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1. Try taking a different route to class the next time it meets. Before you do this, think about how many changes, large and small, you will have to make to do this.

a-Will you have to leave earlier to be in class on time?

b-Will you meet different people on your way to class?

c-See different sights?

d-Would you change your route to class on the day of the final exam?

e-Why or why not? Summarize the positives and negatives of this small change. Relate your responses to this change to the way staff nurses feel when an administrator makes what he or she thinks is a “minor” change.

2. Think about a change that has occurred in your life. Some examples may be a change of role, a move, a marriage, a birth, a divorce, or a death.

a-How did you react to the change?

b-Would you have reacted differently if you had had more information?

c-Using Lewin’s model, describe the basic elements in the situation and how you eventually achieved a comfortable outcome.

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Include in your policy the following information: 2 page minimum  Title of the organization (use a company of your choice) Policy number Effective date Next review date  Policy approver Name of the policy List the department, product and function Summary of the policy structure

Gather your research from at least 2 sources, other than your textbook. Cite your sources using APA guidelines. All submitted work should be free of grammatical errors.

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1-Ischemic ulcer or arterial ulcer occurs when the artery is blocked (Anthony, 2018). Arteries carry oxygenated blood to the tissue and If this artery is blocked, then the supply of oxygen and nutrients to that body part or tissue will be deprived. Finally, this tissue dies and develop to an ulcer. Some potential causes of the arterial ulcer are diabetes, smoking and atherosclerosis whereas venous ulcer is caused by damage to the vein and when a vein is damaged there is deficiency blood flow to the heart and this can result in accumulation of blood in one body part and results in fluid shift to cause edema (Caprini, Partsch, & Simman, 2013). Then this edema halts circulation and eventually the tissue dies to cause an ulcer. Some potential causes are varicose veins, DVT.

Another difference is based on their symptoms. Arterial ulcer has a symptom of pain at night, feeling cold to touch due to poor circulation, deep wound where, as venous ulcer has a sign of swelling, aching or flaking sensation on the body part. Most of the time both tend to affect the extremity but are not restricted to any part of the body (Anthony, 2018).

Reference

Caprini, J. A., Partsch, H., & Simman, R. (2013). Venous Ulcers. The journal of the American College of Clinical Wound Specialists, 4(3), 54-60. Doi: 10.1016/j.jccw.2013.11.001

Anthony K. (2018) Arterial and Venous Ulcers: What’s the Difference? Retrieved [online] from: https://www.healthline.com/health/arterial-vs-venous-ulcers

2-Ms. G. will definitely need outpatient wound care. For healthy people wounds will heal relatively quickly with treatment. Ms. G. has many risk factors to delay the healing process as previously noted with her obesity, sedentary lifestyle, diabetes and poor nutrition. I worked as a homecare nurse for about 5 years and did a lot of wound care and teaching during those years. I worked with a physical therapist who was also certified in wound care. He would provide consultations and recommendations for treatment. These wounds can take weeks to months sometimes to heal or become chronic in nature. Ms. G. would likely need aquacel on the wound base to help debride the wound and absorb the drainage. These dressings don’t need to be changed daily which is nice. We still see people coming out of the hospital with daily dressings or BID dressings and we usually can change that around pretty quickly. I am now in Hospice care and so the goals of care are comfort, but we still care for the wounds even though they aren’t likely to heal for most of our patients.

3-There are various differences between venous and arterial ulcers. Venous ulcers can vary in size, they are generally irregularly shaped, shallow, and seen on lower extremities. Some risk factors for venous ulcers are lack of mobility, malnutrition, heart failure, and obesity. Arterial ulcers have smoother edges. The skin around them tends to be pale and shiny. They have less drainage than venous ulcers. Some risk factors for arterial ulcers are uncontrolled diabetes, poor footwear, vascular insufficiency, and foot structure defects (London Health Sciences Centre, 2018). The area surrounding arterial ulcers is generally cool in temperature. Treatment for both ulcers includes restoring blood flow and oxygenation to the affected area. For arterial ulcers this sometimes requires angioplasty. In order to promote healing, arterial ulcers should be kept clean and dry. For treatment of venous ulcers, dressing changes and compression would likely be indicated (Anthony, 2018).

References:

Anthony, K. (2018, February). Arterial and venous ulcers: What’s the difference? Retrieved from https://www.healthline.com/health/arterial-vs-venous-ulcers#causes

London Health Sciences Centre. (2018). Venous stasis & arterial ulcer comparison. Retrieved from https://www.lhsc.on.ca/wound-care-management/venous-stasis-arterial-ulcer-comparison

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