Case Study: Mrs. J. 

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 Mrs. J., 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

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.”
4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

1. Height 175 cm; Weight 95.5kg.
2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

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

1. Describe the clinical manifestations present in Mrs. J.
2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

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. 

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

 

Read the case study titled “Revitalizing a Brand”, located in the online course shell. Use the Internet or Strayer databases to research the branding and communication strategies of one (1) health services organization that is similar to the health services organizations mentioned in the case study.

Write a four to six (4-6) page paper in which you:

1. Describe the current marketing communication, identity, and brand position of Plaza Home Health Services.
2. Conduct a Strengths Weaknesses Opportunities Threats (SWOT) analysis associated with the current marketing communication, identity, and brand position of Plaza Home Health Services.
3. Assess the importance of benchmarking in Plaza Home Health Services’ development and implementation of an effective brand strategy (marketing communication, identity, and brand position).
4. Compare branding and communication strategies of a similar health services organization with that of Plaza Home Health Services. Determine whether or not Plaza Home Health Services should apply additional best practices into its current branding and communication strategies. Provide a rationale and support for your response.
5. Use at least five (5) quality academic resources. Note: Wikipedia and other Websites do not qualify as academic resources. 

Your assignment must follow these formatting requirements:

• Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
• Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

 

Case Scenario

Ms. G., a 23-year-old diabetic, is admitted to the hospital with a cellulitis of her left lower leg. She has been applying heating pads to the leg for the last 48 hours, but the leg has become more painful and she has developed chilling.

Subjective Data

• Complains of pain and heaviness in her leg.
• States she cannot bear weight on her leg and has been in bed for 3 days.
• Lives alone and has not had anyone to help her with meals.

Objective Data

• Round, yellow-red, 2 cm diameter, 1 cm deep, open wound above medial malleolus with moderate amount of thick yellow drainage
• Left leg red from knee to ankle
• Calf measurement on left 3 in > than right
• Temperature: 38.9 degrees C
• Height: 160 cm; Weight: 83.7 kg

Laboratory Results

• WBC 18.3 x 10¹² / L; 80% neutrophils, 12% bands
• Wound culture: Staphylococcus aureus

Critical Thinking Questions

1. What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.
2. Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”
3. What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.
4. What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

 

You are caring for five patients on a busy, 28-bed neurological medical-surgical unit, which recently transitioned to all electronic documentation and healthcare computerized provider order entry (CPOE). There is no longer any bedside paperwork.

All of your staff members have completed the required training and you have been assigned as expert lead for any questions that may arise during your shift. The expectation is that all nurses and clinical staff will document all care delivery in the bedside computers located in each patient’s room or via the workstation on wheels (WOW).

However, you have noticed a trend with experienced nurses spending extra time at the end of their shifts (30 or more minutes) documenting the nursing care provided during the shift. The expectation is that they should be documenting care delivery as soon as it is complete rather than at the end of their shifts.

Answer the following questions based on the information provided:

1. Explain how you would address the concern with the delay in nursing documentation with your team.
2. Do you see the transition to all electronic documentation as having a positive or negative effect on patient-centered care? Support your answer with evidence from the literature.
3. Explore the role of advancement in information technology and its effect in patient care. Does more technology use improve time with patients? Use at least two sources to support your response.

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

 

You as the advanced practice nurse are working in a community health center. Your next patient is Mrs. Richards,  a 39 year-old Caucasian female, presenting to the clinic with a history of Hypothyroidism, Depression, and recent history of Substance Abuse (Heroine Use). During the initial interview, it is revealed that her husband and two children were killed in a traffic accident 8 months ago and she reports using illicit drugs since their death. 

Based on your knowledge of the Health Promotion Model, make a chart and/or diagram that outlines all components of the theory and how the theory can be applied to this case study to formulate a plan of care for this patient. Also, list one scholarly, practice-based resource (article and/or clinical guideline) that supports the application of the Health Promotion Model in clinical practice.

please see model attached.

http://www.nursing-theory.org/theories-and-models/pender-health-promotion-model.php  

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"