with obesity, high cholesterol diet and drugs that are prescribed to lower cholesterol levels. The excess saturation of cholesterol can lead to the formation of stones. This client had an elevated LDL and low HDL levels that do state the client had excess cholesterol. Biliary stasis, which is slow emptying of the gallbladder, can also cause the formation of stones. An inflammation of the gallbladder allows for excess water and bile salt reabsorption which call also lead to the formation of stones. This client did have wall thickening and distention of the gallbladder that indicates a inflammation of the gallbladder over a period of time. This is the second time the client came to the ER with pain in a 6 week period. Potential Complications: If a gallstone migrates out of the gallbladder into the ducts, it can lead to cholangitis which is an inflammation of the duct. Obstruction of the common bile duct may cause bile reflux into the liver causing pain, jaundice, and liver damage. The clients ALT, liver function test was elevated indicating liver disease process and in this clients case it is due to the back-up of bile into the liver from obstruction in the common bile duct. The client can also have pancreatitis due to the inability of the pancreas to secrete digestive enzymes through the pancreatic duct. The client had mild pancreatitis confirmed by CT scan. Complications of the cholecystitis/cholelithiasis can lead to a collection of infected fluid within the gallbladder, gangrene, and perforation resulting in peritonitis or abscess formation. A fistula into adjacent organs can for such as in the duodenum the colon or stomach. During the laparoscopic cholecystectomy, the client’s gallbladder was noted with gangrene but no perforation, peritonitis, fistula or abscess formation was noted. If this condition goes untreated, death can result from hemorrhage, peritonitis, hypovolemic shock, septicemia and septic shock. The client did not die because treatment and surgery was performed. Nursing Interventions Rationales: Independent: 1. Ambulate with client 1:1 assist. The client should not ambulate alone. The client is at risk for falls for injury to do her activity intolerance for SOB and decreased O2 sats. This will ensure the client does not fall and if she does become weak or unstable it will reduce the injury. . Place the client in semi-fowler during resting time in bed. This will decrease orthopnea and help the client breath better by decreasing pressure on the diaphragm allowing for better expansion of the lungs. 3. Monitor respiratory status and auscultate lung sound every 4 hours. This will help assess interventions and any changes needed for their respiratory status. Dependent: 4. Monitor and assess clients client’s O2 sat level and administer O2 at 2L NC per physician’s orders. The clients O2 Sat had been at 80% room air nd after activity with O2. This will help monitor client needs and evaluate the need for any changes this client may need for a decrease or increase in O2 delivery. 5. Administer morphine sulfate 1-5 mg IV push prn q2h over 2 minutes. Administering pain meds can help decrease pain associated with the client needing to cough and deep breath and will help the client ambulate. Although the client has not indicated much pain, giving prior to activity will help the client tolerate ambulation, cough and deep breath and spirometer. 6. Administer Cefoxitin 1 gm in 100mg/NaCl 0. 9% over 1 hr q8h per physician’s orders. The administration of antibiotics will reduce the client risk for peritonitis from gangrene of the gallbladder and risk of infection form the surgery. This will also help with healing of the clients mild pancreatitis noted on CT scan Interdependent: 7. Collaborate with dietician to meet with the client regarding diet. In a client with the removal of the gallbladder, the client needs to be educated on the types of food to avoid after surgery. This will help identify what types of foods the client can continue to enjoy and those that will facilitate abdominal problems post cholecystectomy. Ensuring the family is also involved when the dietician is present will help increase the likelihood of adhering to a new diet holding the client accountable for food choices. 8. Collaborate with respiratory therapy to assess the need for respiratory assistance such as the need for nebulizer treatment or the need for portable O2 for ambulatory purposes. The client’s O2 quickly drops after taking D/C of O2. 9. Collaborate with occupational therapy to assess the ability for the client to go home. The client is an elderly lady and may need to be evaluated prior to discharge to assess ADL’s since she lives on her own. This will ensure the client can safely return home or may need to be transferred to rehab prior to going home and educate the client on throw rugs, shower use and other in home dangers that elderly clients are at risk for. Client Teaching: Instruct the client on the need to cough and deep breath and spirometry. The client has had SOB post op and decreased O2 saturation. The client has atelectasis in her right upper lobe with diminished lung sounds throughout with decreased expiratory effort. I educated the client on coughing and deep breathing every hour x10 and how to use the pillow for splinting her abdomen due to abdominal pain post operatively. Client understood and demonstrated this very well and prior to end of shift I assessed the client and had her demonstrate what I had taught her prior to leaving and she performed properly and also stated she had been doing it every hour as instructed. Textbook Signs Symptoms . Pain, abrupt onset, severe and steady 2. Pain radiate to the back, right scapula and shoulder lasting from 12-18 hours 3. Nausea, vomiting and anorexia 4. Chills and fever 5. Abdominal guarding Risk Factors 1. Female over age of 65 2. Family history 3. Native American; northern European heritage 4. Obesity 5. Hyperlipidemia 6. Use of oral contraceptives 7. Biliary stasis: pregnancy, fasting or prolonged parenteral nutrition 8. Dise ases or condition: DM; cirrhosis; ileal disease or resection; sickle cell anemiaReferences: Domino, F. n. d. ). 5-minute clinical consult Powered by Skyscape (Ipod). Lippincott, WIlliams Wilkins. LeMone, P. , Burke, K. , Bauldoff, G. (2011). Medical-surgical nursing care critical thinking in patient care (5th ed. ed. ). Upper Sadle River, NJ: Pearson Education. Martini, F. H. , Neth, J. L. (2009). Fundamentals of anatomy and physiology (Eight ed. ). San Fransisco: Pearson Benjamin Cummings. Pagana, K. , Pagana, T. (2009). Mosby’s diagnostic and laboratory test reference (Ninth ed. ). St. Louis, Missouri, United States: Mosby Elsevier. How to cite Cholecystits/Cholelithiasis, Papers