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. Refer to the LopesWrite Technical Support articles for assistance. 

Jamie is a 3-month-old female who presents with her mother for evaluation of “throwing up.” Mom reports that Jamie has been throwing up pretty much all the time since she was born. Jamie does not seem to be sick. In fact, she drinks her formula vigorously and often acts hungry. Jamie has normal soft brown bowel movements every day and, overall, seems like a happy and contented baby. She smiles readily and does not cry often. Other than the fact that she often throws up after drinking a bottle, she seems to be a very healthy, happy infant. A more precise history suggests that Jamie does not exactly throw up—she does not heave or act unwell—but rather it just seems that almost every time she drinks a bottle she regurgitates a milky substance. Mom thought that she might be allergic to her formula and switched her to a hypoallergenic formula. It didn’t appear to help at all, and now Mom is very concerned.

Cases like these are not uncommon. The mother was concerned and thinking her daughter may have an allergy; she changed to a different formula. However, sometimes babies have immature GI tracts that can lead to physiology reflux as they adapt to normal life outside the uterus. Parents often do not consider this possibility, prompting them to change formulas rather than seeking medical care. As in the case study above, GI alterations can often be difficult to identify because many cause similar symptoms. This same issue also arises with adults—adults may present with symptoms that have various potential causes. When evaluating patients, it is important for the advanced practice nurse to know the types of questions he or she needs to ask to obtain the appropriate information for diagnosis. For this reason, you must have an understanding of common GI disorders such as gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis.

To Prepare

• Review this week’s media presentation on the gastrointestinal system.
• Review Chapter 35 in the Huether and McCance text. Identify the normal pathophysiology of gastric acid stimulation and production.
• Review Chapter 37 in the Huether and McCance text. Consider the pathophysiology of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. Think about how these disorders are similar and different.
• Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on this factor.
• Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for gastritis. Consider the epidemiology and clinical presentation of gastritis.

To Complete

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

• Describe the normal pathophysiology of gastric acid stimulation and production. Explain the changes that occur to gastric acid stimulation and production with GERD, PUD, and gastritis disorders.
• Explain how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
• Construct a mind map for gastritis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.

4 References no later than 5years

zero plagiarism 

 Write a 3- to 4-page paper in which you:  

Compare the horizontally integrated health system and the vertically integrated health system you have selected (e.g., size, settings/locations, and types of services). Explain each health system’s rationale for pursuing integration and the strategies it has used to achieve integration. Assess the business and health care-related implications of integration for your selected health systems, including how integration impacts the patients/consumers the organization serves. 

 The following is another student DQ post to wish a have to reply adding some other information related to the post. Remember APA and less than 20 % similarity. 

Professor instructions:

All your postings should have references and citations

All your postings should have three paragraphs with three sentences

Student Post:

Question 1

There are some behaviors that indicate potential boundary crossing by nurses when dealing with patients. The first red flag is spending more time than is required with a patient. This shows that the relationship between the two has moved from professional to personal businesses that may negatively affect output (Erikson & Davies, 2017). Secondly, showing favoritism to a particular patient is another alert sign of professional boundary crossing.

Another common alert sign of professional boundary crossing is discussing intimate issues with patients. While a nurse may need some personal information about a patient while taking care of them, such data as likes and dislikes and other intimate details is often a sign of professional boundary crossing (Erikson & Davies, 2017). Also, engaging in behavior that could be reasonably interpreted as flirting constitutes an alert sign.

Meeting patients in settings other than those for provision of care is also a warning sign of professional boundary violation (Erikson & Davies, 2017). This include meeting patients at home or for coffee after they have been treated. Also, if patients start asking questions about a particular nurse, professional boundaries may be crossed.

Question 2

Terminal sedation is an end-of life intervention to end suffering as the last result. To relieve suffering that has not responded to other means, the patient is sedated to the point where refractory symptoms are controlled. With no intention of causing death, the patient is sedated to an unconscious level (Bryer et al., 2019). These drugs may result in his/her slow and painless death.

Rational suicide involve a well-thought out decision by an individual to die. Rational suicide occurs when a person reasons and decides to end their own life. In this case, the patient in end of life care should also be capable of action so that they can administer the drug (Bryer et al., 2019). Therefore, they administer the lethal drug on themselves rather than by a medical professional or other persons.

Assisted dying involve the hastening of death by administration of a lethal substance. In assisted dying, a drug or lethal substance is administered to the patient to end their life (Bryer et al., 2019). In this case, there can be active euthanasia where someone other than the patient carry out the action that ends the life.

Question 3

One major moral dilemma with end of life care is regarding hastening death or the principle of double effect. Some decisions that a nurse will make produce both negative and positive effects. For example, while a nurse may need to administer pain medicine, the drug may have negative effect on the patient (Masters, 2017). Here while the principle of non-maleficence apply, the nurse is in a dilemma or whether or not to administer.

Another moral dilemma in end-of life care is that involving respect for autonomy. According to Harwood (2020), patients have the right to make decision in regard to their treatment preferences. However, there are limitations when it comes to observing certain patient requirement which may have negative effects. Nurses often find themselves digressing from the patient’s preferences in treatment.

Another major challenge with end of life care is in regard to disclosing prognosis or diagnosis to patients. Due to religious beliefs, emotional reactions and other factors, family members may request nurses not to disclose results of diagnosis to patient (Harwood, 2020). As this act against nursing ethics, it present an ethical dilemma due to potential consequences of the disclosure.

References

Bryer, E., Neault, M., & Mintzer, D. (2019). Managing Dying: Medical Care and Decision Making at the Very End-of-Life. Palliat Med Care, 6(1), 1-6.

Erikson, A., & Davies, B. (2017). Maintaining integrity: How nurses navigate boundaries in pediatric palliative care. Journal of pediatric nursing, 35, 42-49.

Harwood, R. H. (2020). Ethical and moral dilemmas including do not attempt resuscitation orders, advanced care planning, and end-of-life care. Stroke in the Older Person, 283.

Masters, K. (2017). Patient-centered care and professional nursing practice. Role development in professional nursing practice, 273-278.