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 Technical Support articles for assistance. 

 Challenges of the interview of the ARNP

Listed below are the three most challenging interview questions,  please provide a clear and concise answer as to how you as the APRN will answer each interview question.

What is your biggest Weakness?

Describe how you resolved conflict with a co-worker or patient?

Tell me about yourself?

Include current scholarly articles as reference.

 Three topics I found interesting in Chapter 12 were religion, sacred, and profane. Overview: This purpose of the week 10 discussion board is to examine the education system and religion. Answer prompt 1. Then select and answer one prompt from prompts 2-3. Refer to Chapter 12 to answer the prompts.

Instructions: Respond to prompts in paragraph form (200-400 words) 

Prompt 1: Describe 3 topics from Chapter 12 that you found interesting.

Prompt 2: Apply functionalism, conflict theory and symbolic interactionism to the education system.

Prompt 3: Apply functionalism, conflict theory and symbolic interactionism to religion.

 
1 postsRe: Topic 3 DQ 2

A theory, as classically understood, is made up of interrelated concepts. Together these concepts aim to explain why actions or events take place. Nursing theories, also composed of concepts, models, and propositions, seek to explain and guide our thinking and understanding about nursing. In nursing, the four most common and influential concepts are the person, the environment, health, and nursing (2020). Nurses will often choose theories that best align with their way of thinking and their values, ultimately leading to meaningful nursing practice (Smith et al., 2020)

On the other hand, the nursing conceptual model looks at how various concepts relate to each other. Using theories allows us to see alternative effects when variables are changed (2020). As it applies to nursing, the conceptual model can help with research to find solutions to problems in the practice that will lead to improved patient outcomes.

The first know theorist was Florence Nightingale. She formulated the Environmental Theory. As defined in the nursing practice, this theory uses a patient’s environment to aid in healing. Nurses need to arrange factors such as cleanliness, noise, ventilation, light, and nutrition to help re-establish a patient’s health (Gonzalo, 2021). From my experience, nursing units nationwide are designed with the Environmental Theory in mind. For example, to reduce noise levels, my unit installed carpets and designated quiet times. The nursing staff makes sure every patient has a supply of fresh water and appropriate meals. We ensure rooms are clean and free of clutter. Sadly, we see patients being admitted to hospitals because such factors are not in place in their current care settings. Currently, the Corona Virus is a prime example of the application of the Environmental Theory to nursing. With the knowledge that the virus was easily transmissible, it was crucial for staff to maintain patient rooms clean. With this outcome in mind, practices changed, and the staff meticulously cleaned all equipment in between patients, properly donned and doffed personal protective equipment in between patients.

References

Gonzalo, A. (2021, March 5). Florence Nightingale’s Biography and Environmental Theory: Study Guide. Nurseslabs. https://nurseslabs.com/florence-nightingales-environmental-theory/#environmental_theory.

Nursing theories. (2020, November 29). Retrieved March 09, 2021, from https://currentnursing.com/nursing_theory/

Please just respond to this discussion above using 200-250 words with at least two references. 

Listed below are the three most challenging interview questions you may experience during the interview process. To fully prepare for the future interview, please provide a clear and concise answer as to how you as the APRN will answer each interview question. 

What is your biggest Weakness?

Describe how you resolved conflict with a co-worker or patient?

Tell me about yourself?

Develop this topic and include current scholarly articles as reference.

-About my self I am a hard worker, I like teamwork……