Assignment:Case Study Mrs.J.

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Assignment:Case Study Mrs.J.

Assignment:Case Study Mrs.J.
Assignment:Case Study Mrs.J.

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Assignment:Case Study Mrs.J.
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Question Description

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 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

Subjective Data

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

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.

Objective Data

Height 175 cm; Weight 95.5kg.
Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
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.
Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention

The following medications administered through drug therapy control her symptoms:

IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/ NC
Critical Thinking Essay

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

Describe the clinical manifestations present in Mrs. J.
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.
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.
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.
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.
Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
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.

Study Material:

-Read Chapter 1 in Pathophysiology: Clinical Applications for Client Health.

URL:

https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/pathophysiology_clinical-applications-for-client-health_1e.php

-Read “Patient Perceived Impact of Nurse-Led Self-Management Interventions for COPD: A Systematic Review of Qualitative Research,” by Baker and Fatoye, from International Journal of Nursing Studies (2019).

https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S002074891830258X-Read “Atrial Fibrillation Symptom Perception,” by Streur, from Journal for Nurse Practitioners (2019).

URL:

https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1555415518306974

-Read “Congestive Heart Failure and Congenital Defects,” located on the American Heart Association website.

URL:

http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofConge%20Heart-Failure_UCM_307111_Article.jsp#.XPaS1hZKiUm

URL:

https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S002074891830258X

Read “Evaluating the Effectiveness of an Online Cardiac Rehabilitation Resource (www.svhhearthealth.com.au) in Improving Knowledge and Confidence for Patients With Newly Diagnosed Cardiac Conditions: A Pre-Experimental Pilot Study,” by Molan, Emmanuel, Langley and Holloway, from Heart, Lung and Circulation, 2019.

URL:

https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S144395061830129X

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
Assignment:Case Study Mrs.J.

Assignment:Case Study Mrs.J.

Assessment Description

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.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Case Study: Mrs. J. – Rubric

Criteria Description

Clinical Manifestations of Mrs. J.

5. Excellent

12 points

Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms.

4. Good

10.68 points

Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms.

3. Satisfactory

9.48 points

Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete.

2. Less Than Satisfactory

9 points

Clinical manifestations are partially presented. There are major omissions and inaccuracies.

1. Unsatisfactory

0 points

Clinical manifestations are omitted.

Criteria Description

Evaluation of Nursing Interventions at Admissions

5. Excellent

12 points

Evaluation of appropriateness of nursing interventions at the time of admission is thoroughly discussed. A well-supported explanation for each of the medications listed is presented. Strong and compelling rationale is provided.

4. Good

10.68 points

Evaluation of appropriateness of nursing interventions at the time of admission is discussed. An explanation and general rationale for each of the medications listed are presented. Some information is required for accuracy or clarity.

3. Satisfactory

9.48 points

Evaluation of appropriateness of nursing interventions at the time of admission is summarized. A general explanation and some rationale for each of the medications listed are presented. There are minor inaccuracies.

2. Less Than Satisfactory

9 points

Evaluation of appropriateness of nursing interventions at the time of admission is partially presented. An incomplete explanation for each of the medications listed is presented. The discussion contains significant inaccuracies.

1. Unsatisfactory

0 points

Evaluation of appropriateness of nursing interventions at the time of admission and explanation of the rationale for each of the medications listed are not discussed.

Criteria Description

Cardiovascular Conditions Leading to Heart Failure and Interventions

5. Excellent

12 points

Four cardiovascular conditions that may lead to heart failure are clearly described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. Overall, the discussion demonstrates insight into medical and nursing interventions used to prevent heart failure.

4. Good

10.68 points

Four cardiovascular conditions that may lead to heart failure are described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. There are minor inaccuracies, or information is needed for clarity.

3. Satisfactory

9.48 points

Four cardiovascular conditions that may lead to heart failure are summarized. Medical or nursing interventions to prevent the development of heart failure in each condition are generally discussed. There are some inaccuracies.

2. Less Than Satisfactory

9 points

Four cardiovascular conditions that may lead to heart failure are partially described. Medical or nursing interventions to prevent the development of heart failure in each condition are incomplete. There are significant inaccuracies.

1. Unsatisfactory

0 points

Fewer than three cardiovascular conditions that may lead to heart failure, and medical or nursing interventions to prevent the development of heart failure in each condition, are described.

Criteria Description

Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions

5. Excellent

12 points

Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. The discussion fulfills the assignment criteria and strong rationale for the interventions is provided.

4. Good

10.68 points

Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. Overall, the discussion meets assignment criteria and general rationale for the interventions is provided.

3. Satisfactory

9.48 points

Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are summarized. Overall, the discussion meets assignment criteria but requires more rationale for the interventions. There are minor inaccuracies.

2. Less Than Satisfactory

9 points

Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are partially presented.

1. Unsatisfactory

0 points

Fewer than three nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are presented.

Criteria Description

Health Promotion and Restoration Teaching Plan

5. Excellent

18 points

A well-developed health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are clearly discussed. An strong explanation for how rehabilitation resources and modifications assist patient transition to independence is presented. The overall discussion is well-supported.

4. Good

16.02 points

A health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are discussed. An explanation for how rehabilitation resources and modifications assist patient transition to independence is presented.

3. Satisfactory

14.22 points

A health promotion and restoration teaching plan for the patient is summarized. Multidisciplinary resources for rehabilitation and any modifications that may be needed are generally presented. A summary for how rehabilitation resources and modifications assist patient transition to independence is presented. There are minor inaccuracies.

2. Less Than Satisfactory

13.5 points

A health promotion and restoration teaching plan for the patient is partially presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are omitted or incomplete. An explanation for how rehabilitation resources and modifications assist patient transition to independence is omitted or incomplete.

1. Unsatisfactory

0 points

A health promotion and restoration teaching plan for the patient is omitted.

Criteria Description

Method for Providing Education to Prevent Hospital Readmissions

5. Excellent

18 points

A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is thoroughly described. The method is clearly appropriate for the client and prevents readmission. Strong rationale is provided for support.

4. Good

16.02 points

A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is described. Overall, the method is appropriate. General rationale is provided for support.

3. Satisfactory

14.22 points

A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is summarized. The method is generally appropriate. Some rationale is provided for support.

2. Less Than Satisfactory

13.5 points

A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is partially summarized. The method may not be relevant to for this situation. More information is needed. There are major inaccuracies.

1. Unsatisfactory

0 points

A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is omitted. The method is not appropriate for the client or health status.

Criteria Description

COPD Triggers and Options for Smoking Cessation

5. Excellent

12 points

All appropriate COPD triggers exacerbating return visits are clearly outlined. Strong options for smoking cessation are detailed and are highly relevant to the patient.

4. Good

10.68 points

Key COPD triggers exacerbating return visits are outlined. General options for smoking cessation relevant to the patient are summarized.

3. Satisfactory

9.48 points

General COPD triggers exacerbating return visits are generally presented. Some options for smoking cessation relevant to the patient are summarized. Some support or information is needed.

2. Less Than Satisfactory

9 points

Some COPD triggers exacerbating return visits are partially presented. Options for smoking cessation are incomplete; it is unclear if the options are relevant to the patient.

1. Unsatisfactory

0 points

COPD triggers exacerbating return visits and options for smoking cessation are omitted.

Criteria Description

Thesis Development and Purpose

5. Excellent

6 points

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

4. Good

5.34 points

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

3. Satisfactory

4.74 points

Thesis is apparent and appropriate to purpose.

2. Less Than Satisfactory

4.5 points

Thesis is insufficiently developed or vague. Purpose is not clear.

1. Unsatisfactory

0 points

Paper lacks any discernible overall purpose or organizing claim.

Criteria Description

Argument Logic and Construction

5. Excellent

6 points

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

4. Good

5.34 points

Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

3. Satisfactory

4.74 points

Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

2. Less Than Satisfactory

4.5 points

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

1. Unsatisfactory

0 points

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Criteria Description

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

5. Excellent

6 points

Writer is clearly in command of standard, written, academic English.

4. Good

5.34 points

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

3. Satisfactory

4.74 points

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

2. Less Than Satisfactory

4.5 points

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

1. Unsatisfactory

0 points

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Criteria Description

Paper Format (use of appropriate style for the major and assignment)

5. Excellent

2.4 points

All format elements are correct.

4. Good

2.14 points

Appropriate template is fully used. There are virtually no errors in formatting style.

3. Satisfactory

1.9 points

Appropriate template is used. Formatting is correct, although some minor errors may be present.

2. Less Than Satisfactory

1.8 points

Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.

1. Unsatisfactory

0 points

Template is not used appropriately, or documentation format is rarely followed correctly.

Criteria Description

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

5. Excellent

3.6 points

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

4. Good

3.2 points

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

3. Satisfactory

2.84 points

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

2. Less Than Satisfactory

2.7 points

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

1. Unsatisfactory

0 points

Sources are not documented.

Total 120 points
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