Need ONE Response Per Each Discussion Total 6 Responses. Attached Are The Discussions and Rubric  Please Follow Them. Posts Will Be A Minimum Of 100 Words, APA Format.One reference per each discussion 

Laura Saldivar 

                The development of pressure ulcers, or bed sores, remains one of the biggest problems in nursing care for immobile patients today (Sharp, Schulz, & McLaws, 2019). It is a definite problem in the health care system, which affects both patients, their families, medical staff and healthcare facilities. For the patient, they may experience severe pain, helplessness, as well as financial difficulties from increased cost of treatment (Gill, 2015). Unfortunately, medical staff may find great challenges to prevent these skin issues, as well and treat them after they have occurred. Pressure ulcers are also referred to as bed sores, skin tears, or deep tissue injuries that happen due to constant pressure, shearing, or friction for prolonged periods of time (Gillespie, Chaboyer, McInnes, Kent, & Whitty, 2014). These wounds are common in the geriatric population and immobile patients who spend a great amount of time laying or sitting down (Sharp, Schulz, & McLaws, 2019).  

           The decreased physical movement, immobility and inability to turn are the main cause of pressure ulcers, there is a variety of strategies practiced by nursing staff to prevent them from occurring (Gillespie, Chaboyer, McInnes, Kent, & Whitty, 2014). Most hospital protocols enforce staff to manually turn the patient which is the most common mode of prevention.  By shifting a patient’s position in bed every 2 hours, it promotes blood flow, which is necessary for healthy skin (MedlinePlus, 2017). Due to lack of turning, blood and waste tend to pool in the tissues which inhibits nutrient exchange from healthy tissues. Frequently turning a patient helps the release of waste build up and promotes healthy skin (Hess, 2009). Every hospital or healthcare facility has their own scheduled repositioning protocol. Although, intensive care units as well as long term care facilities whose population has decreased mobility, the standard time is two hours (John Maynard, 2015).  Unfortunately, staff tends to be unaware of the turn Q2 rules or fails to perform the task which has led to this becoming one of the largest occurrences of hospital acquired injuries or HAI’s (Fletcher, 2017). 



Cooper, K. L. (2013). Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit. Critical Care Nurse, 57-66. 

Fletcher, J. (2017). Reposition Patients Effectively to Prevent Pressure Ulcers. Wounds International, 7-10. 

Gill, E. C. (2015). Reducing hospital acquired pressure ulcers in intensive care. Biomedical Journal, doi: 10.1136/bmjquality.u205599.w3015. 

Gillespie, B. M., Chaboyer, W. P., McInnes, E., Kent, B., & Whitty, J. A. (2014). Repositioning for pressure ulcer pre


 Muller Sanon

            ICU nurses are often confronted with critical events from the caring of patients who are exposed to infection because the central line dressing was not changed on the required day or it was found soiled or loose and the nurse does not change it.  CLABSIs are preventable, yet they result in thousands of deaths every year with billions of dollars dedicated to addressing these adverse events.  In many facilities throughout the country, the number of ClABSIs have increased in recent years, despite efforts to lower its incidence (Ista et al., 2016).

            The practice issue is that none maintenance was found in my current practice because the central line dressing was not changed on the required day or it was found soiled or loose and the nurse does not change it.  In the future, I’d like to conduct a search by identifying the major elements of my PICOT question and find subject descriptors, MeSH terms, or descriptors that identify the elements of my research.  I want to start with a broad search and move to a narrower search with terms for the comparison, outcome, and time factors of my study.  By using database filters, I will be able to make the evidence more specific and target the studies I am looking for. 


Ista, E., van der Hoven, B., Kornelisse, R. F., van der Starre, C., Vos, M. C., Boersma, E., & Helder, O. K. (2016). Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. The Lancet. Infectious Diseases16(6), 724-734. doi:10.1016/S1473-3099(15)00409-0. Retrieved from:

 Guillermo Carabeo

Discussion 4



        Prepare a 350-word draft of a clinical problem that you would like to use for your Research project. There should be an introduction to the problem (as to why it is a problem) that is documented with literature, a clear problem statement (one declarative sentence that begins with “The problem is…”, and a purpose to your project. Post this as your Initial response. (Essential I-IX).

      Community-acquired pneumonia continues to have a significant impact on elderly individuals, who are affected more frequently and with more severe consequences than younger populations. As the population ages it is expected that the medical and economic impact of this disease will increase. Despite these concerns, little progress has been made in research specifically focusing on community-acquired pneumonia in the elderly. The problem is Community-acquired pneumonia in elderly patients. Despite widespread availability of antibiotic therapy and sophisticated severity of illness assessments, community-acquired pneumonia (CAP) continues to be a leading cause of death worldwide. In the elderly population, defined as those aged over 65 years, the impact of pneumonia is far greater than in other age groups. The annual incidence of pneumonia in the elderly is four-times that of younger populations. In addition, older adults have higher rates of hospitalization and are more likely to die as a result of CAP. The elderly population is increasing at twice the rate of the general population, necessitating a better understanding of the pathophysiology, microbiology, treatment and prevention of this common affliction. The mechanisms behind the disproportionate incidence and mortality rates in elderly pneumonia patients are not fully understood. Several physiologic changes in older adults have been implicated as risk factors for CAP. Changes in basic lung physiology as a result of aging include decreased elastic recoil, increased air trapping (senile emphysema), decreased chest wall compliance and reduced respiratory muscle strength. These factors may act to increase baseline work of breathing, giving older individuals less reserve to cope with bacterial infections in the lung. In addition, reduced mucocilliary clearance and diminished cough reflex have been described. These findings, combined with greater upper airway colonization with virulent organisms, may predispose this population to develop lower respiratory tract infections.














Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde-Zwirble WT. Hospitalized c


 Magdaleine Selondieu


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Recently, transitional nursing has been a challenge in many countries hence becoming an issue of concern in the world. Transitional nursing refers to the act of giving care to the patients all the way from the hospitals to the homes of the patients (Toles et al, 2016). Therefore, the lack of proper transitional nursing is involving some elements of medical error. The medical error includes a lack of proper care to the patients including lack of quality treatment. In this context, medical error is one of the crucial reasons for the increased death in the world.  However, some medical practitioners defined transitional nursing as an act of changing the location of giving health care to the patients after being transferred to another place of health care. In this context, the patients require great care of the nurses who should visit their homes regularly to check the ongoing of the client. The reason for the need of this great care is because some patients are very old and they cannot control the use of medicine as prescribed by the doctors. For instance, the patients who are aged seventy years and above find difficult in following all the instructions hence the need of nurses becoming essential.

The health care problems among the patients are crucial and require the immediate effect of bringing the medical personnel to help the patients (Toles et al, 2016). However, the main challenge is that in most countries there has been a small number of available nurses who can manage to cake of the patients from the hospital up to their homes. In most cases, you find that one nurse is serving a variety of patients thus becoming very difficult to the patient who relocated from one place to another in the process of medication to receive the same service he used to get. Furthermore, the transitional nursing becomes more complex when the transition of nurses occurs because there is a possibility that patients may start receiving services from a nurse who is not well experienced as the one used to give them services of health care. In this context, the most transition done in the field of nursing includes promoting the more experienced nursing and finally getting the less experienced to occupy the space of more experienced.


Toles, M., Colón-Emeric, C., Naylor, M. D., Barroso, J., & Anderson, R. A. (2016). Transitional care in skilled nursing facilities: a multiple case study. BMC health services research16(1), 186.


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  Maritza Leon



Urinary Tract Infections in the Elderly




Prepare a 350-word draft of a clinical problem that you would like to use for your Research project. There should be an introduction to the problem (as to why it is a problem) that is documented with literature, a clear problem statement (one declarative sentence that begins with “The problem is…”, and a purpose to your project. Post this as your Initial response. (Essential I-IX).                                                                                     


          Urinary tract infections (UTI) occur frequently in older people. UTIs are generally caused by bacteria, but can also result from certain viruses and fungi. Mainly noted symptoms include burning sensation during urination, frequent urge to urinate, and pain in the back or lower abdomen. If left untreated, a UTI can lead to acute or chronic kidney infections, which could permanently damage these vital organs and even lead to kidney failure. This common infection is also a leading cause of 
 a potentially life-threatening infection of the bloodstream. Non-specific symptoms, such as confusion, are often suspected to be caused by urinary tract infection (UTI) and continues to be the most common reason for suspecting a UTI despite many other potential causes. The problem is that this can leads to significant overdiagnosis of UTI, inappropriate antibiotic use and potential harmful outcomes. An alternative method for prophylaxis of patients who suffer from recurrent infections must be found while minimizing the risk of developing or propagating antibiotic resistance.  This problem is particularly prevalent in nursing home settings. The elderly is particularly susceptible to urinary tract infections. Older individuals are more vulnerable for many reasons, including their overall susceptibility to infections due to a weakened immune system. “As you get older your immune response changes; it’s part of normal aging,” says Anna Treinkman, a nurse practitioner at the Rush Alzheimer’s Disease Center in Chicago and president of the National Conference of Gerontological Nurse Practitioners.

           Elderly men and women also experience a weakening of the muscles of the bladder and pelvic floor, which can lead to increased urine retention (incomplete emptying of the bladder) and incontinence. These things all contribute to infection. It has been noticed that women are more prone to this infection. Because, due to the short distance between urethra and bladder, i


Daylamis Gonzalez

Discussion 4



Prepare a 350 word draft of a clinical problem that you would like to use for your Research project. There should be an introduction to the problem (as to why it is a problem) that is documented with literature, a clear problem statement (one declarative sentence that begins with “The problem is…”, and a purpose to your project. Post this as your Initial response. (Essential I-IX).

The problem is falls among elderly and its relation with their health problems and surrounding environmental factors. Falls are one of the most common problems in the elderly around the world. A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or at another lower level. Currently, there is no numerical criterion that classifies people as “elderly.” However, the United Nations has determined that the age of 60+ should be used to refer to people as being “elderly. This is in spite of the fact that most developed countries take the chronological age of 65 years to define the ‘elderly. In the United States, falls are a leading cause of morbidity and mortality among mature adults. It is the second leading cause of accidental or unintentional injury/death after road traffic injuries. For example, of the 11 million adults aged 65 years and over living in the UK, around 30% of community-dwelling mature adults fall at least once in their lifetime. It was found in a study conducted in the Eastern Mediterranean Region that 30%–40% of adults older than 65 years residing in the community fall each year. The rates were higher in hospitalized patients and nursing home residents. Moreover, the incidence of falls rose steadily from middle-age onward peaking in persons older than 80 years.

Falls may be associated with various contiguous environmental hazards such as carpets and rugs. Most falls (72.8%) occur at home. Women represented 80.2% of fall injury victims. Not surprisingly, perhaps, the most common location for fall injuries in the home is the bathroom (35.7%). Other environmental hazards include poor stairway design and disrepair, inadequate lighting, clutter, slippery floors, unsecured mats, and the lack of nonskid surfaces in bathtubs. There is a paucity of literature on the important topic of falls amongst the elderly in the Kingdom of Saudi Arabia. However, our study will focus on estimating the true extent of falls among the elderly within the community alone and examine the relationship between the health status of elderly people as well as the impact of the environment on their propensity to experience falls.









Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701–7