DUE TUESDAY 01/10/2017 —> ADVANCE NURSING PRACTICE 1

 

Assignment 2: Case Study Analysis and Care Plan Creation

Click here (I COPIED AND PAST IT ON BELOW)  to download and analyze the case study for this week. Create a holistic care plan for disease prevention, health promotion, and acute care of the patient in the clinical case. Your care plan should be based on current evidence and nursing standards of care.

 

CASE STUDY

 

Week 2: Respiratory Clinical Case

 

Patient Setting:

 

65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily.  She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.

 

HPI

 

Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no seizure activity since initiation of therapy.

 

 

 

PMH

 

History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.

 

 

 

Past Surgical History

 

None

 

 

 

Family/Social History

 

Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF

 

Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.

 

 

 

Medication History

 

Theophylline SR Capsules 300 mg PO BID

 

Albuterol inhaler, PRN

 

Phenytoin SR capsules 300 mg PO QHS

 

HTCZ 50 mg PO BID

 

Enalapril 5 mg PO BID

 

Allergies

 

NKDA

 

ROS

 

Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.

 

Physical exam

 

BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”

 

VS after Albuterol breathing treatment – BP 134/79, HR 80, RR 18

 

Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.

 

Laboratory and Diagnostic Testing

 

Na – 134

 

K – 4.9

 

Cl – 100

 

BUN – 21

 

Cr – 1.2

 

Glu – 110

 

ALT – 24

 

AST – 27

 

Total Chol – 190

 

CBC – WNL

 

Theophylline – 6.2

 

Phenytoin – 17

 

Chest Xray – Blunting of the right and left costophrenic angles

 

Peak Flow – 75/min; after albuterol – 102/min

 

FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%

 

 

Visit the South University Online Library and research for current scholarly evidence (no older than 5 years) to support your nursing actions. In addition, consider visiting government sites such as the CDC, WHO, AHRQ, and Healthy People 2020. Provide a detailed scientific rationale justifying the inclusion of this evidence in your plan.

Next determine the ICD-10 classification (diagnoses). The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM) is the official system used in the United States to classify and assign codes to health conditions and related information.

Click here to access the codes.

https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx?generalError=Thank+you+for+your+interest+in+the+Medicare+Coverage+Database.+You+may+only+view+the+page+you+attempted+to+access+via+normal+usage+of+the+Medicare+Coverage+Database.

 

 

I PUT IT AT THE END OF THIS POST

Click here to download the care plan template to help you design a holistic patient care plan. The care plan example provided here is meant only as a frame of reference for you to build your care plan. You are expected to develop a comprehensive care plan based on your assessment, diagnosis, and advanced nursing interventions. Reflect on what you have learned about care plans through independent research and peer discussions and incorporate the knowledge that you have gained into your patient’s care plan.

Format

Your care plan should be formatted as a Microsoft Word document. Follow the current APA edition style. Your paper should be 2 pages excluding the title page and references and in 12pt font.

Name your document: SU_NSG6001_W2_A2_LastName_FirstInitial.doc.

Submit your document to the W2 Assignment 2 Dropbox by Tuesday, January 10, 2017.

Assignment 2 Grading Criteria	Maximum Points
Subjective Data The submission included the patient’s interpretation of current medical problem. It included chief complaint, history of present illness, current medications and reason prescribed, past medical history, family history, and review of systems.	15
Objective Data The submission included measurements and observations obtained by the nurse practitioner. It included head to toe physical examination as well as laboratory and diagnostic testing results and interpretation (especially those that pertain to the diagnosis).	15
Assessment The submission included at least three priority diagnoses. Each diagnosis was supported by documentation in subjective and objective notes and free of essential omissions. All diagnoses were documented using acceptable terminologies and current ICD-10 codes.	15
Plan of Care Plan included diagnostic and therapeutic (pharmacologic and non-pharmacologic) management as well as education and counseling provided. The plan was supported by evidence/guidelines, and the follow-up plans were noted.	20
APA Used APA standards consistently and accurately when citing in the SOAP note and reference page. Utilized proper format with coversheet and header.	10
Total	75

 

 

SAMPLE (OR TEMPLETE) FOR THE WORK

 

Title of Plan of Care

 

Name

 

South University Online

 

Faculty Name

 

NSG 6001

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**Please delete this statement and anything in italics prior to submission to shorten the length of your paper.

 

Patient Initials ______

 

Subjective Data: (Information the patient tells you regarding themselves: Biased Information):

 

Chief Compliant: (In patient’s exact words)

 

History of Present Illness: (Analysis of current problems in chronologic order using symptom analysis [onset, location, frequency, quality, quantity, aggravating/alleviating factors, associated symptoms and treatments tried]).

 

PMH/Medical/Surgical History: (Includes medications and why taking, allergies, other major medical problems, immunizations, injuries, hospitalizations, surgeries, psychiatric history, obstetric and history sexual history).

 

Significant Family History: (Includes family members and specific inheritable diseases).

 

Social History: (Includes home living situation, marital history, cultural background, health habits, lifestyle/recreation, religious practices, educational background, occupational history, financial security and family history of violence).

 

Review of Symptoms: (Review each body system –This section you should place POSITIVE for… information in the beginning then state Denies…). – General:; Integumentary:; Head:; Eyes:  ; ENT:; Cardiovascular:; Respiratory: ; Gastrointestinal:; Genitourinary:; Musculoskeletal:; Neurological:; Endocrine:; Hematologic:; Psychologic: .

 

Objective Data:

 

Vital Signs:  BP – ; P ; R ; T ; Wt. ; Ht. ; BMI .

 

Physical Assessment Findings: (Includes full head to toe review)  

 

HEENT:

 

Lymph Nodes:

 

Carotids:

 

Lungs:

 

Heart:

 

Abdomen:

 

Genital/Pelvic:

 

Rectum:

 

Extremities/Pulses:

 

Neurologic:

 

Laboratory and Diagnostic Test Results: (Include result and interpretation.)

 

 

 

Assessment: (Include at least 3 priority diagnosis with ICD-10 codes.  Please place in order of priority.)

 

Plan of Care: (Addressing each dx with diagnostic and therapeutic management as well as education and counseling provided).

References

 

 

1) **********All attached format ( “Article Analysis 1” template ) must be completed according to the attached example ( Article Analysis Example 1 )

2)¨**********APA norms  ( All paragraphs need to be cited properly. All responses must be in a narrative format and each paragraph must have at least 4 sentences)

3)********** It will be verified by Turnitin and SafeAssign 

4) **********References from the last 5 years  

_______________________________________________________

1) Find three different health care articles that use quantitative research in Nursing  

2) Complete an article analysis for each using the “Article Analysis 1” template.

provide a meaningful response to at least two of your peers’ posts by the end of the week. In your responses to your peers, you might offer a perceived roadblock to the individual’s ability to learn.

 

Peer # 1 Tamira Parker                          

1.An individual who has recently been diagnosed with lung cancer has a need for information about the stage of the cancer, treatment options, and odds of survival. This individual could use a lot of support during this rough time.

2. A family caring for an elderly individual with AD needs to learn positive coping mechanisms to deal with the family member, taking a break when they feel exhausted, and support groups. Support groups can help the patient and or family to meet other people that are going through the same exact thing.

3. A community in which adolescent cigarette smoking is on the risk adolescents need to be educated on the risks associated with smoking such as lung cancer and heart disease. If guidelines permit refer the adolescent to counseling to see if there is a possibility that smoking is secondary to another issue. Also refer adolescent to cessation programs if guidelines permit, if not discuss with parent and decide what is in the best interest of the child.

 

Peer #2 Samantha Pearce                           

An individual who has recently been diagnosed with lung cancer. Start off by informing the patient of the different type of treatment. Immunotherapy is a type of cancer treatment that works by boosting or activating your immune system, so it recognizes and kills cancer cells. Also, there are lots of active support groups for patients and family caregivers, so no one has to face a lung cancer diagnosis alone. Furthermore you would teach/inform the patient how to cope with these emotions by communicating with your friends and family members, expressing your thoughts in a journal and quitting smoking, eating right, staying physically active and managing your stress helps your body stay healthy.

A family caring for an elderly individual with Alzheimer’s disease. Teach the caregiver that they must understand how AD changes a person, learn how to cope with these changes. Make the home safe for the person with AD. Caregivers could also find out about helpful resources, such as websites.

A community in which adolescent cigarette smoking is on the rise. It is well known that tobacco use increases the risk for contracting a variety of diseases and health conditions, including lung, bladder, colorectal, esophageal, kidney, larynx, mouth, throat and other cancers, respiratory infections, diabetes, and coronary heart disease. A Campaign for an adolescent young girl is good to inform the public of these risks, combined with smoking legislation regulating the age of access and smoking in public places have led to a general decrease in smoking prevalence among all age groups.

  

Assignment:
The Ethics and Legalities of Medication Error Disclosure 

American writer Nikki Giovanni once said: “Mistakes are a fact of life. It is the response to the error that counts” (Goodreads, 2012). Whenever you make an error when writing a prescription, you must consider the ethical and legal implications of your error—no matter how seemingly insignificant it might be. You may fear the possible consequences and feel pressured not to disclose the error. Regardless, you need to consider the potential implications of non-disclosure. How you respond to the prescription error will affect you, the patient, and the health care facility where you practice. In this Assignment, you examine ethical and legal implications of disclosure and nondisclosure of personal error.

Consider the following scenario:

· You are working as an advanced practice nurse at a community health clinic. You make an error when prescribing a drug to a patient. You do not think the patient would know that you made the error, and it certainly was not intentional.

To prepare:

· Consider the ethical implications of disclosure and nondisclosure.

· Research federal and state laws for advanced practice nurses. Reflect on the legal implications of disclosure and nondisclosure for you and the health clinic.

· Consider what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error.

· Review the Institute for Safe Medication Practices website in the Learning Resources. Consider the process of writing prescriptions. Think about strategies to avoid medication errors.

Write a 2- to 3- page paper that addresses the following:

· Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to reference laws specific to your state.

· Describe what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error. Provide your rationale.

· Explain the process of writing prescriptions including strategies to minimize medication errors.

Link:

https://www.ismp.org/recommendations/error-prone-abbreviations-list

Discussion: Using Evaluation Tools to Assess Quality Improvement Efforts

Like most other things in life, outcomes are the bottom line with respect to measurement of success along the path of quality improvement. However, without a careful analysis of the link between access, process, and structure of care, improvements in outcomes seem unattainable.—Sadeghi, Barzi, Mikhail, & Shabot, 2013In this Discussion, you consider how to collect and analyze qualitative and quantitative data to evaluate the results of quality improvement initiatives. In addition, you discuss the significance of evaluation and how you, as a nurse leader-manager, can contribute in an organization to the large-scale goal of facilitating quality improvement.

To prepare:Review methods for measuring and evaluating quality improvement efforts presented in the Learning Resources. Pay particular attention to how and why it is important to measure outcomes.Select one evaluation tool and analyze its benefits and relevance for the quality improvement plan you are developing for your Course Project.Consider how you, as a nurse leader-manager, can use the results from the evaluation to support the organization’s overarching goals for quality improvement.

By Day 3 Post a brief description of the evaluation tool that you selected. Explain the benefits of applying this tool as part of your quality improvement plan in the Course Project. Also explain how you could use the results from the evaluation to support the organization’s overarching goals for quality improvement. 

Validate an idea with your own experience and additional resources.

Required ReadingsHickey, J. V., & Brosnan, C. A. (2017). Evaluation  of health care quality in for DNPs (2nd  ed.). New York, NY: Springer Publishing Company.Review Chapter 3, “Conceptual Models for Evaluation in Advanced Nursing Practice” (pp. 61-86) (assigned in Week 3)Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. M. (2013). Integrating quality and strategy in health care organizations, Burlington, MA: Jones & Bartlett Publishers.Review Chapter 8, “Quantifying the Quality Performance Gaps” (pp. 161–177) (assigned in Week 6)                  The authors focus on performance measures with particular focus on the relationship between financial and quality performance.                  Review Chapter 9, “Closing the Gaps” (pp. 179–194) (assigned in Week 7)                  This chapter explains how to utilize data collected during the evaluation stage in order to improve the quality of health care.                 Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.Retrieved from https://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf This report outlines the Institute of Medicine’s (IOM’s) six aims to improve the quality of health care. Review this information through the lens of evaluation. (Assigned in a previous week.)