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 Te

Assignment – Application of Concepts from Caring SciencePoints: 300 | Due Date: Week 4, Day 7 | CLO: 3, 4 | Grade Category: Assignments

Assignment Prompt

Summary: A theory can be used to guide practice.  This assignment is an exercise in supporting a clinical practice with theory and evidence.

Directions: Identify an outcome of nursing practice in your area of practice that can be improved.  For example, if you work in home health, you may identify that throw rug use by fall risk patients is too prevalent.  You may be able to use the problem that inspired the theory concepts that you developed in week two. Identify the concept in Watson’s Theory of Caring that could represent or include the outcome.  In our example, the outcome would be the changes in self through the change in the patient’s floor covering practice. Identify a practice that can be changed or implemented that may influence the outcome. Identify the concept in Watson’s Theory of Caring that includes the practice.  In our example, the practice could be to improve the understanding of fall hazards through the engagement in a teaching-learning experience, one of Watson’s Caritas Processes. Identify exactly how these two concepts will be measured with their operational definitions. Develop a proposition between the two. Present your outcome in an APA formatted paper  meeting the University’s standards for a written assignment.

Expectations

• Due: Monday, 11:59 pm PT
• Length: 5 to 7 pages including title and reference pages
• References: 3 to 10.  There should be enough to support the links between the concepts of the problem and the concepts of Watson’s Theory of Caring.

See USU NUR Research Paper Rubric for additional details and point weighting.

  

Case Study: Chronic Hypertension

Female was admitted to inpatient care with a diagnosis of chronic hypertension with severe features and started on Labetalol 200 mg po q 8 hours. She was monitored for 3 days and her BP stabilized at 130/78. Fetal testing was reassuring. She was discharged home on hospital day 3 on Labetalol and was to be seen twice weekly for BP checks, and was instructed to take her BP at home twice daily. Safety of medications was discussed in-depth with her. Signs/symptoms of PIH were reviewed with her. Two weeks later she had po nifedipine added. She subsequently delivered a healthy baby girl at 39 weeks gestation. She was discharged home on above medications (as she was breastfeeding) and continued meds for hypertension past her 6-week postpartum appointment. She was referred to her primary care provider for continuing care. 

Purpose of this case study is to address the significantly different standards of labs and vital signs for pregnant patients. 

· Based on the case study above, complete a comprehensive well-woman exam 

· What is your primary diagnosis? Explain. 

· What are two other differential diagnoses? Explain.

· What additional questions you would ask the patient? Explain your reasons for asking the additional questions

· Then, what types of symptoms you would ask for? Be specific and provide examples. (Note: When asking questions, consider sociocultural factors that might influence your question decisions.)

· Lastly, explain which treatment options and diagnostic tests you might recommend

 Please follow the instruction

Zero plagiarism

4 references

 

Although experiential therapy and narrative  therapy are both used in family therapy, these therapeutic approaches have many differences in theory and application. As you assess families and develop treatment plans, you must consider these differences and their potential impact on clients. For this Assignment, you compare Experiential and Narrative Family Therapy.

Learning Objectives

Students will:

• Compare experiential family therapy to narrative family therapy
• Justify recommendations for family therapy

To prepare:

• Review this week’s Learning Resources and reflect on the insights they provide on experiential and family therapies.

The Assignment

In a 2- to 3-page paper, address the following: 

• Summarize the key points of both experiential family therapy and narrative family therapy. 
• Compare experiential family therapy to narrative family therapy, noting the strengths and weakness of each.
• Provide a description of a family that you think experiential family therapy would be appropriate, explain why, and justify your response using the Learning Resources. 

Note: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided by the Walden Writing Center provides examples of those required elements (available at  http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

Part 2: Family Genogram

Develop a genogram for the client family you selected. The genogram should extend back at least three generations (parents, grandparents, and great grandparents).

Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.

It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions.

To Prepare:

• Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.
• Consider how key regulations may impact nursing practice.
• Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion..

By Day 3 of Week 5

Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.

By Day 6 of Week 5

Respond to at least two of your colleagues* on two different days and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region. Be specific and provide examples.

References

APA 7 format. 

Use complete sentences make sure to put the references DOI