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. 

 

Week 7: NR700 Reflection on Learning

Re-submit Assignment

• Due Feb 21 by 11:59pm
• Points 100
• Submitting a text entry box or a website url

Purpose

The purpose of this activity is to deepen learning through reflective inquiry. This activity will allow for expansion in self-awareness, identification of knowledge gaps, and assessment of learning goals.

Course outcomes: This assessment enables the student to meet the following course outcomes:

1. Explore the DNP role and advanced practice issues within collaborative teams across diverse healthcare systems. (PO 1, 6, 8, 9)
2. Examine nursing ways of knowing and the development of nursing science. (PO 3, 5, 9)
3. Analyze the concepts and principles used in theory development in nursing. (PO 3, 5. 9)
4. Differentiate research, quality improvement, and evidence based practice as it relates to the role of the DNP. (PO 3, 5, 6)
5. Demonstrate evidence search techniques to support translation science (PO 3, 5)
6. Critically appraise level and quality of evidence (PO 3, 5)
7. Translate evidence at the microsystem, mesosystem, and macrosystem levels of healthcare systems (PO 2, 3, 4, 5, 6, 9)

Due date: Sunday 11:59 p.m. MT at the end of Week 7. The Late Assignment Policy applies to this assignment.

Total points possible: 100 points

Preparing the Assignment

Follow these guidelines when completing each component of this assignment. Contact your course faculty if you have questions. It is each student’s responsibility to save and maintain all artifacts required in the e-Portfolio (Links to an external site.).

1. Write a brief 1-2 paragraph weekly reflection addressing the questions posed in the Reflect section of each weekly module. Edit your ePorfolio Reflection to include each weekly reflection.
2. Include the following sections in your ePorfolio Reflection.Week 1
   • What were the most important concepts you learned in week 1?
   • Why are these concepts important?
   • How will they prepare you for your future role as a DNP-prepared nurse?
   • In what ways do you feel prepared for your new role? In what ways do you feel unprepared?
   • Week 2
   • Provide one specific example of how you achieved the weekly objectives.
   • What do you value most about your learning this week?
   • What else do you need to explore to further grow as a DNP practice scholar?
   • Week 3
   • Provide one specific example of how you achieved the weekly objectives.
   • What personal values, if any, were challenged this week?
   • What values can you reaffirm or want to reconsider after this learning?
   • Week 4
   • Provide one specific example of how you achieved the weekly objectives.
   • What concepts, theories, models, tools, techniques, and resources in this week did you find most valuable?
   • What issues had you not considered before?
   • Week 5
   • Provide one specific example of how you achieved the weekly objectives.
   • How might you use this information in your future role as a DNP practice scholar?
   • What topics, if any, had you not considered before?
   • Week 6
   • Provide one specific example of how you achieved the weekly objectives.
   • What knowledge do you still need to demonstrate competency in the weekly concepts?
   • What skills do you need to continue developing to apply these concepts?
   • Week 7
   • Provide one specific example of how you achieved the weekly objectives.
   • What are the core values and best practices that define the roles of the DNP practice scholar?
   • How will this knowledge improve your effectiveness as a DNP practice scholar?
   • What skills do you need to implement these best practices and how will you develop them?
   • Writing Organization and Mechanics
   • Grammar and mechanics are free of errors.

  

Reflective Questions 

       

Mrs. Wong, a first-time mother, is admitted to the birthing   suite in early labor after spontaneous rupture of membranes at home. She is   at 38 weeks of gestation with a history of abnormal alpha-fetoprotein levels at 16 weeks of pregnancy.

She   was scheduled for ultrasonography to visualize the fetus to rule out an open   spinal defect or Down syndrome, but never followed through. Mrs. Wong and her   husband disagreed about what to do (keep or terminate the pregnancy) if the   ultrasonography indicated a spinal problem, so they felt they did not want this information.

     

As the nurse, what priority data   would you collect from this couple to help define relevant  interventions to meet their   needs? 

  How can you help this couple if   they experience a negative outcome in the birthing suite? What are your   personal views on terminating or continuing a pregnancy with a risk of a   potential anomaly? What factors may   influence your views? 

 With the influence of the recent   Human Genome Project and the possibility of predicting open spinal defects earlier in   pregnancy, how will maternity care change in the future?

 

1) Minimum 3 full pages (Follow the 3 x 3 rule: minimum three paragraphs per part)

             Part 1: Minimum 2 pages

             Part 2: minimum 1 page

            

Submit 1 document per part

2)¨******APA norms

          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

Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references per part not older than 5 years

5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next

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.do

__________________________________________________________________________________

Part 1:  Life Span

Topic: Common Respiratory Complaints

A 75-year-old man with a history of hypertension, diabetes, environmental allergies, and colon polyps presents to the office with a complaint of persistent dry hacking cough that does not improve with over-the-counter treatment with antitussives and allergy medications. The man reports that he has had the cough for three months and is tired of the coughing spells he experiences. His medical history reveals that he started taking lisinopril six months before this appointment, has taken an over-the-counter allergy medication for several years, had his last colon polyps removed six years ago, and his blood pressure today is 145/70. Other medications include metformin XR 500 mg daily, aspirin 81 mg once daily, and loratadine 10 mg daily. The physical exam is negative for any issues other than his mild neuropathy from long-term diabetes. The cough is noted to be dry and hacking as the patient has described. The man is not in acute distress.

Case Questions:

1.Using OLDCARTS, what questions would have been asked as part of the medical history?

2. What physical aspects would have been completed as part of the physical exam and why? Include the diagnostics that you would order and rationale.

3. Based on the medical history and physical exam, what is the most likely cause of his cough?

4. What other possible diagnoses should be considered and why?

5. Are there any other tests that should be completed before producing a diagnosis? Why or why not?

6. What is the treatment for this patient, including education?

Part 2:  Women Health

 Explore federal agencies that are concerned with women’s health. 

1. Which ones may be of benefit to vulnerable populations? 

2. Explore and describe nonprofit agencies that are concerned with women’s health. 

3. Share resources aimed at benefitting women in your state or area (Florida).

  

Case Studies, Chapter 21, Nursing Management of Labor and Birth at Risk

1. Laura is a 26-year-old G2P1 who had a cesarean delivery for fetal distress with her first pregnancy. Laura is now struggling with deciding between a repeat cesarean delivery or attempting a VBAC. (Learning Objective 9)

a. In order to ensure that Laura has the facts to assist her in her decision, explain the risks of a repeat cesarean deliver

b. Laura can’t understand why more women don’t want to try a VBAC delivery. Discuss the possible reasons for this.

c. Describe the management of care for a woman attempting a VBAC delivery.

Antepartum Case Studies 

As you provide answers to the questions in the following case studies below please refer to your Essentials of Maternity, Newborn, and Women’s Health Nursing textbook’s Chapter 19 and 20 to provide you with pertinent information in reference to these cases.

Each of the objectives listed in the following case studies are in reference to those found in the textbook chapters listed alongside the case studies heading.

Please use this document as your template and insert your responses after each question in a different color or font. 

Case Studies, Chapter 19, Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications

1. Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared. (Learning Objectives 1, 2, 4, and 5)

a. Why is Teresa’s pregnancy considered a high-risk pregnancy?

b. Discuss potential pregnancy-related complications for Teresa.

c. Discuss the potential risks to the babies.

2. Sarah is 19-year-old G1P0 at 36 weeks’ gestation. Sarah has been followed weekly in the clinic for mild–moderate preeclampsia. At her clinic appointment today, Sarah’s blood pressure reading was 188/104. She is admitted to the antepartum unit for management of her worsening preeclampsia. You perform her admission assessment and note that her reflexes are brisk, her heart rate is 94, she complains of having an intense headache, and is seeing spots before her eyes. You perform an abdominal assessment and note that she has significant epigastric tenderness. (Learning Objective 4)

1. Develop a plan of care for the woman      experiencing preeclampsia and/or eclampsia

Case Studies, Chapter 20, Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations

1. Nikki is a 17-year-old G1P0 at 33 weeks’ gestation. Nikki comes to the clinic today for her prenatal visit and you notice that her hair and clothing have the distinct odor of marijuana and tobacco smoke. You directly ask Nikki if she has been taking any other drugs besides marijuana. Nikki is surprised by the question and denies it. When you explain that you can smell it in her hair and on her clothing, she starts to cry and says, “Please don’t take my baby away from me.” After reassurance, Nikki further admits to sporadic binge alcohol consumption and smoking “pot” and cigarettes. She relates that she also consumes four to five caffeinated beverages per day. (Learning Objectives 10 and 12)

1. Describe      how cigarette smoking, marijuana use, binge alcohol consumption, and      excessive caffeine intake can affect Nikki’s pregnancy.
2. What      possible affects are there to Nikki’s baby from the maternal ingestion of      these substances?
3. Describe      the nursing care you would provide for Nikki.