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Community, Culture, and Nursing

The discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.

By the due date assigned, post a response to one of the two discussion topics below, using information from the lectures, reading assignments, library resources, and Internet resources. All responses should be posted to the appropriate topic in the Discussion Area.

Topic 1: Community-Based Nursing

Nursing services play an important role in caring for patients and families in the community and providing them the support they need. For patients with problems ranging from chronic health conditions to need of elder care, nursing has proved itself an important part of the healthcare team. In fact, many people now prefer sending their elderly parents to a daycare for nursing, rather than to a long-term care facility.

For this topic, interview a community-based nurse or nurse practitioner who sees individuals in the home setting. Ask the following questions:

What are your job responsibilities?
Does a correlation exist between your job description and your practice?
Are you involved in policy formulation that affects client services?
Do you belong to a professional organization related to your current job position?
Topic 2: Culturally Competent Care

A broad range of cultures exists in the world today. Nursing professionals often interact with people from cultural backgrounds that differ from their own.

Share an experience where you cared for a patient in the healthcare setting who was from a culture different from your own. How did you accommodate this patient’s needs? How would you apply the Purnell Model to future cultural encounters?
Which one of the twelve domains of culture from the Purnell Model do you feel is most important? Why?
Citations should conform to APA guidelines. You may use this APA Citation Helper as a convenient reference for properly citing resources or connect to the APA Style website through the APA icon below.

APA

Before the end of the week, comment on at least two of your peers’ responses. You can ask questions or respond generally to the overall experience. Be objective, clear, and concise. Always use constructive language, even in criticism, to work toward the goal of positive progress. All comments should be posted to the appropriate topic in the Discussion Area
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 You will design a patient education tool that can be used by nurses for teaching patients using computer applications. You will then present your tool to the class and explain the purpose, how you created it, reasoning for your choice of applications, and provide current evidence of the effectiveness of this patient education. This presentation is 5-10 minutes 

You have to create an E-Poster on what you see as the future of nursing practice and the role of nursing in the emerging health-care environment. You need to predict the future based on present evidence.

The E-Poster needs to include the following:

1. Introduction 

2. Statement of the issue

3. Evidence supporting the issue 

4. Prediction of the future role of the nurse 

5. Conclusion 

6. References: minimum of three references from peer-reviewed nursing journals (encourage the use of international journals).Articles need to be within the last 3 years unless historical.

Essentials of Nursing Leadership & Management
6th Edition

Sally A. Weiss  MSN, EdD, RN, CNE, ANEFRuth M. Tappen  EdD, RN, FAAN

ISBN-13: 978-0-8036-3663-7

In a 1- to 2-page paper, address the following:

• Briefly describe how supportive and interpersonal psychotherapies are similar.
• Explain at least three differences between these therapies. Include how these differences might impact your practice as a mental health counselor.
• Explain which therapeutic approach you might use with clients and why. Support your approach with evidence-based literature. Provide evidenced-based article to support your response

Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111,  R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF)

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)

Differential Diagnosis: Peripheral Vascular Disease (PVD)

Plan:

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP – not available.

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).

Questions:

1.     According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.     Does he need medication(s) given his history of MI?