Case Study: Mrs. J.

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. 

Please complete ALL THREE of the Professional Development exercises.

• Conduct a literature search to locate a nursing intervention delivered via telehealth. Summarize the findings of the literature review in the form of a table. This table should include the article title, database used, summarize the key points of article, summarize findings, Is this applicable to patient population
• Imagine that you are a public health informatics specialist and you and your colleagues have determined that the threat of a new strain of influenza indicates a need for a mass inoculation program. What public health data would have been used to determine the need for such a program and what data will be collected to determine the success of such a program?
• What are the ethical considerations related to interoperability and a shared electronic health record?

Please submit the literature review table and one APA formatted analysis for bullets 2 and 3 between 500-1000 words, not including the title and reference page. The assignment should have a minimum of two scholarly sources, in addition to the textbook.

Assignment Description

Signature Assignment Title: The Holistic Patient Assessment

Part 1: Choose an adult (over the age of 18) friend or relative and perform a holistic health assessment. Clearly document your holistic health assessment data

Your assessment should include the following parts:

• Health History
• Physiological Assessment
• Psychological Assessment
• Social Assessment
• Cultural Assessment
• Developmental Assessment
• Spiritual Assessment

Part 2: Interpret the findings in your holistic health assessment data according to pathophysiologic disease states.  

• Choose one physiologic abnormality and discuss possible pathophysiologic reasons for the abnormality.  
• Look at the abnormality on a holistic basis.  
• How does this abnormality impact the other areas of the patient’s life, especially those areas discussed in this course?
• Discuss the client’s stress and coping mechanisms.  
• Are they healthy?  
• What improvements could be made?

Part 3: Create a teaching plan that addresses the client holistically by applying the assessment data you have analyzed.  

• Describe at least one client goal for each of the categories (physical, psychological, social, cultural, developmental, and spiritual).
• How will you teach the client about the goal?  
• How will you evaluate your teaching?  

Part 4: Prepare a PowerPoint presentation for your patient teaching.  

• You should have at least six slides (one for each type of goal – physical, psychological, social, cultural, developmental, and spiritual), in addition to the title slide, objective slide, and references slide.  
• Please be sure to have at least one scholarly source in the PPT.

Assignment Expectations:

• Length: Essay of 1200 words; PP of 6-12 content slides (and include a title, objective, and reference slides – these do not count towards the required content slides)
• Structure: PP as noted above. Essay: Include a title page and reference page in APA format. These do not count towards the minimum word count for the essay part of the assignment. Your essay must include an introduction and a conclusion. 
• References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of three scholarly sources plus the textbook are required.

Scenario

In your weekly one-on-one meeting your boss congratulates you on the comprehensive and well-researched work you have done to date. The CEO has been working with the rest of the organization’s leadership team to adopt the overarching strategies for the organization that your boss recommended. However, your boss and CEO are seeking clarification on how to translate these strategies into meaningful benchmarks, or performance measures. They want to know how the organization will measure progress in following these strategies. In previous discussions with your boss, you have been describing the SMART methodology for writing objectives that support the overarching strategies. She has asked you to share the SMART objectives you have written for each strategy with the CEO in a brief presentation.

You are ready to begin creating your presentation and the slides that you will use to support your key points and conclusions. Your boss reminds you that the CEO expects a brief, substantive, and concise presentation. You will be lucky to get 15 minutes of the CEO’s time. Consequently, she suggests that you include no more than 10–12 slides, or you will run out of time and cautions you about not creating a “death by PowerPoint” experience for the CEO. You already know from experience that your organization expects professional presentations that adhere to the organization’s branding standards.

Instructions

Create an executive-level presentation, with voiceover, of the SMART objectives that correspond to the organization’s main strategies, associated performance indicators and metrics, and strategic plan recommendations.

Practice your presentation until you are satisfied with it, staying as close as possible to the limited time allotted. Remember that the audience is your organization’s CEO. All the work you have done so far in this course has prepared you for this briefing, but you are ready.

Presentation Requirements

The requirements, outlined below, correspond to the grading criteria in the Strategic Plan Objectives and Balanced Scorecard Scoring Guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.

• Present your operational recommendations and strategic control mechanisms.
  • Include goals, objectives, resources, and action steps for reconfiguring and aligning the organization’s structure, systems, shared values, management style, staff, and skills.
• Define critical success indicators that enable an organization to measure success in implementing the strategy.
• Propose a strategic plan to optimize outcomes and mitigate risks in the organization.
• Analyze potential long-term opportunities and operational components in the strategic planning process.
• Analyze the effect of strategy formulation on human, financial, and technical resources.
  • Weigh factors of measurement against current organizational benchmarks.
• Create a visually pleasing, professional presentation tailored to a specific audience.
  • Use charts and/or images that support the content.
• Communicate critical content clearly and persuasively in a limited time.

Presentation Format and Length

Your presentation should consist of 10–12 slides and be 10–15 minutes in length. Use the notes portion of each slide to write your script (the notes section is required).

You may use the structure below as a guide for organizing and timing your presentation. You do not need to place your slides in this specific order.

• Slide 1: Title slide (15 seconds).
• Slide 2: Revised/updated directional strategies (vision, mission, and values) from the Unit 7 assignment. (30 seconds).
• Slide 3: Gap analysis: desired versus actual position (1 minute).
• Slide 4: Recommend Overarching Strategy One with three objectives (2 minutes).
• Slide 5: Recommend Overarching Strategy Two with three objectives (2 minutes).
• Slide 6: Recommend Overarching Strategy Three with three objectives (2 minutes).
• Slide 7: Recommend Overarching Strategy Four with three objectives (2 minutes).
• Slide 8: Visual: Balanced scorecard table with 1–3 performance indicators and associated metrics (1 minute).
• Slide 9: Analysis (1 minute).
• Slide 10: Recommendation of new strategic plan strategies based on the balanced scorecard (1 minute).
• Slide 11: Overall recommendations/conclusions (1 minute).
• Slide 12: References.

Include all relevant supporting details, such as data, charts, and graphs, as an addendum to the presentation. Indicate the slide associated with the relevant data set. In addition, include all relevant data and narrative in the notes section of each slide.

Supporting Evidence

Cite a minimum of six references to current scholarly and authoritative sources to support your presentation. Format your citations and references according to APA style and formatting guidelines.

Submission Requirements

Proofread your slides and addendum, before you submit them, to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your presentation.

Portfolio Prompt: You may choose to save your presentation to your ePortfolio.

Resources

• Strategic Plan Objectives and Balanced Scorecard Scoring Guide.
• ePortfolio.
• Using Kaltura [PDF].