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Question: Discuss about theImplementing and Monitoring Nursing Care for Clients. Answer: Chronic Kidney Disease and its Clinical Manifestation This is a condition portrayed by a progressive improper kidney functioning over a period[1].When kidney disease develops to severe levels, toxins accumulate in the blood making the victim to develop diseases like high blood pressure, nerve damage, and heart ailment. Symptoms include edema, blood in urine, insomnia and itchy skin[2]. Explaining Possible Physical or Psychological impacts Chronic kidney disease sources other complications leading to inactivity in some patients limiting their movement and carrying their daily activities. This is accompanied by psychological problems since the patient lives with uncertainty. Thus, physicians should be precise in giving information to ensure adequate measures are taken to manage the disease. Planning on how to discuss health issues with healthcare team Handling a client with chronic illness needs one to have the health history of the client. Hence consulting with the healthcare team on how to help the client will require one to know the social, emotional and cognitive status of the client and identifying the needs of the patient through screening for priority reasons. Planning the care of stomach cancer patient requiring palliative care Palliative care is usually given to patients with life-threatening sickness whose chances of survival are minimal[3]. Caring for such a patient will include relief of pain and related symptoms, counseling and suffering support, help for emotional, cultural and spiritual aspects and connections to services like home help and monetary support. Interventions for congestive Cardiac Disease. Supplement oxygen should be administered to increase oxygen for heart muscles uptake to counter the outcome of hypoxia. Reducing or avoiding salty liquids helps in decreasing myocardial workload since salty solutions leads to liquid retention. The legs should be elevated to counter pressure on the knees to decrease venous stasis and decreasing occurrences of thrombus. Administer vasodilators for example Nitro-Dur and Isordil which increases heart output and reduces circulating volume hence decrease ventricular workload administering morphine sulphate also reduces myocardial workload escpecially when heart congestion is present. Motivate rest to decreases heart muscle oxygen demand or consumption and workload[4]. Tracheostomy care Nurses give tracheostomy care to maintain the required openness of the tube and limiting infections. Infection maybe as a result of inhaled air that is filtered. To achieve this, suctioning and cleaning of the tracheostomy regularly is essential. Course of Action of Stroke Stroke associated with clotting of blood, clot-dissolving medication for example tissue plasminogen activator (tPA) is administered. Other interventions include giving antiplatelet medication preventing clot formation and anticoagulants such as aspirin as a blood thinner[5]. Health Issues for Severe Dementia Dementia is a cognitive ailment hence affecting judgment and leads to memory loss. This makes it hard to treat associated health issues. However, health conditions such as depression due to limited interaction with people and cognitive weakening and fall-related injuries resulted by poor balance usually accompanies dementia. Other health issues for dementia are limited movement, poor feeding and dehydration, and bladder infection[6]. A problem-solving approach to establishing effects of chronic disease. The approach entails assessing the situation where the nurse gathers information on the impacts or the effects of the disease. The report will be picked by talking to the family members taking care of the patient and the patient. Information collected when discharging a client with Chronic Disease. According to Medicare, discharge plan is a procedure used to determine the needs of a patient for a smooth movement from one level of health care to another[7]. The information gathered in discharging include evaluation of the patient if moving is necessary, having the clients mind or family about the movement, planning for another care facility, determining the need for training the caregiver and arrangements for follow up tests. Healthcare team involved in discharging a client with chronic ailment Doctors give the green light for releasing a client from the hospital after doing tests and determining their conditions. The ones that process he discharging plan to its completion are the nurses, health workers or case managers. The family members or support groups in the community take care of the patient after being discharged from the hospital. Breaking down the barriers of a stigmatized client. Stigma results from negative social identity where a stigmatized individual shows marks of failure or shame. The victim feels rejected, excluded and discriminated[8]. Breaking down the barriers should include ensuring the client feels accepted and safe in the hospital environment and letting them know that you understand what they are going through. Code Blue Team Roles and Responsibilities Code blue points to a cardiopulmonary arrest. The team for code blue includes bedside nurse who is acquainted with the patients where about hence communicates vital information to the team. The physician gives instructions oversees the emergency, performs critical tasks such as chest compressions and terminates the code. Anesthesia representative inserts a tube on the patient's airway to keep it open. Critical care nurse gives medication and defibrillates the client. Recorder nurse communicates to the code leader and puts down the procedure on the code blue information paper. Crash cart nurse passes out supplies from the crash cart. The additional nurse links the code blue team and the family, controls the entry of people in the area and attending physicians[9]. Code Blue Scenario Steps Perform cardiopulmonary resuscitation (CPR). Secure, efficient airway through intubation. Perform automated external defibrillator then administer crush cart medication. The interventions were taken, and the signatures of the physician and nurses are documented. Progress note based on the nursing interventions for code blue In writing the progress notes will adapt the SOAP format. Where S is subjective which involves writing the patients condition, O is objective focusing on the patients examination, A is for assessment where working diagnoses that will improve the patients condition is stated and P is plan where tests assessment plan and other therapies are documented[10]. Adapting SOAP format progress notes will be: Condition: The client has a history of stroke, hypertension and diabetes mellitus type 2 and smoking related ailments. Results upon examination: He is unresponsive and not breathing insinuating that he is unconscious Intervention: Priority is ensuring he is breathing and gaining consciousness. Cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) is perfomed. Other therapies: Intubating the patient to ensure a secure airway and administering epinephrine. Cultural and religious considerations for practice. This is the ways of life and beliefs of an individual which govern their behavior and practices in different scenarios and circumstance. Chronic rehabilitation strategies and techniques Involves sharing responsibilities for meeting the needs and addressing the problems of patients with multifaceted issues. Age and gender considerations for practice This consists taking in to account the age and the gender of the patient before diagnosis. It is vital since may prevent overdosing and inappropriate medication. Legal requirements for practice. The laws of the land governing any practice are essential to put in check the extremes and to protect both stakeholders. In nursing, this rules and regulations are in place to protect the patient and the caregiver. The nurse should be acquainted with this legal requirement governing the profession to be efficient in providing health care. References Levey, Andrew S., et al. "National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification",Annals of internal medicine, vol.139, no. 2, 2003, pp. 137-147. Schiffrin et al. "Chronic kidney disease",Circulationvol. 116, no. 1, 2007, pp. 85-97. Copp, Gina. "Palliative care nursing education: a review of research findings",Journal of Advanced Nursingvol.19, no. 3, 1994, pp. 552-557. McMurray, John JV, et al. "ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012."European journal of heart failure, vol. 14, no. 8, 2012 pp. 803-869. Saver, Jeffrey L., et al. "Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke."Jamavol. 309, no. 23, 2013, pp. 2480-2488. Herrmann, Nathan, and Serge Gauthier. "Diagnosis and treatment of dementia: 6. Management of severe Alzheimer disease."Canadian Medical Association Journalvol. 179, no. 12, 2008, pp. 1279-1287. Bull, Margaret J., Helen E. Hansen, and Cynthia R. Gross. "Predictors of elder and family caregiver satisfaction with discharge planning."Journal of Cardiovascular Nursing, vol. 14 no. 3, 2000, pp. 76-87. Overstreet, Nicole M., and Diane M. Quinn. "The intimate partner violence stigmatization model and barriers to help seeking."Basic and applied social psychology, vol. 35, no. 1, 2013, pp. 109-122. Dorney, Paulette. "Code blue: Chaos or control, an educational initiative."Journal for Nurses in Professional Development, vol. 27, no. 5, 2011, pp. 242-244. Aghili, Houtan, et al. "Progress notes model in a clinical information system." U.S. Patent No. 6,289,316. 11 Sep. 2001.