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. 

ASSIGNMENT IS DUE TOMORROW AT 12 PM

This assessment requires you to visit the The Research Clinic: 

https://ori.hhs.gov/TheResearchClinicVideo/

You will click to play Jan Klein, RN. Work your way through the brief videos, choosing the best response as the RN assisting in research. 

Upon completing the videos, you will submit a Word file that summarizes the essential elements of informed consent, special populations that require special legal and ethical research considerations, and the nurse’s role in advocating for the patient in research situations. 

Your summary should be between 200-300 words. Provide a minimum of 2 references, in APA format, supporting your summary.

Description of the Assignment

The assignment provides an opportunity for the student to:

• Develop and leadership profile based on leadership style and personality profile
• Apply their leadership profile to advanced communication situations
• Develop strategies that will improve and/enhance advanced communication skills
• Engage in reflective practice through writing

IV. Preparing the Assignment

Preparing the Assignment

1. Address all components of the Advanced Communication in Systems Leadership paper as outlined under “Assignment Directions and Criteria”.
2. The paper is graded on quality and completeness of information, depth of thought, organization following outline provided, substantive narrative, use of citations, use of standard English, and writing conventions.
3. Format:
   1. American Psychological Association. (2010). Publication manual of the American Psychological Association (current ed.). Washington, DC: Author. Is the source used for this paper
      1. Required elements
         1. Title page, reference page
         2. Use Microsoft Word
         3. Page numbers, running head, doubles-spaced, times new roman, 12pt font, 1″ margins, level 1 headings
         4. Paper length: 6 maximum, excluding reference page, title page, and assessment tool
   2. Scholarly sources
      1. Minimum of four (4) scholarly resources no older than 5 years
   3. Proof-reading
      1. Use spell check and grammar check and correct all errors
      2. Compare final draft to detailed outline directions to ensure all required elements included
      3. Submitting the paper
         1. Submit to Week 2 Assignment portal by Sunday, 11:59 p.m. MT
         2. Must achieve TII score < 24% to be graded

Final submission only will be graded

DIRECTIONS AND ASSIGNMENT CRITERIA

This paper is a reflective practice experience that requires you to describe selected communication experiences, analyze them through the lens of your newly developed leadership profile, and describe implications for future experiences. You will need to draw on knowledge of advanced communication skills as well as past experiences and knowledge in certain communication situations. Scholarly inquiry into the specified communication types will be needed from at least one (1) peer reviewed journal per situation. Use the detailed outline found in the Assignment Guidelines with Scoring Rubric document above to organize your paper. The headings included in that document should be used for your paper and represent what is included in a completed paper. 

To create your Empathy map, simply draw four quadrants on a piece of paper. Each quadrant represents a different aspect of yourself, the quadrants are as follows;

Seeing; The See quadrant explores what you see from the situation and how that impacts what you then do.

Doing; The Does quadrant explores the actions the Individual takes

Thinking; The Thinks quadrant captures what the Individual is thinking throughout the experience

Feeling. The Feels quadrant is the Individuals emotional state

Next, consider the following case study of Rosie and her family, explore the emotion in you. In each quadrant, write down the relevant aspects of each perspective. Your word count for this assessment is 500 words. Whilst APA referencing is not required for the purpose of this assessment as this work is based on your own personal knowledge you are required to submit a Bibliography which is not included in your word count. 

Case Study

Rosie is a 28-year-old single mother to Sam, her 6-year-old son. Sam was diagnosed with Neuroblastoma which is a form of cancer that is made up of cells that are found in nerve tissues of the body at the age of 4 and has been receiving a variety of known treatment options throughout this time inclusive of Chemotherapy which Sam is currently undergoing. Rosie has no current contact with any of her family members due to her traumatic childhood.

This has been a long journey for their family and Rosie has consistently struggled with watching Sam decline health wise throughout treatment and constantly analyses Sam’s quality of life. Sam cannot play sport of any kind, at times due to his level of unwellness he cannot hold a book at bedtime, he has not commenced school due to his treatment therefore has minimal friends to support him throughout this time period. Sam became extremely unwell during his last round of treatment which again provoked Rosie to assess how this medical intervention was helping her son.

Following Sam’s last round of treatment, scans took place which concluded the Neuroblastoma had again spread throughout Sam’s body however Doctors were confident that Sam would be eligible for a new drug trial. Following Rosie’s assessment of Sam who is undernourished and unwell from the impact of chemotherapy she has declined any further treatment for Sam and has requested support to prepare for Sam’s death with the inclusion of the Palliative care team.