Every family has to come to a decision regarding end of life at some point.  In the case of the COVID pandemic, families are making this painful decision at a moment when they are not even able to visit with the patient.

In my ER, a patient came in from a memory care facility where multiple residents tested positive for COVID, including my patient.  When he arrived his sats were at 68% and we was on a non-rebreather.  We switched him over to a high flow oxygen and his O2 went up to 95%.  He had Alzheimer’s and communication was difficult.  There was no DNR in place for him and I contacted his daughter, who is his proxy, to let her know his current situation.  The admitting doctor spoke to her and they decided to put in DNR in place.  I Facetimed with her so she could say goodbye to her father.  It was the most heartbreaking thing I have ever done.  When we brought him up to the ICU he was stitched over to a nasal cannula at 2 liters and passed away shortly afterwards.  The family was unable to visit with him before he passed because he was COVID positive.

There was discussion about hospitals considering DNR for COVID patients so that staff is not put at risk because of PPE shortages (Masson, 2020).   Hospitals such as Northwestern Memorial Hospital in Chicago, are considering placing orders regardless of family and patient wishes (Masson, 2020).  This is an uncertain time, where we really don’t know where the disease process will go.  In another study it was found approximately 77% of participants believed the decision about DNR should a team decision which consists of the physician, nurse, patient, and the families (Tajari et al., 2018).  Many of these decisions are made when the patient is critical. 

In finding the CPR decision aid for patients and their families on the Ottawa Hospital Research Institute site, this is a useful tool in aiding with this painful decision.  The tool went into detail about what occurs during CPR and lets families know what the outcomes would be and the small chance of a normal life.  There is an honest paragraph about the side effects of CPR such as broken bones, punctured lungs, and impaired mental function (OHRI, 2019).  When discussing this with families and the patient it is important to have an honest discussion so an informed decision can be made.  I will use this aid for work because it’s important to have open communication about the reality of life.

Tajari, M., Jalali, R., Vafaee, K.  Attitudes of patients’ relatives in the end stage of life about do not resuscitate order. Journal of Family Medicine and Primary Care.  Doi: 10.4103/jfmpc.jfmpc_144_18:10.4103.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259503/?report=printable

Masson, G.  (2020) Hospitals consider do-not-resuscitate order for all COVID-19 patients.  https://www.beckershospitalreview.com/public-health/we-re-going-to-be-coding-dead-people-hospitals-consider-do-not-resuscitate-order-for-all-covid-19-patients.html

The Ottawa Hospital Research Institute. (2019) Patient Decision Aids.  https://decisionaid.ohri.ca/

Reading Assignment from Smith and Parker Textbook

Chapter 25: The Community Nursing Practice Model

Chapter 26: Rozzano Locsin’s Technological Competency as Caring in Nursing

Discussion Initial post Due: 07/22/2020 By 11:59 PM

Respond to two peers by Saturday, July 25, 2020 at 11:59 PM

 1- How do you see the benefit of using both the Community Nursing Practice Model and Locsin’s Technological Competency as Caring in Nursing in today’s nursing environment?

 Please remember to adhere to APA 6th edition publication standards and please following the grading rubric. One post is your original submission and two responses to your peers are required.

Discussion Board Rubric

Proficient

Novice

Introduction and quality of discussion’s Argument 

1 point

It is consistent with application in research related to its context. Clarity of ideas.

0.50 point

The topic has a partially weak association to the clarity of ideas and related topics. 

The objectivity of Tone, overall quality & Review of

Literature in APA 6th format within the past 7 years

1 point

The tone is consistent, addressed professionally and objectively. 

Evidence in literature supports arguments.

0.50 point

The tone is not consistently objective. Partially poor evidence in the review of the literature.

Quality of Reply posts

1 point

Consistent clarity and supported by research evidence.

0.25 point

Partially lack clarity or lack of support with research evidence.

 Dr. Davis

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. 

below i have attached weeks 1 project. this weeks project has to correlate with weeks one project. 

Instructions

Describing the Aggregate

In a Microsoft Word document of 3-4 pages formatted in APA style, you will submit your final description of the aggregate and community in which the aggregate is located, based on feedback from your instructor on your Week 1 paper and your continued work.  Please note that the title and reference pages should not be included in the total page count of your paper.

Describe the Aggregate

Begin the assignment by describing your aggregate. Include the following information:

• Name of the aggregate
• Geographical location and size
• Population
• A brief history
• Basic vital statistics
• Crude birth rate, infant mortality rate, life expectancy, leading causes of death, and any other relevant statistical information related to the health of the aggregate from the windshield survey.
• Explain, giving at least two reasons, why you selected this particular aggregate for your Capstone project.

Windshield Survey

With the use of public transportation or by driving a vehicle around the community, you can assess the common characteristics of the community of your selected aggregate.

Key observations to make during your windshield survey include the following:

• Age and condition of the homes in the community
• Location and condition of parks and other recreational areas
• Amount of space between homes and businesses
• Neighborhood hangouts
• Transportation in the community
• Quality of streets and sidewalks
• Types/numbers of stores and other businesses
• People out in the community
• Race/ethnicity
• Cleanliness of the community
• Billboards or other media displays
• Places of worship
• Availability of services—doctor, dentist, social centers, recreation centers, hospital

On a separate references page, cite all sources using APA format.

• Use this APA Citation Helper as a convenient reference for properly citing resources.
• This handout will provide you the details of formatting your essay using APA style.
• You may create your essay in this APA-formatted template.
• Use relevant charts and graphs to support the information you collected. Identify the sources of your information and describe how you went about collecting the information.

Assignment:

Identifying A Clinical Question

Write a 1000-1500 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be three main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least five (5) sources using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.

Identify a clinical question related to your work environment (Nursing: Long Term Care & Short Term Rehab), write the question in PICOT format and perform a literature search on the identified topic.

Purpose

To enable the student to identify a clinical question related to a specified area of practice and use medical and nursing databases to find research articles that will provide evidence to validate nursing interventions regarding a specific area of nursing practice.

Review the Application Case Study for Chapter 3: Finding Relevant Evidence to Answer Clinical Questions as a guide for your literature search.

Guidelines

· Identify a clinical question related to your area of clinical practice and write the clinical foreground question in PICOT format utilizing the worksheet tool provided as a guide.

· Describe why this is a clinical problem or an opportunity for improving health outcomes in your area of clinical practice. Perform a literature search and select five research articles on your topic utilizing the databases highlighted in Chapter 3 of the textbook (Melnyk and Finout-Overholt, 2015).

· Identify the article that best supports nursing interventions for your topic. Explain why this article best supports your topic as you compare the article to the other four found in the literature search.

Assignment Expectations:

Length: 1000 – 1500 words

Structure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this 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 five (5) scholarly sources are required for this assignment to support the topic.

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.