I need a response for this case study:

In Mrs. Allen’s case, ACC/AHA guideline is applicable, especially in the context of the intervention of CVD. Although the primary focus of the guideline is prevention, there are alternative aspects of the framework that suit the health status and situation of Mrs. Allen (Leening & Ikram, 2018). A multidisciplinary team will dissect issues that are relevant to the patient, such as barriers to access to care, social-economic risk concerns, and cultural influences relating to her African American background, race and ethnicity, and, most importantly, the health goals.

                        The 68-year-old patient has no significant safety concerns for a high-intensity statin. The patient requires medication despite MI history. In situations involving MI and acute coronary syndromes, the ASCVD guideline recommends categorization into a distinctive statin benefit group (Leening & Ikram, 2018). In terms of specificity, Mrs. Allen should take daily dosages that help to lower LDL-C by an average of 50% in the high-intensity category. She requires 80 mg of Atorvastatin, while the low-intensity minimum is 10 mg. Crestor in the form of Rosuvastatin should be 40 mg or a moderate of 10 mg. Additional considerations include lovastatin 40 mg and Fluvastatin at 40 mg two times a day (Ross, Shah, & Leeper, 2016). Safety considerations and appropriate dosage are paramount requirements in the ACC/AHA guideline. 

                She needs as well take antiplatelet medications, such as Plavix, Brilinta, or Effient in combination with aspirin because she had surgery of stent placement and history of MI. In additional, Mrs. Allen needs to take Furosemide, because she experiences shortness of breath and pitting edema of the lower extremities. Patients, who has history of MI needs to take ACE inhibitors if they have no contraindications to it. Since Mrs. Allen is African-American, she may not tolerate ACE inhibitor and may develop allergic reaction (dry cough or swelling of the lips, tongue, face, or throat). In this case she needs to take Angiotensin receptor blockers (Mercado, Smith, & Macconnon, 2013).  

                              Conclusively, there is no doubt that Mrs. Allen requires urgent medical intervention. There are social-economic concerns such as financial constraints to afford medication. The ACC/AHA guideline stipulates the ideal mechanisms to help alleviate the suffering of such patients. Additional complications on the part of the patient require a cautious approach to medication, especially in regards to dosage (Ross, Shah, & Leeper, 2016). The guidelines and framework for patients with Arteriosclerotic Cardiovascular Disease is the most realistic path to Mrs. Allen’s positive health outcomes.

This is the original work if you needed:

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? 

 

Part 1

In your opinion, what are the three most important power sources for a nurse leader? Why?

The three most important power sources for nurses in my personal opinion are the following:

Expert power refers to such power that can influence others by using knowledge and skills. Experience knowledge and skills together make an expert power that is possessed by nurse leader and transferred to other nurses during practice of nursing. (The Sentinel Watch, 2010).  For a nurse leader to have the respect of those around him or her, I believe that first and foremost they must have the confidence that their leader knows what they are doing.  If the leader isn’t capable of doing the job, how can they be capable of supervising or evaluating my performance?

Coercive power refers to authority of a nurse leader i.e. nurse leader can impose penalties or punish other nurses by taking their privileges if they are not doing a good job. If nurses are not doing satisfactory job, nurse leader ensures that every nurse is doing a good job and ensuring patient’s satisfaction. The truth is that the underlying fear of retribution for poor performance comes into play at some point for most employees. 

 Reward power depends on the ability of the person who holds power to confer valued material rewards.The reward source of power depends on the ability of one person to grant another some type of reward for specific behaviors or changes in behavior. Nurses, in their daily provision of care, can use this source of power to influence client behavior as well as others employees.

 So I think that these power sources are most important in nurse leader as these powers influence directly to nurses and help them to get educated punctual and skillful at the same time.

How are they best used in a leadership role? Describe                                                   

Power sources are best used in leadership role as these powers are true essence of the leadership. Nurse leader empowered by skills and expertise will be a good mentor and a working role-model for the junior staff nurses. Her/his authorities to keep a strict check on them give them a sense of responsibility. On one hand, reward for doing great job gives them a challenging, encouraging and motivating working environment; meanwhile, a threat to punish can bring best out of them.  A nurse leader makes best use of her power sources by supervising and managing the duties of nurses to satisfy patient’s demands. (Yapton, 1998)

What sources of power do you see most often displayed in your work environment? Why?

Part 2

 You brought up a good point about coercive power. In health care coercive power is used to maintain standards. Many nurses think that this type of power is negative, but this is not always the case. Several times we must protect other staff and our patients from dangerous situations or incompetent care. The human resource roles are used to uphold many standards for employees, and coercive power is used to sustain them (Stapleton, 2017). The leader must be careful how they use this power, but using it is not a negative situation unless it is done in a ruthless and unfair way. It is a leadership skill to know how to use all the types of power they possess. Have you had a situation where another employee was suspended or fired after an incident? Do you think the use of coercive power was fair in this situation? 

The purpose of this assignment is to have you incorporate your new knowledge on nursing theory into your personal philosophy. You must use the template provided and utilize APA format for this assessment. In-text citations, grammar, spelling and sentence structure along with appropriate APA format will be evaluation for your grade. Re-read your paper carefully and make sure that your have addressed all areas on the rubric.

Here’s a list of the 5 nursing theorist.. Choose one for the paper!

Nightingale, Watson, Erickson, Neuman and Roy.

And I also posted the template below!!

 

• Type of paperPresentation or Speech
• SubjectNursing
• Number of pages2
• Format of citationAPA
• Number of cited resources4
• Type of serviceWriting

this is an online group presentation on Diabetes type 2. I need to make a power point as well but as far as the side notes go is the most important the directions are long but i only have to do question 4 on the instructions the other group members are doing the rest Due Date: Jul 23, 2017 23:59:59 Max Points: 200 Details: This is a Collaborative Learning Community (CLC) assignment. It is important to promote the professional role of the nurse to provide health promotion and disease preventive care. Collaborating with other health care professionals and consumer groups in the community in redesigning health care can help meet the goals for Healthy People 2020. Refer to http://www.healthypeople.gov/ to open the Healthy People 2020 home page. Select the″Topics & Objectives″ tab to access the 2020 Topics & Objectives – Objectives A-Z page. Select one of the Healthy People ″Topic Areas″ for improving health. Submit the proposed area to the instructor for approval. No group may work on the same focus area as another group. Develop a PowerPoint presentation (15-20 slides) with accompanying speaker′s notes and citations. For help designing PowerPoint slides, refer to the ″Create Your First Presentation″ PowerPoint tutorial, located on the Microsoft website: https://support.office.com/en-us/article/Create-your-first-presentation-ac88d138-a7a0-402c-b5a5-812641e59c8e?ui＝en-US&rs＝en-US&ad＝US In the presentation, address the following: State the objective of the presentation. State the Healthy People 2020 focus area your group has selected and the rationale for selection of the specific focus area. Explain how the focus area relates to the individual, the family, and the community, as well as to all age groups throughout the life span. Identify ways to enhance or optimize health in the selected focus area using evidence-based research. A minimum of three peer-reviewed articles must be utilized. Address the health disparity among different segments of the population for the selected focus area. Provide a brief desсrіption of at least two community resources and at least two website resources for professionals and clients. Provide a brief profile of at least one health-related organization for the selected focus area. APA format is required for essays only. Solid academic writing is always expected. For all assignment delivery options, documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. 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 not required to submit this assignment to Turnitin.