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

  

1. Choose a nurse leader who holds a leadership nursing position in their organization who have direct reports (they supervise other employees). Examples of this include Director of Nursing, Director, Unit Manager. *You may not be employed in the same facility as your interviewee or shadow during personal work hours* (If special accommodations need to be made, approval by your instructor is required first). 

2. Develop an interview guide before conducting the interview. Identify information that you want to know before the interview and plan clarifying questions. You must include at least one question about technology/informatics.

3. Conduct an interview regarding their professional role in the organization, and a current health care issue that is of interest to you (ethics, conflict management, budget, staffing, culture of safety, “just culture”, career advancement, quality improvement, etc.). Identify the name of the organization and use names of all involved (no anonymity).

4. Prepare a written report of the interview.

Sample questions below. Feel free to vary the content of the questions to fit your interview:

• Please describe the nursing and inter-professional      teams that operate in this facility/on this unit.
• Can you provide an example of a nursing practice that      has been changed in the last year based on current best evidence?
• What do you consider your biggest challenge?
• What do you love most about your job?
• Why did you choose this job?
• What other kinds of nursing/other job did you ever do?
• How would you describe your company’s culture?
• How would you describe your role in admission and      staffing decisions?
• What is your leadership style?  

* If you are employed in a large healthcare facility that has more than one location, you may interview the nurse leader in that organization with prior permission from your instructor. The purpose of this is to get you out of your organization and explore other nursing leadership roles than you might be familiar with.

Assignment Expectations:

Length: 1500 to 1750 words in length; Upload log Separately 

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. Your essay should have at least two scholarly references in addition to the textbook. Please be sure to cite the interview in APA format.

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.

Instructions:

1. Read the Case Study 11-2: Go to the Hospital and Come Back with Four More Medications in Chapter 11 of the textbook. ISBN:9781284104479
2. Once you have read the Case Study thoroughly, answer the following questions:
   1. What does the administration of antibiotics have to do with a Clostridium difficile (C. diff infection) infection?
   2. List all the inappropriate medications prescribed for K.L. and describe the reason why they are inappropriate.
   3. What kind of treatment regimen is utilized for a patient with a C. diff infection?
   4. Do any of these treatments regimens raise suspicion as being inappropriate for K.L.?
   5. List the therapy and if contraindicated, give a reason why it is inappropriate.  
3. Your paper should be:
   • One (1) page or more.
   • Use factual information from the textbook and/or appropriate articles and websites.
   • Cite your sources – type references according to the APA Style Guide.

Overview: This journal assignment will provide you the opportunity to review the case study that corresponds with your final project. You will begin to identify key components of the case study. Journal assignments in this course are private between student and instructor.

Prompt: In this journal assignment, you will have the opportunity to reflect on the key components from the case study document found in the module readings. You will begin to consider the elements of the current system in relation to the facilitation of interoperability and security risks. After reading the case study and the article Privacy and Security Challenges in 

· What are the strengths of the current organization in regard to the implementation of a health information exchange?

· In this case, what are the risks and weaknesses of the implementation of a health information exchange system?

· What security considerations need to be made to ensure patient information is secure? What information should not be exchanged?

· Make recommendations on how patient information can be kept secure in a health information system.

Rubric:

Guidelines for Submission: Submit journal assignment as a Word document.

Attention Wizard_ Kim. 

    This is from my chair: GM, Patricia, Please see your document attached. You need to proof-read your work before you send it to me. I still see you talking about Job Satisfaction and Employee Performance. 

    Remember you are studying Leadership Style and quality measures. Please review the examples below the form and also correct the remaining form in a fresh form below. Please correct and send back immediately. 

Dr. B.

See the attached,