Case Study

Heart Failure

Patient Profile

M.G. is a 77 year old woman who saw her health care provider for dyspnea. She is now being admitted to the hospital for acute heart failure. She was diagnosed once before with heart failure 6 years ago. She is currently taking the following medications:

Furosemide 40mg po daily

Potassium chloride 20meq po daily

Enalapril 10mg po BID

Subjective data

Was taking furosemide at home but ran out two days ago and has not been able to refill her prescription

Complains of difficulty breathing; had to “sleep in the chair” last night

Has some swelling in her feet that is worse than usual

Objective Data

Physical examination

· Temp 98.4 F, pulse 92 irreg., resp. 24 labored, blood pressure 144/86, oxygen saturation 89% on Room air

· Ht. 5’5”, wt. 170 lbs.

· Alert and oriented to person, place, and time

· Fine crackles bilateral lower lobes

· Shortness of breath with minimal exertion

· S1 and S2 without murmur or extra heart sounds

· Capillary refill sluggish in lower extremities, normal in upper extremities

· 2+ pitting edema bilateral lower extremities

Interprofessional Care

Admission orders include: 

· Oxygen 2L/ nasal cannula

· Furosemide 40mg intravenous BID

· Enalapril 10mg po BID

· ECG now

· Vital signs with SPO2 q 4 hrs

· 2 gm sodium diet

· Strict I&O

· Daily weight

Answer the following questions thoroughly and cite resources appropriately in APA format.

Describe a plan for implementing these orders. 

Based on M.G.’s clinical manifestations, what type of heart failure do you suspect? Support your answer

What assessment data will you use to determine the effectiveness of the provider’s orders?

What is the rationale for the oxygen, IV furosemide, and enalapril?

What are the priority nursing diagnoses for this patient? (list at least 3)

What other orders might you anticipate for this patient?

Think about plans for discharge, what are your primary concerns for this patient?

Any other information you need or would like about this patient?

I need a reply for this 2 peers. 

A minimum of 2 paragraphs is required for all posts  

Support all posts with at least 2 cited peer review references within 5 years of publication (references cannot be older than 5 years). 

All posts are to be written in APA 6th edition format  

Peer 1 

The Role of Advanced Practice Nursing in Safe Prescribing 

The s. 893.03 Florida Statutes mandate the APRNs to prescribe controlled substances in line with the supervisory standards. The professionals have to engage in three-hour training sessions on safe prescribing and the effective implementation of the related strategies (Florida Board of Nursing, 2016). The APRNs have to evaluate and define the patients’ health issues to offer the right prescriptions. They should also equip patients with relevant information about warnings as well as how one should take the prescribed drugs (Pigman et al., 2016). Additionally, the practitioners monitor the patients regularly to make sure they receive the intended benefits of the prescriptions at hand. According to the state requirements, the APRN practitioners have to meet the same prescription standards as physicians. 

Prescribing Barriers for APRNs 

Various barriers limit the APRN practitioners from undertaking their prescription roles effectively. First, state licensure restricts the APRNs from engaging in full practice in line with their educational qualifications. The practitioners can only engage in one of the NP roles based on collaborative agreements. Secondly, APRN training programs may fail to equip learners with advanced skills for delivering high-quality health care services. Negative perceptions of the existing working conditions and inadequate knowledge also limit the practitioners from performing their prescription roles effectively (Jun, Kovner, & Stimpfel, 2016). Additionally, certain payer policies deter the APRN from engaging in health care delivery activities to the full extent of their training as well as licensure. For instance, some scope-of-practice policies restrict practitioners to specific roles. Job satisfaction issues also hinder practitioners from undertaking their prescription roles in a way that impacts significantly on patient outcomes. Some practitioners experience unfavorable working conditions, which reduce their productivity. 

Peer 2 

ARNPs have in their hands a high level of responsibility when prescribing medications. The degree of responsibility depends on whether they can or not prescribe medicines that rely on the state’s laws related to the prescriptive authority given to APRNs. There are twenty-one states that are fully independent prescribing by nurse practitioners (Teri, & Marylou, 2015). The responsibility for the final decision on which drug to use and how to use it depends on the APRN prescriber. To be a safer prescriber, it is important that APRN assume the higher level of legal responsibility that is required. Also, the knowledge of medicine, pharmacology, determine the diagnose for which the drug will be ordered, prescribe the appropriate drug, monitor the outcome, and educate the patient about the medication and possible adverse effects. 

Despite many positive expansions to the APRN role that include caring for ethnically diverse, underserved populations within an aging society and across many healthcare settings, there are a lot of barriers requiring attention. Prescribing medications is one of the main components of the APRN role and essential to his/her practice. One of the barriers is the restrictions on prescriptive authority that limit the ability of NPs to provide comprehensive health care services. AANP recommends that NP prescribing authority be solely regulated by state boards of nursing and in accordance with the NP role, education and certification. This process of license and regulation exclusively by the nursing board promotes public safety and competent practice (Hain, D., & Fleck, L., 2014). 

The Florida Board of Nursing states that ARNP may only prescribe or dispense a controlled substance as defined in s. 893.03 Florida Statutes if the ARNP graduated from a program with a master’s or doctoral degree in a clinical nursing specialty area with training in specialized practitioner skills. However, all ARNPs and PAs are required to complete at least three hours of continuing education on the safe and effective prescribing of controlled substances. Also, Under the new law, an ARNP’s prescribing privileges for controlled substances listed in Schedule II are limited to a seven-day supply and do not include the prescribing of psychotropic medications for children under 18 years of age, unless prescribed by an ARNP who is a Psychiatric Nurse. The bill also clarifies that only allopathic physicians licensed under chapter 458, Florida Statutes, or osteopathic physicians licensed under chapter 459 Florida Statutes may dispense medications or prescribe controlled substances in a registered pain management clinic (Florida Board of Nursing, 2016).In addition, every person who prescribe controlled substances must register and obtain a registration number with the US Drug Enforcement Administration. Also, they have to maintain and keep on file for a minimum of 2 years accurate records of controlled drugs they purchase, distribute, administer, and dispense.  (Teri, & Marylou, 2015). 

This is the original assignment if you needed: 

Discuss the role of advanced practice nursing in safe prescribing and 3  prescribing barriers for APRNs. 

https://www.flsenate.gov/Committees/BillSummaries/2016/html/1424 

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-19-2014/No2-May-2014/Barriers-to-NP-Practice.html 

https://floridasnursing.gov/new-legislation-impacting-your-profession/ 

https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioner-prescriptive-privilege 

SCHOOL POLICY 

NO PLAGIARISM 

AT LEAST 120-150 WORDS FOR EACH QUESTION PLEASE AND THANK YOU 

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*** DUE TODAY IF POSSIBLE .. 8 PM EASTERN TIME***

1- Who would ultimately determine and approve the mission and vision of an organization?  Why? 

2-   Consider a large organization with maybe 500 employees – how would you be able to get all staff involved in creating the mission and vision?  Doesn’t final approval need to reside with one person or a small group of key leaders?

3- Describe the difference between mission and vision of an organization. 

Read and watch the lecture resources & materials below early in the week to help you respond to the discussion questions and to complete your assignment(s).

(Note: The citations below are provided for your research convenience. Students should always cross reference the current APA guide for correct styling of citations and references in their academic work.)

Ritter, L.A., Graham, D.H. (2017). Multicultural Health (2nd ed.). Burlington, MA: Jones and Bartlett Learning.
ISBN: 9781284021028
Chapters 11 and 12

Online Materials & Resources

1. Visit the CINAHL Complete under the A-to-Z Databases on the University Library’s locate and read the article(s) below:
   • Arritt, T. (2014). Caring for patients of different religions. Nursing Made Incredibly Easy, 12(6), 38-45.
   • Hudson, C.C., Adams, S., Lauderdale, J. (2016). Cultural expressions of intergenerational trauma and mental health nursing implications for U.S. health care delivery following refugee resettlement: An integrative review of the literature. Journal of Transcultural Nursing, 27(3), 286-301. doi: 10.1177/1043659615587591.
2. View the videoss below:
   • TEDx Talks. (2014, May 30). Decoding the unique medical needs of the Amish | Kevin Strauss | TEDxLancaster [Video file]. Retrieved from Decoding the unique medical needs of the Amish | Kevin Strauss | TEDxLancaster (Links to an external site.)
   • Page, R. (2014, July 16). PIER-Meeting the Healthcare Needs of American Muslims [Video file]. Retrieved from PIER-Meeting the Healthcare Needs of American Muslims (Links to an external site.)

Respond to the Case Study presented in Chapter 12 (p. 286) about direct-to-consumer advertising of prescription drugs. What impact have you observed in the populations you serve in your nursing practice? Comment on the ethics of this practice, in terms of autonomy, beneficence, non-maleficence, and justice.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. YRead

 

Complete and submit in a word document

1. Classify each of the following as an element, a compound, or a mixture

a. Milk

b. Diamond (pure carbon)

c. Pure water (H2O)

d. Sea water

e. Air

2. Identify each of the following as solid, liquid, or gas.

a. Ice

b. Air in a tire

c. hot tea in a cup

d. A bar of gold

e. water in a shower

3. Identify each of the following as a physical or chemical change.

a. Melting ice

b. Wood burns in wood stove

c. Wood is chopped for the fire place

d. In contact with the air, a copper pipe becomes green

e. When a bar of zinc is submerged in hydrochloric acid, a gas bubbles form this mixture

4. Classify the following mixtures as homogenous or heterogeneous

a. Tea

b. sugar completely dissolved in water

c. Water with sand

d. Steel (a mixture of iron and carbon)

e. Air

5. Give the period and group numbers for each of the following

a. Chlorine

b. Calcium

c. Helium

d. Copper

e. Sulfur

f. Xenon

6. Write the name and symbol of the elements with the following atomic number

a. 11

b. 17

c. 30

d. 24

e. 6

f. 34

g. 19

h. 26

7. For the following atoms determine the number of protons, neutrons, and electrons.

a. 23Na

b. 35Cl

c. 78Rb

d. 14C

e. 32S

8. Place the following elements in order of increasing atomic size

a.  Ca, Ra, Be, Sr, Mg

b. Ge, Fe, Cr, Mo, Br

9. Classify the following elements as alkali metal, alkali earth metal, transition element or a halogen

a. Rb

b. I

c. Fe

d. Be

e. Au

f.  F

10. Write the group number and electron arrangement for each of the following

a. Phosphorus

b. Nitrogen

c. Magnesium

d. Aluminum

e. Chlorine