CHAPTER 12 CASE STUDY

You and your partner respond to a motor vehicle crash involving two cars. En route, you follow standard precautions in preparation for your arrival at the scene, where you find a 25-year-old man. Law enforcement informs you that the other car left the scene. The patient was restrained and is sitting outside the car. He is pale. You observe the car for damage. The air bag has deployed and the steering wheel has some damage.

1. On      the basis of your scene size-up, what may potentially be wrong with the      patient?
2. What      is your general impression of this patient?

You approach the patient and introduce yourself. He appears visibly upset but he lets you take his vital signs. His vital signs are a pulse of 115 beats/min, respirations of 26 breaths/min, and a blood pressure of 110/75 mm Hg. He has a laceration on his knee where it hit the dashboard.

1. What      are the next steps in assessing this patient?
2. Is      there a significant mechanism of injury?

You place a bandage on his laceration as he explains what happened. You also ask questions to obtain a SAMPLE history. The patient says that he recently had strep throat. As you are talking, you take another set of vital signs. His pulse is 118 beats/min, respirations are 28 breaths/min, and blood pressure is 108/70 mm Hg. His skin is clammy.

1. What      are your concerns for this patient?
2. What      is the significance of his recent illness?

You and your partner immobilize the patient on a long backboard. The patient seems anxious; he states that he does not feel well and needs to get to the hospital immediately. He is loaded into the ambulance, and your partner reassesses his vital signs. Your partner reports that the vital signs are a pulse of 122 beats/min, respirations of 30 breaths/min, and a blood pressure of 106/68 mm Hg. Your partner places a blanket over the patient and administers high-flow oxygen.

1. What      do his vital sign changes indicate?

Summary questions:

1. List      the approximate systolic BP values for each palpable pulse location:

             Radial: ___________________

             Carotid: __________________

             Femoral: _________________

1. The      mechanism of injury (MOI) in this scenario is significant. Although the      patient was restrained, airbag deployment and damage to the steering wheel      indicate that there was force involved. What specific      organs/structures would be susceptible to injury from this MOI?
2. How      is the patient’s recent history of strep throat significant when      evaluating the level and possible progression of shock?
3. Is      the patient in compensated or decompensated shock? How do you know?
4. Without      a specific scenario, how would you describe the general presentation of a      patient in profound shock? Use medical terminology.

 

Assignment Overview

Select a vulnerable population in your community. To do this, conduct  a windshield survey in your community. A windshield survey is completed  by observing a population by looking out of a window of your car (or a  bus, or riding your bike) to identify a vulnerable population in your  community. Conduct research on your chosen population via the Internet  and by calling or visiting your local health department. Develop a  PowerPoint presentation to communicate your observations and research.  An example listing of vulnerable populations has been included for your  consideration.

Assignment Details:

Perform the following tasks:

• Complete the reading assignment and the interactive lesson before attempting this assignment
• Attend the instructor session to prepare for this assignment.
• Complete the Windshield survey.
• From the vulnerable population observed, research the population 
  • Identify the vulnerable population in detail.
  • Identify health risks and needs of the vulnerable population.
  • Identify resources that are available and those needed but not available.
  • Describe service gaps/interventions that could be used (primary, secondary, tertiary) that could fill gaps in resources.
  • Summarize your findings for each of the different categories.
• Prepare a PowerPoint presentation to communicate your observations and research.
• Include the proper file naming convention: PRN208_wk10_assn_jsmith_mmddyyyy
• Vulnerable Populations to consider from the textbook:

   

Poor and homeless persons

Pregnant adolescents

Migrant workers and immigrants

Severely mentally ill individuals

Substance abusers

Abused individuals and victims of violence

Persons with communicable disease

People at risk of disease transmission

Persons who are HIV positive

Persons with Hepatitis B virus

Populations at risk of a sexually transmitted disease

Other suggestions:

Elderly

Children

Battered/abused women

Women with high risk pregnancies

Women with no risk to prenatal care

Recovering substance abuse

Substance abuse

Community Research PowerPoint

• Prepare a power point presentation that identifies each of the following.
• Include and introduction, citation and reference slide.

I. Population; Describe in detail:

1. Demographics
2. Religion
3. Ethnicity
4. Culture
5. Employment
6. Socioeconomic status
7. Health/Lifestyle Behavior

II. Health Risks; Identify and explain:

1. Health promotion
2. Health risks
3. Specific health needs
4. Include what resources are required to ensure health

III. Resources; Identify and describe the following availability in the community

1. Resources to meet population need
2. Programs to meet population need
3. Services to meet population need

IV. Service Gaps/Interventions.

1. Identify services that are not currently available but would be valuable and improve outcomes for the vulnerable population. List as: 
   1. Primary interventions
   2. Secondary interventions
   3. Tertiary interventions

V. Summary; Summarize research plans to address:

1. Health promotion
2. Health risks
3. Actual health issues

For this assignment, conduct a community observation to assess a vulnerable population. See the assignment details for complete assignment instructions.

Select Next to complete the  NCLEX Review Questions.

 

Rubric

 Week 10 Assignment      Week 10 Assignment     Criteria Ratings        Pts              This criterion is linked to a Learning Outcome  Populations Describe in  detail. Include all of the following criteria: demographics, religion,  ethnicity, culture, employment, socioeconomic status and  health/lifestyle behaviors             20 to >17.0 pts                  Exceeds Expectations 85% – 100% • Describe population in detail, uses all criteria and/or includes additional  data.         17 to >14.0 pts                  Meets Expectations 70% – 84% • Describe population including 75% of criteria.         14 to >0 pts                  Needs Work <70% • Describe population superficially, uses less than 50% of criteria.         20 pts
         This criterion is linked to a Learning Outcome  Health Risks Identify and  explain health promotion, health risks, and health needs specific to  each group. Include what resources they require to ensure health.             30 to >25.5 pts                  Exceeds Expectations 85% – 100% • Include health promotion needs, health risks, and actual health issues for population.         25.5 to >21.0 pts                  Meets Expectations 70% – 84% • Include actual health issues and risks, does not address health promotion needs.         21 to >0 pts                  Needs Work <70% • Include actual health issues, does not address health risks or health promotion needs.         30 pts
         This criterion is linked to a Learning Outcome  Resources Identify and describe the resources, programs, services that are currently available in the community to meet the health needs.             30 to >25.5 pts                  Exceeds Expectations 85% – 100% • Identify  8-10 resources • All descriptions of resources are detailed and accurate         25.5 to >21.0 pts                  Meets Expectations 70% – 84% • Identify  5-7 resources • Most of the descriptions of resources  are detailed and accurate         21 to >0 pts                  Needs Work <70% • Identify less than 5 resources. • Few of the descriptions of resources are detailed and accurate         30 pts
         This criterion is linked to a Learning Outcome  Service Gaps/Interventions Identify  services that are not currently available but would be valuable. Select  primary, secondary, and tertiary interventions that could improve health  outcomes for each group.             30 to >25.5 pts                  Exceeds Expectations 85% – 100% • Identify 5 or more services that would be helpful • Include interventions from all 3 levels of prevention.         25.5 to >21.0 pts                  Meets Expectations 70% – 84% • Identify 3-4 services that would be helpful • Include interventions from 2 levels of prevention.         21 to >0 pts                  Needs Work <70% • Identify 1-2 services that would be helpful • Include interventions from 1 level of prevention.         30 pts
         This criterion is linked to a Learning Outcome  Summary Summarize research and plans to address health promotion, health risks, and actual health issues.             30 to >25.5 pts                  Exceeds Expectations 85% – 100% • Comparison of the vulnerable population is thorough and in depth. • Include all criteria listed above.         25.5 to >21.0 pts                  Meets Expectations 70% – 84% • Description of the vulnerable population is superficial • Include 75% of criteria listed above.         21 to >0 pts                  Needs Work <70% • Description of the population is minimal or absent. • Include less than 75% of criteria listed above.         30 pts
         This criterion is linked to a Learning Outcome  Grammar, Spelling, and Punctuation              10 to >8.5 pts                  Exceeds Expectations 85% – 100% • 1 or 2 grammar, spelling, punctuation errors, and/or typographical errors. • All references and citations in proper APA format.         8.5 to >7.0 pts                  Meets Expectations 70% – 84% • Minimal errors. • Few typographical  errors • 75% or more of references and citations in proper APA format.         7 to >0 pts                  Needs Work <70% • Multiple errors • Many typographical errors. • Less than 50% of references and citations in proper APA format.         10 pts 

You are working with Dr. Lorenzen, who asks you to start interviewing Susan Johnston, a patient she knows well who is here to discuss recent symptoms of chest pain.

Before seeing the patient, Dr. Lorenzen asks you to review the differential diagnosis for chest pain. She reminds you, “There are many causes of chest pain including cardiac, gastrointestinal, pulmonary, musculoskeletal, and psychogenic causes.”

1. List below three potential causes of chest pain in each of the categories mentioned.

2. Discuss the history of present illness that you would take on this patient in preparation for the clinic visit. Include questions regarding Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity (OLDCARTS).

3. Describe the physical assessment and diagnostic tools to be used for Ms. Johnston. Are there any additional you would have liked to be included that were not? 

4. What plan of care will Ms. Johnston be given at this visit; what is the patient education and follow-up?

please use apa style with references

  wk/project

While treating the chronically ill, a major challenge is developing a plan of care that addresses the specific needs of a patient and a caregiver. You need to be in close touch with patients and their support group, family and peers, to come up with an ideal plan.

In this course project, you are going to develop a plan of care for a chronic illness group of your choice using the Healthy People 2020 Topics. While executing the tasks of this project, remember that while you need to give a general overview of the biomedical considerations of the case, the focus should always be on the psychosocial elements. Your perspective in this care plan should be the patient’s goals rather than those of the medical team.

Each week, you will complete a part of this project. You will submit a final completed project in Week 5. Be sure to take the time to carefully complete each of the weekly assignments and then put it all together in Week 5.

Ensure that you save a copy of this course project after you have submitted it at the end of this course. You are expected to resubmit this project along with the other course projects at the end of the Registered Nurse (RN) to Bachelor of Science in Nursing (BSN) program. File Transfer Protocol (FTP) details will be provided in the Capstone course.

Identifying a Group

Identify an area of chronic illness of specific interest to you and that is represented as a Healthy People 2020 topic (healthypeople.gov). Explain your choice and your interest in it. Prepare a questionnaire utilizing your knowledge of health and illness, with the aim of acquiring all information you need from patients to prepare a plan of care for the specific illness group. Submit your information in a 4- to 5-page Microsoft Word document. In addition to your questionnaire, be sure to include the following details in your paper.

· Chronic Illness of interest

· Morbidity and comorbidity of the disease

· Impact of the chronic illness and patient morbidity and the affect to overall health of nation

· Healthy People 2020 goals and objectives for specific illness group

Support your responses with examples.

On a separate references page, cite all sources using APA format.