Respond to these discussion posts below by offering suggestions/strategies for working with this database from your own experience or offering ideas for using alternative resources.

250 words for each discussions post each. APA format. 2 in text citation each and 2 references each 

Discussion post 1

I found a peer-reviewed article about how the health of incarcerated individuals and the care they receive impacts the health of their

community (Uggen et. al, 2023). To find this article, I used the search words “incarceration” and “health” using the Boolean operator “AND” to broaden

my search. Boolean operators serve to narrow or expand a search (Walden University Library, n.d.a).  I chose to search for literature using these two

words because, upon becoming a nurse practitioner, part of my job will include caring for the incarcerated population at my local county jail. I have

interest in learning about how medical care provided to the incarcerated population impacts the health of inmates and the greater community.

               Library databases are useful for clinical research because they allow researchers to narrow their search using database limiters (Walden

University, n.d.b). The database I used to search for the article was ScienceDirect. I only had one problem with my search, which took me a couple

minutes to solve. Initially, my results were limited because I only typed one year into the “Year(s)” search box. I wasn’t sure how to enter more than one

year as ScienceDirect’s search engine is different than search engines I have used in the past. I wasn’t satisfied with my initial results. I then searched

for articles from the last five years by typing “2018-2023”; this significantly expanded the number of articles for my search.

               ScienceDirect would be useful to colleagues because it holds a vast number of articles to choose from. It contains more than 19 million

scientific articles and chapters from more than 2,650 different peer-reviewed journals (Elsevier, n.d.). I found the search engine easy to use because it

allowed me to enter multiple search words to narrow my search. It also allowed me to refine my search based on specific criteria and it allowed me to

sort my results by relevance or date. I would recommend this database to others because it contains only peer-reviewed literature (Elsevier, n.d.).  

discussion post 2

The purpose of scholarly writing is to uncover and present evidence that will reveal the truth.” (Walden University LLC, Producer,

2018). To cite a scholarly article, a person must understand what the meaning of it is and what the person critiquing should be looking for.

According to Al-Jundi and Sakka (2017), they provide a checklist of ten standard questions to help critically appraise a peer-reviewed

article. I was able to review the article to answer the questions based on the 10 standard common questions by Al-Jundi and Sakka

(2017) to know that my article met the criteria for a scholarly peer-reviewed article. This led me to the article “All Social Media Are Not

Created Equal: Instagram, Finsta, and Loneliness” in Walden library. My article goes over the study conducted by Schoenfeld and Fiori

(2021) and how they found that Instagram usage and other social media platforms are related to loneliness. This interests me because

networking is done through social media, and this is one way to get people help if they are having mental health issues or encourage them

to seek it themselves. It also interests me because I have seen people close to me go through this on various levels. People are more likely

to reach out to their peers, even strangers, before they go to an actual facility to seek help due to the stigmatism around out.

        At first, going through the Walden library was not easy. I had to watch the videos provided this week in the resources tab. I had to

follow the guidelines from Walden University’s library on “Evaluating resources: Journal” (Walden University Library, 2019). I limited my

search to peer-reviewed journals regarding mental health. By doing this, it helped narrow down my search of journals, and I was able to

look and choose from there. I would recommend searching through the Walden library database after taking a tutorial on how to use it or

talking with the librarian because this can be a little overwhelming and confusing to navigate. The library has many resources to help

guide your search so you can find what you are looking for. You just need to have time and patience and know who you can ask if you

need help.

1. What is the research question?
2. What research method is being used?
3. How are the subjects chosen (explain the parameters & how many)
4. What are the results of the study?
5. What are the recommendations?
6. What is your opinion? 
7. Your references must be within the last five years, and websites are unacceptable. I am looking for scholarly research – peer-reviewed journal research articles. 

 Mr. Nguyen is a 58-year-old patient that had septic shock and developed Acute Respiratory Distress Syndrome. He is orally intubated and on a mechanical ventilator. He is paralyzed and sedated.

• What manifestations might you observe for a patient with ARDS?
• What complications can Mr. Nguyen develop from being mechanically ventilated?
• List priority nursing interventions to prevent complications associated with ventilatory support.
• What interventions can be implemented specifically to prevent the development of Ventilator Acquired Pneumonia (VAP)?
• You are orienting in the ICU, the nurse you are working with is not implementing the VAP interventions. What would you do?

Initial Post 1:(A.T)

 Severe respiratory distress and low oxygenation are characterizations of ARDS. Manifestations of ARDS include severe dyspnea (difficulty breathing), shallow, rapid breathing, Low oxygen concentrations or hypoxemia, cyanosis (bluish lips or skin as a result of low oxygen levels), reduced lung compliance, increased effort of breathing, bilateral infiltrates seen on the X-ray of the chest, altered mental state as a result of hypoxia. A number of complications can develop for Mr. Nguyen from being on mechanical ventilation, such as ventilator-associated pneumonia (VAP), oxygen toxicity, ventilator-induced lung injury (VILI), barotrauma (high airway pressure-induced lung damage), and ventilator-associated events (VAEs). Priority nursing interventions to prevent complications with ventilatory support include regular evaluation of Mr. Nguyen’s respiratory condition, to avoid self-extubation and lessen agitation continue to administer appropriate sedation and analgesics, keep an eye on and maintain the proper ventilator alarm settings, changing positions frequently to avoid pressure sores and atelectasis, oral hygiene to stop VAP, ensure appropriate ventilation circuit and endotracheal tube hygiene, trials of weaning to evaluate preparedness for extraction. The following are some interventions to avoid ventilator-associated pneumonia (VAP): To lessen the chance of aspiration, raise the bed’s head to a position between 30 and 45 degrees. using chlorhexidine for oral hygiene to stop the growth of microorganisms, routine evaluation of endotracheal tube (ETT) suctioning requirements, To reduce contamination, use a closed suctioning system. To avoid microaspiration, the ETT cuff pressure should be regularly assessed. Reduce the amount of time that patients need mechanical ventilation by using a sedative strategy. Sedation vacations are interrupted every day to evaluate preparation for extubation. It would be imperative to take immediate action if I saw an ICU nurse failing to apply VAP preventative treatments. I would document the circumstance and your activities for my charge nurse or unit manager and If the problem persists, I would talk to my nurse manager or supervisor to make sure that best practices and procedures are followed and maybe consider reeducation for the nurse. In the ICU, patient safety is the top priority. 

Initial Post 2:(B.M.)

Acute Respiratory Distress Syndrome, or ARDS, is a dangerous lung condition that can develop in people who are critically ill and necessitates frequent mechanical ventilation to maintain breathing. One of the symptoms of ARDS identified in Mr. Nguyen was a cluster of respiratory and systemic symptoms. The underlying lung tissue injury and inflammation that obstruct the lungs’ ability to exchange oxygen and carbon dioxide are reflected in these signs and symptoms. Extreme shortness of breath, rapid breathing (tachypnea), cyanosis (bluish skin color), restlessness, fatigue, decreased urine output, tachycardia, low blood pressure (hypotension), and altered mental status are a few of the main symptoms.

When caring for critically ill patients, nurses must consider the potential difficulties of mechanical ventilation, as in Mr. Nguyen’s case. The process of mechanical ventilation requires placing a tube in the patient’s airway in order to deliver oxygen and remove carbon dioxide. Even while treatment can save lives, there are risks and a chance of problems. Ventilator-associated pneumonia (VAP), barotrauma (high air pressure lung damage), ventilator-associated lung injury (VALI), ventilator-associated events (VAE), pressure ulcers, cuff-related tracheal injury, sedation-related complications (such as excessive sedation or inadequate pain management), and infection at the site of the endotracheal tube insertion are a few potential side effects of mechanical ventilation.

Priority nursing interventions include regular evaluations of the patient’s vital signs, oxygen saturation, and respiratory status to gauge how they are responding to mechanical ventilation. Maintaining proper ventilation settings and keeping an eye out for signs of high or low airway pressures are necessary to prevent lung injury and maximize respiratory assistance. The patient must be moved frequently to lessen the chance of pressure sores and to improve lung expansion, which may be compromised in ARDS patients. Regular sedation intervals and assessments of extubating readiness are necessary to avoid prolonged artificial breathing and reduce the risk of sedation-related issues.

In order to prevent the emergence of Ventilator-associated Pneumonia (VAP), nurses should implement specific measures. Among them are regular suctioning of the endotracheal tube to remove secretions and reduce the risk of aspiration, maintaining proper positioning of the endotracheal tube to prevent micro aspiration of gastric contents, and routine oral hygiene using antiseptics to lessen bacterial colonization in the oropharynx. Raising the head of the bed by at least 30 degrees can prevent aspiration, and closely following infection control protocols such hand hygiene and sterile procedures lowers the risk of infection.

While orienting in the ICU, if I see a nurse not using VAP treatments, I would do the following:

I would speak to the nurse politely and respectfully to express my worries on the lack of VAP interventions. I want to underline how important VAP prevention is for patient safety and outcomes, and how it is our responsibility to adhere to best practices in the ICU.I would share my knowledge and understanding of the importance of VAP prevention, emphasizing how it may significantly impact patient recovery and minimize the likelihood of issues. I would give the nurse the tools and knowledge she needs to carry out the VAP interventions, or I would volunteer to help her. Accurate documentation is essential for maintaining a culture of cooperation and stability in our healthcare system and delivering high-quality care to our patients.