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CASE STUDY 3 – Reflecting on week 4’s lessons in the syllabus, select a patient population (pediatric, young adult, adult or geriatric), and briefly analyze a chronic cardiovascular disease (HTN, Heart failure, Dyslipidemia, Heart murmur etc.…), that  may affect this population. Briefly tell how it impacts the patient’s  quality of life and analyze the current research evidence on this topic  and gold standard of care if any for your chosen population. (You may  use an example from your clinical rotation (past or present) that you  have encountered). Describe how you, the FNP, can/or have made a  difference in the care of patients with this specific disease and tell  of one specific patient care teaching that he/she may do to help  minimize disease symptoms. Please post your  CS directly in the thread so that your colleagues can see it and be sure  to read and respond/comment on one of your colleagues posting. 

 

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The Scenario

Sagecrest Nursing and Rehabilitation Center in Las Cruces, NM has been identified by Medicare as a “special focus facility” and is in danger of losing its certification status with CMS. You have been hired as a consultant to evaluate and improve this facility. Based on what you have learned about long term care services, policies and regulations, you are to prepare a brief report that provides recommendations for improvement.

Use the web to find pertinent information with which to guide your recommendations. Some important resources may include:

· Nursing Home Compare: https://www.medicare.gov/nursinghomecompare/search.html

· State of New Mexico Nursing Home Regulations: http://www.hpm.umn.edu/nhregsplus/NHRegs_by_State/New%20Mexico/NM%20Complete%20Regs.pdf

· CMS.gov – Nursing Homes: https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/nhs.html

· Federal Nursing Home Regulations and State Laws: http://www.nursinghomealert.com/federal-nursing-home-regulations-and-state-laws

· Facility website (http://www.sagecrestrehabilitation.com/). IMPORTANT NOTE: Do NOT contact the site directly. This is a learning exercise. Since you are not actual consultants, contacting the facility directly would be inappropriate. 

In your report, include the following:

• Summary of identified problems
• Relevant policy that guides nursing home practice
• Prioritized list of recommendations
• Suggested action plan for implementing changes

Your report should be 3-4 pages in length, page length does not include the title page, tables, graphs, charts, pictures or reference page.. The paper should be double-spaced with 1” margins on all sides. Format, in-text citations and references should adhere to APA format. 

MUST USE THE CASE 2 TEMPLATE

 

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  CASE STUDY 4 – Reflecting on week 9’s lessons in the syllabus, select a patient population (young adult, adult or geriatric), and briefly analyze a common STDs & urological disorder (ex – UTI,  Hematuria, Urolithiasis, Urinary Incontinence, Ac. Pyelonephritis, HIV,  Bacterial vaginosis, Chlamydia, Gonorrhea, Trichomoniasis, Syphilis)  that may affect this population. Briefly  tell how it impacts the patient’s quality of life and analyze the  current research evidence on this topic and gold standard of care if any  for your chosen population. (You may use an example from your clinical  rotation (past or present) that you have encountered). Describe how you,  the FNP, can/or have made a difference in the care of patients with  this specific condition and tell of one specific patient care teaching  the patient can benefit from. Please post  your CS directly in the thread so that your colleagues can see it and be  sure to read and respond/comment on one of your colleagues posting 

 

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1: Please provide a detailed summary of the case. Please ensure to include and discuss all relevant material (10 points).

 

2: Please discuss at least four challenges facing inner city urban hospitals today (external research from respectable sources is required to answer this question) (10 Points).

 

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Mrs. Jones, a 40-year-old female patient, is presenting for a history and physical. The nurse gathers a family history from the patient. She shares that her mother died at 70 years of age of colon cancer and had adult onset diabetes controlled with oral agents, hypercholesterolemia, and hypertension. She had a stroke before passing away. Her father died at 67 years of age from a stroke. He had a long history of alcoholism and smoked two packs per day of cigarettes for 50 years. He had hypertension, hypercholesterolemia, and two heart attacks; the first heart attack was at 30 years of age and the second at 52 years of age. He had adult onset diabetes controlled with oral agents since 50 years of age. He had renal stenosis that was unsuccessfully treated with a renal angioplasty and he developed end-stage renal failure requiring hemodialysis. Mrs. Jones has two brothers. One brother developed hypertension, hypercholesterolemia, and adult onset diabetes controlled with oral agents at 50 years of age. The second brother has no health problems. The maternal grandmother died at 88 years of age of a stroke and had hypertension. The maternal grandfather died at 70 years of age of a massive heart attack and had a history of hypertension. The paternal grandmother died at 80 years of age of a heart attack. The paternal grandfather died at 50 years of age from bleeding esophageal varices related to long-standing alcoholism. The patient shares that her mother’s first cousin, George, died at 52 years of age of Hodgkin lymphoma. She has another first cousin Mabel, 72 years of age, who is alive but has had cancer of the colon and had a recent stroke, and has a history of hypertension, hypercholesterolemia, and adult onset diabetes controlled with diet. Her mother’s sister, who is 68 years of age, is alive and has a history of hypertension and hypercholesterolemia. Her mother’s brother died at 68 years of age of renal cancer and had a history of hypertension, hypercholesterolemia, and adult onset diabetes controlled with oral agents. He also had a heart attack at 45 years of age and a coronary artery bypass graft operation of three vessels at 55 years of age. He smoked cigarettes for 50 years. The patient’s father was an only child and her father’s family all lived to be over 80 years of age.

1. What genetic-related diseases do the patient’s first-order relatives have?
2. What genetic-related diseases do the patient’s second-order relatives have?
3. Optional: Draw a genogram of the patient’s family’s health history using the example in the textbook (see Fig. 5-2) as a guide.

2. The registered nurse prepares to conduct a nutritional assessment on Mrs. Varner, a 52-year-old Caucasian female who describes herself as “overweight most of my adult life.” The client states that her health is good. She works part time as a receptionist and volunteers about 10 hours per week in her church. The nurse obtains Mrs. Varner’s height as 64 inches and her weight as 165 pounds. 

1. What is the rationale for computing body mass index? What is Mrs. Varner’s BMI?
2. Calculate her ideal body weight. What is your assessment of her BMI and weight?
3. Based on Mrs. Varner’s BMI and weight, the nurse measures her waist circumference. Describe the proper procedure for this assessment.
4. Mrs. Varner’s waist circumference is 38 inches. What is your assessment?
5. What laboratory values would the nurse review to evaluate Mrs. Varner’s protein levels?

 

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