Cardiovascular Case Study

John is a 76-year-old man with a long history of stable angina and hypertension. He is prescribed nitroglycerin tablets as needed for chest pain and lisinopril for his hypertension. John has noticed that his chest pain is occurring with increasing frequency and less activity is required to initiate the symptoms; however, the pain subsides quickly with rest and one or two nitroglycerin tablets.

John is awakened from sleep with chest pain and shortness of breath. The pain is much more severe than his usual anginal pain and radiates to the jaw and the left arm. He experienced some nausea and became diaphoretic and pale. Upon admission to the local emergency department, he was noted to have significant ST-segment elevation on a 12-lead electrocardiogram (ECG).

Discussion Questions:

1. What diagnosis is consistent with John’s history and physical exam?

2. Please differentiate between a STEMI and Non-STEMI.

3. What are the pathophysiological findings specifying an MI?

4.What are the differences between angina, silent ischemia, and myocardial ischemia?

5.Provide a description of the three factors associated with Sudden Cardiac Death.

6.What are the possible complications post-MI might the NP be aware of when caring for John?

Do two pages.

Provide references.

  

The patient is a 58-year woman diagnosed with Stage IIIB breast cancer which required a mastectomy, chemotherapy and radiation treatments. She has a variety of chronic illnesses, including hypertension, diabetes and asthma. She is knowledgeable about her health and sees the doctor regularly to stay healthy.

She is very devout Catholic and grew up in a strongly devout family. Her church family is very important to her. Her mother and siblings live out of state. All of her family prays regularly for her along with their church and friends.

The patient was very sick as a child requiring frequent hospitalizations. Although her parents were repeatedly told that the patient would soon die from pneumonia, she always pulled through. This caused her family to note her strong-willed nature as a child. Her family nick name was “the happy child” because she was known for her cheerful, optimistic nature despite her frequent illnesses.

She has been married for 36 years. Her husband is very supportive. She has 2 grown sons who live about 4 hours away. Neither son is married.  Her best friend is a local nursing instructor. The friend has taken her back and forth for most of her treatments because her husband cannot get time off. Her co-workers are very supportive and assisted with money and food during chemotherapy. She has been a teacher in the community for 20 years. Her former students created a face book page to keep up with her progress and regularly send her encouragement.

1. Describe the patient’s world view. 

2. Explain the concept of affiliated-individuation. 

3. Explain the concepts of self-care, self-care knowledge, self-care resources, and self-care action. 

a, self-care-

b. self-care knowledge –

c. self-care resources –

d. self-care action –

4. What is APAM in MRM theory? 

a. What does it mean? 

b. Describe her adaptation potential. .

c. What was the stressor?

d. What was the arousal response?

e. What happened with the arousal? 

5. Identify one way the nurse can role-model for this patient. 

6. Using the patient in the scenario, discuss at least one nursing intervention for each of the MRM Five Aims of Interventions.  

a. Build trust

b. Promote Positive Orientation

c. Promote Perceived Control

d. Affirm and Promote Positive Strengths

e. Set Mutual Health Promotion Goals

 

Visit the website of an insurance company, such as Aetna, Blue Cross/Blue Shield, or Humana and identify one of the company’s insurance plans. In a four-paragraph paper, describe what the plan provides and what obligations it places on patients. Contrast this with another plan offered by the insurance company or by another insurance company.

Save the file as “InsuranceWebQuest” 

 

Discussion: Creating, Developing, and Leading Effective Teams

Coming together is a beginning. Keeping together is progress. Working together is success.
—Henry Ford

A critical skill for all nurse managers is the ability to create, develop, and lead effective teams. When people are part of an effective and well-functioning team, they are more productive and have a stronger commitment to the organization. Nurse managers have a responsibility to create teams that fulfill functional needs within their units or departments. These can include leadership teams, ad hoc project teams, or primary work teams.

As a nurse manager, there is a variety of ways that you can enhance team functioning. The first step is developing the structural elements of the team and then designing the team with the appropriate membership. Just as you must critically examine each application during the employment process, so will you critically examine the skills and attributes of each employee before appointing him or her to a collective team.

In this week’s Discussion, you lay the groundwork for creating and developing a team for your unit, department, or health care setting. You also identify leadership strategies that you could employ to increase the team’s organizational effectiveness.

To prepare

• Review Chapter 5, “The Art of Effectively Facilitating Processes” from the course text, From Management to Leadership: Strategies for Transforming Health Care. Carefully examine the section, “Essential Elements of a Team” to identify the six steps of creating an effective team.
• Consider a team you might create for your current organization or one with which you are familiar. For example, is there a project to be accomplished or a problem to be solved? Perhaps there is a need for a leadership team within your unit or department?
• Identify the purpose or goal for your team. Then, reflect on the following questions:
  • What type of team would you create (leadership, ad hoc, or primary work team) to accomplish this purpose or goal? What are the benefits or disadvantages of creating this type of team?
  • What staff members would you want on this team? Why? How could their skill sets and positions make them effective team members?
• Explore this week’s Learning Resources to identify leadership strategies you might employ before, during, and after the team-building phase. For example, what leadership strategies might influence synergy among team members while also increasing the effectiveness of the team?

Post a description of the team you would create, including the purpose or goal the team would serve, the team type, and the specific skills each member would contribute as well as their job positions. Describe at least two leadership strategies you could implement to help this team effectively achieve its purpose or goal.

 

Required Readings

Manion, J. (2011). From management to leadership: Strategies for transforming health care (3rd ed.). San Francisco, CA: Jossey-Bass.
Chapter 5, “The Art of Effectively Facilitating Processes” (pp. 179–242)This chapter describes the many components that make up the facilitating process. Some of these elements include empowerment, authority, resolutions, and negotiation.

Chapter 6, “Getting Results” (pp. 243–282)The main points of this chapter are the components that contribute to effective teamwork. The author lists the benefits and pitfalls of proactive behavior, group decision making, and problem solving.

Beeson, J. (2011). Build a strong team. Leadership Excellence, 28(2), 15.  Retrieved from the Walden Library databases.

Beeson’s article focuses on the importance of building a structured team. He provides five steps that leaders can implement in the workplace to create a strong team that benefits the whole workplace.

Calendrillo, T. (2009). Team building for a healthy work environment. Nursing Management, 40(12), 9–12.  Retrieved from the Walden Library databases.

In this article, Calendrillo states that skilled communication is the foundation for strong team building in clinical settings. When skilled communication has been mastered and used, quality patient care and healthy work environments are among the many results.

Pentland, A. (2012). The new science of building great teams. Harvard Business Review, 90(4), 60–70.  Retrieved from https://cb.hbsp.harvard.edu/cbmp/pl/76756181/76756183/15ba87a24642f03cb8854352b1d046fc

This article addresses how communication is a key to team efficiency. The author provides three communication dynamics that were used by the teams that were most communicative.

Tasks:

• Advances in technology have fed the explosion of wearable devices and patient self-monitoring. How can nurses leverage this technology to promote healthy lifestyles and improved compliance with self-care and monitoring?
• There are vast quantities of consumer data available today. For example, every time you use your grocery store loyalty card, data about what you purchased is collected, analyzed, and saved. This data in the hands of population health professionals can contribute to the creation of healthy lifestyle programs. However, the same data in the hands of health insurance plans could lead to higher insurance costs of denial of insurance. Should there be regulations on how these consumer data are used?

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.

By 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 Discussion Area.