Review the following case study and complete the questions that follow. Submit your completed paper to Blackboard using the assignment link.

As a public health nurse at a free clinic, you are assessing and interviewing a 21-year-old woman who has come to the clinic because she doesn’t have any energy and hasn’t felt good in weeks. During the interview, you learn that she averages one meal per day, smokes up to two packs of cigarettes per day, and rummages through trash to find items she can sell to purchase food, snacks, and cigarettes. She admits to using street drugs every once in a while when she can find someone who will share with her. She admits her life is a mess and she doesn’t know how to make it better.

• What data can you gather based on available client information?
• What questions should you ask yourself while interviewing this client?
• During planning, how can you, as the nurse, best assist this client?
• What are the potential strategies that would assist the client to a “better” life?

Your paper should be 2 pages in length, in APA format, typed in Times New Roman with 12-point font, and double-spaced with 1” margins. If outside sources are used, they must be cited appropriately.

 

In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

1. Background
2. Clinical problem statement.
3. Purpose of the change proposal in relation to providing patient care in the changing health care system.
4. PICOT question.
5. Literature search strategy employed.
6. Evaluation of the literature.
7. Applicable change or nursing theory utilized.
8. Proposed implementation plan with outcome measures.
9. Discussion of how evidence-based practice was used in creating the intervention plan.
10. Plan for evaluating the proposed nursing intervention.
11. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
12. Appendix section, if tables, graphs, surveys, educational materials, etc. are created.

Review the feedback from your instructor on the Topic 3 assignment, PICOT Question Paper, and Topic 6 assignment, Literature Review. Use this feedback to make appropriate revisions to these before submitting.

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.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

RN to BSN

1.1:     Exemplify professionalism in diverse health care settings.

2.2:     Comprehend nursing concepts and health theories.

3.2:     Implement patient care decisions based on evidence-based practice.

 

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 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. 

 

1) Minimum 10 full pages  

               Part 1: minimum 1 page

               Part 2: minimum 3 pages 

               Part 3: minimum 3 pages

               Part 4: minimum 3 pages

 

               Submit 1 document per part

2)¨******APA norms (Mandatory) 

            All paragraphs must be narrative and cited in the text- each paragraphs

            Bulleted responses are not accepted

            Dont write in the first person 

            Dont copy and pase the questions.

            Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

3) It will be verified by Turnitin and SafeAssign

4) Minimum 15 references not older than 5 years

           Minimum 2 references in part 1

           Minimum 5 references in part 2

           Minimum 4 references in part 3

           Minimum 4 references in part 4

5) ***************Identify your answer with the numbers, according to the question.

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

 

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc 

______________________________________________________________

Part 1:

 

1Discuss how functional patterns help a nurse understand the current and past state of health for a patient. 

2)Using a condition or disease associated with an elimination complexity, provide an example.

Part 2

Purpose: you will distinguish between Medicare and Medicaid. Your paper must include the following topics:

1) Provide a brief history of both Medicare and Medicaid.

2) Define the populations that they are intended to serve.

3) Determine whether your state has expanded Medicaid.

4) Articulate the reasons that states choose not to participate in Medicaid expansion.

5) Analyze your role in your specialized area of nursing practice when interfacing with Medicare and/or Medicaid recipients.

Part 3

Case Study: Malpractice Action Brought by Yolanda Pinellas

Yolanda Pinellas is a 21-year-old female student studying to be a music conductor. She was admitted for chemotherapy. The medication Mitomycin was administered by intravenous infusion through an infusion pump.

During the evening shift the infusion pump began to beep. The RN found that the IV was dislodged and discontinued the infusion, notified the physician and provided care to the infusion site. The patient testified that a nurse came in and pressed some buttons and the pump stopped beeping. She was groggy and not sure who the nurse was or what was done. The documentation in the medical record indicates that there was an infiltration to the IV.

Two weeks after the event, the patient developed necrosis of the hand and required multiple surgical procedures, skin grafting, and reconstruction. She had permanent loss of function and deformity in her third, fourth, and fifth fingers. The patient is alleging that because of this, she is no longer able to perform as a musical conductor.

The risk manager had noted when doing chart reviews over the last 3 months prior to this incident that there were issues of short staffing and that many nurses were working double shifts, evenings, and nights then coming back and working the evening shift. The risk manager also noted a pattern of using float nurses to several units.

Questions:

 Using the information from the case study, discuss the following issues from the perspective of the APN Administrator role:

1) What were the standards of care that were violated? 

2) Who was responsible for the violations?

In your role:

3) What risk management steps needs to be taken before or after the incident to alleviate the issue?

Part 4

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 Mr. C., 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

Mr. C., a 32-year-old single male, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, even as a small child, gaining approximately 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control by restricting dietary sodium. Mr. C. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.

Objective Data:

Height: 68 inches; weight 134.5 kg

BP: 172/98, HR 88, RR 26

3+ pitting edema bilateral feet and ankles

Fasting blood glucose: 146 mg/dL

Total cholesterol: 250 mg/dL

Triglycerides: 312 mg/dL

HDL: 30 mg/dL

Serum creatinine 1.8 mg/dL

BUN 32 mg/dl

Critical Thinking Essay

1) Describe the clinical manifestations present in Mr. C.

2) Describe the potential health risks for obesity that are of concern for Mr. C. 

3) Discuss whether bariatric surgery is an appropriate intervention.

4) Assess each of Mr. C.’s functional health patterns using the information given. 

5) Discuss at least five actual or potential problems can you identify from the functional health patterns and provide the rationale for each. (Functional health patterns include health-perception, health-management, nutritional, metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)

6) Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.

7) Consider ESRD prevention and health promotion opportunities. Describe what type of patient education should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.

8) Explain the type of resources available for ESRD patients for nonacute care and the type of multidisciplinary approach that would be beneficial for these patients. Consider aspects such as devices, transportation, living conditions, return-to-employment issues.

An important role of nursing is to provide health promotion and disease prevention. Review the 2020 Topics and Objectives on the Healthy People website. Choose a topic of interest that you would like to address, in conjunction with a population at-risk for the associated topic. Submit the topic and associated group to your instructor for approval.

Create a 15-20-slide PowerPoint presentation for your topic and focus group. Include speaker notes and citations for each slide, and create a slide at the end for References.

Address the following:

1. Describe the approved topic and associated population your group has selected. Discuss how this topic adversely affects the population. How does health disparity affect this population?
2. Explain evidence-based approaches that can optimize health for this population. How do these approaches minimize health disparity among affected populations?
3. Outline a proposal for health education that can be used in a family-centered health promotion to address the issue for the target population. Ensure your proposal is based on evidence-based practice.
4. Present a general profile of at least one health-related organization for the selected focus topic. Present two resources, national or local, for the proposed education plan that can be utilized by the provider or the patient.
5. Identify interdisciplinary health professionals important to include in the health promotion. What is their role? Why is their involvement significant?

Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria and public health content.