FIRST PAPER

  

Case Study: Mr. M.

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. M., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.

Case Scenario

Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.

Objective Data

1. Temperature:      37.1 degrees C
2. BP      123/78 HR 93 RR 22 Pox 99%
3. Denies      pain
4. Height:      69.5 inches; Weight 87 kg

Laboratory Results

1. WBC:      19.2 (1,000/uL)
2. Lymphocytes      6700 (cells/uL)
3. CT      Head shows no changes since previous scan
4. Urinalysis      positive for moderate amount of leukocytes and cloudy
5. Protein:      7.1 g/dL; AST: 32 U/L; ALT 29 U/L

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. M.’s situation. Include the following:

1. Describe      the clinical manifestations present in Mr. M.
2. Based      on the information presented in the case scenario, discuss what primary      and secondary medical diagnoses should be considered for Mr. M. Explain      why these should be considered and what data is provided for support.
3. When      performing your nursing assessment, discuss what abnormalities would you      expect to find and why.
4. Describe      the physical, psychological, and emotional effects Mr. M.’s current health      status may have on him. Discuss the impact it can have on his family.
5. Discuss      what interventions can be put into place to support Mr. M. and his family.
6. Given      Mr. M.’s current condition, discuss at least four actual or potential      problems he faces. Provide rationale for each.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

 

SECOND PAPER

  

Case Study: Mr. C.

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. C., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. C., a 32-year-old single male, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, even as a small child, gaining approximately 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control by restricting dietary sodium. Mr. C. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.

Objective Data:

1. Height:      68 inches; weight 134.5 kg
2. BP:      172/98, HR 88, RR 26
3. 3+      pitting edema bilateral feet and ankles
4. Fasting      blood glucose: 146 mg/dL
5. Total      cholesterol: 250 mg/dL
6. Triglycerides:      312 mg/dL
7. HDL:      30 mg/dL
8. Serum      creatinine 1.8 mg/dL
9. BUN 32      mg/dl

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:

1. Describe      the clinical manifestations present in Mr. C.
2. Describe      the potential health risks for obesity that are of concern for Mr. C.      Discuss whether bariatric surgery is an appropriate intervention.
3. Assess      each of Mr. C.’s functional health patterns using the information given.      Discuss at least five actual or potential problems can you identify from      the functional health patterns and provide the rationale for each.      (Functional health patterns include health-perception, health-management,      nutritional, metabolic, elimination, activity-exercise, sleep-rest,      cognitive-perceptual, self-perception/self-concept, role-relationship,      sexuality/reproductive, coping-stress tolerance.)
4. Explain      the staging of end-stage renal disease (ESRD) and contributing factors to      consider.
5. Consider      ESRD prevention and health promotion opportunities. Describe what type of      patient education should be provided to Mr. C. for prevention of future      events, health restoration, and avoidance of deterioration of renal      status.
6. Explain      the type of resources available for ESRD patients for nonacute care and      the type of multidisciplinary approach that would be beneficial for these      patients. Consider aspects such as devices, transportation, living      conditions, return-to-employment issues.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. 

 

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 Details:

Write a 1,200-1,500 word analysis of “Case Study: Healing and Autonomy.” In light of the readings, be sure to address the following questions:

1. Under the Christian narrative and Christian vision, what sorts of issues are most pressing in this case study?
2. Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful to James?
3. According to the Christian narrative and the discussion of the issues of treatment refusal, patient autonomy, and organ donation in the topic readings, how might one analyze this case?
4. According to the topic readings and lecture, how ought the Christian think about sickness and health? What should Mike as a Christian do? How should he reason about trusting God and treating James?

Prepare this assignment according to the guidelines found in the APA Style Guide

 

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     Case Study

Read the following case study:

A small community hospital in the Midwest has used a homegrown information system for years. The system began in the early 1970s with a financial module. Over time, additional modules were added. A limited number of departments selected a commercial system and interfaces were used to integrate these into the overall functionality of the hospital information system. Except for physicians, most in-house clinical or care-related documentation is online. However, about 15% to 20% of this documentation is done by free text and is not effectively searchable. In addition, the screens, including the drop-down and default values, were built using terms selected by the in-house development team in consultation with clinical staff; thus there is no data dictionary or specific standard language. In the last few years, the hospital has purchased two outpatient clinics (obstetrics and mental health) and a number of local doctor practices. The clinics and doctors’ offices are now being converted to the hospital administrative systems. A few of the clinical applications that are tied directly to the administrative systems such as order entry and results reporting are also being installed. 

A major change is being planned. A new chief information officer (CIO) was hired last year and she has appointed a chief medical information officer (CMIO) and a chief nursing information officer (CNIO). No other significant staff changes were made. With her team in place, one of the CIO’s first activities was to complete an inventory of all applications. Rather than continue to build, a decision was made to switch to a commercial vendor and the hospital selected a commercial system. 

As a member of the clinical staff with informatics education, the CIO has requested that you develop a training and information presentation for the clinical staff that will:

· Identify two or more issues with the existing system

· Provide staff with appropriate “work-around” for using the existing system

· Provide an overview of two of the standard languages used within the new system including discipline or specialty, updating frequency, and available cross-maps

o One standard language should pertain only to nursing 

o One standard language should be multidisciplinary.

· Obtain clinical staff input, using a five-question survey, of specific methods to support transition to the new system; questions should be open-ended.

  

PowerPoint Presentation

Directions:

1. Review the case study.

2. Download the provided PowerPoint template to create a presentation that includes:

· Your name on the title slide of the presentation

· Identification of two or more issues with existing system

· Identification of “work-a-round” solutions when using existing system

· Overview of standard language used only in nursing

· Overview of multidisciplinary standard language

· Set of five (5) open-ended survey questions for staff input on transitioning to the new system

· Presentation is free of spelling and grammar errors.

2. Submit the Week 10 Assignment via Blackboard by clicking on the “Week 10 Assignment” link. Include the proper file naming convention: 

· CMP105_wk10_assn_jsmith_mmddyyyy.

  

References

 

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Linda is a 28-year-old female in a discordant relationship with her boyfriend of 1 year. Linda is 12 weeks pregnant based on her last menstrual period. She is engaged in HIV-care and is naïve to antiretroviral therapy (ART) because her CD4 cell count is 538 per mm3 and viral load is 8,300. No tobacco, alcohol, or illegal or illicit drug use. 

Physical examination: Normal, healthy 28-year-old gravid female. She is overweight with a body mass index of 28.2.

Laboratory and other tests: Genotype is pan-sensitive without HIV mutations. Ultrasound at her 2-day follow-up estimates she is 15 weeks pregnant.  

Assignment Questions

1. What are the Public Health Service Panel on Antiretroviral Guidelines for Adults and Adolescents guidelines for HIV-positive pregnant females regarding starting ART? What antiretroviral medications are recommended as first line?  Which drugs should be avoided?  Provide a rationale for all answers.
2. What education does Linda need regarding her medication? 
3. Are there any risks to the baby during labor?
4. What should be done for the baby at birth if he/she tests positive for HIV? What will the providers need to do in terms of monitoring the baby?

Instructions 

• Prepare and submit a 3-4 page paper [total] in length (not including APA format).
• Answer all the questions above. 
• Support your position with examples.
• Please review the rubric to ensure that your assignment meets criteria.
• Submit the following documents to the Submit Assignments/Assessments area:
  • Case Study: HIV Patient

 

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  1.Choose an herbal supplement or a vitamin and discuss the origin, culture, mechanism of action, condition or disease that it is used for. Discuss risk factors, regulations, reliability of your sources. Include any current newsworthy information related to the supplement that you have chosen to report. 2.Support your paper with cited peer reviewed journals no older than 5 years.

 

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