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. 

In a Microsoft Word document of 4-5 pages formatted in APA style, you will develop a process for advocating about an issue as a nurse, from identifying a problem that needs to be solved through articulating a process for doing so.

This assignment consists of answering each of the questions listed below from the “Political Analysis and Strategies” chapter of your course textbook. Write each question as a new topic area; then follow with a paragraph or two to answer the question.

Let us assume that you are a school nurse in a high school. At a recent school athletic event, a spectator suffered a cardiac arrest in the stands. A coach of the home team went into the high school to fetch the automatic emergency defibrillator (AED) only to find out that it was not readily available. In the meantime, an emergency squad arrived and resuscitated the spectator. On Monday morning, you learn of the absence of the AED only to find out that it had been locked in the custodian’s closet. Reflect on the following questions outlined in the “Political Analysis and Strategies” chapter

• What is the issue?
• Is it my issue, and can I solve it?
• Is this the real issue or merely a symptom of a larger one?
• Does it need an immediate solution, or can it wait?
• Is it likely to go away by itself?
• Can I risk ignoring it?
• What are the possible solutions? Are there risks to these solutions?
• What steps would you need to take in order to solve the issue?
• Does anyone else at the school need to be involved in the solution?
• Where is the power leverage in the school to reach the preferred solution?
  • Reaching a solution requires the use of power vested in the nurse. Review Box 9-1 (Sources of Power) and determine which type(s) of power the school nurse has in this situation. State your reasons for your answer.

On a separate references page, cite all sources using APA format. Helpful APA guides and resources are available in the South University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the South University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style.

 1) Discuss the importance the role of culture and cultural characteristics of communities play in effectively planning, implementing, and evaluating health education and promotion programs. What must a health educator do first?  

150 words minimum****

 Please include in addition to your textbook one (1) outside source that supports your position. References should come from a credible source; such as scholarly journals, etc 

 

2) Watch the video on Germany’s healthcare system: https://www.youtube.com/watch?v=1d3QLPdHysc

How is it different from the US? What are some things that are better than the US? Worse than the US? How does Germany compare to other Western countries?

minimum 350 words******

need both discussions seperately

Discussion Question

Describe the difference between the Qualitative and Quantitative research; discuss what type of research reveals better outcomes and why?

·       Must address the topic.

·       Rationale must be provided.

·       May list examples from your own nursing practice.

·       150-word minimum/250-word maximum without the references.

·       Minimum of two references (the course textbook must be one of the references) in APA format, must have been published within last 3-5 years.

Please do not copy and paste this is going to be using turniting .

 

Agonist-Antagonist

The use of psychopharmacological agents is to help correct a suspected imbalance of chemicals within our brain, and to do this the medications either enhance, suppress, or help transport with the help of signals and receptors. To help achieve these processes, the medications produce either an agonist or antagonist to achieve the desired response. An agonist action locates target receptors and bind and alter the activity at the receptor to achieve the desired response from the receptor, using affinity and intrinsic efficacy properties (either full or partial) (Berg & Clark, 2018). An Antagonist action does not have any intrinsic efficacy but does have affinity and may not produce a response but will till bind to the target receptor and thus will reduce the available presence and response for target binding of an agonist (Berg & Clark, 2018). By increasing the occupancy at the receptor with additional agonist, it would cause a blocking effect of the antagonist (Berg & Clark, 2018). For referral of maximal response would be a full agonist (which does not always require maximum number of receptors to provide achieved response) and a partial agonist does just that, provide a partial response with the use of all required receptors, if the intrinsic efficacy is greater is another agonist, it will require less occupancy of receptors (Berg & Clark, 2018). Inverse agonist binds to target receptors and provide negative intrinsic efficacy which decreases the activity at that receptor and can vary from either partial (which are weak) or strong agonists (responses) (Berg & Clark, 2018). Competition can exist between different agonists at target receptor sites and can only hold one ligand at each receptor.

G Protein Couple and Ion Gated Channels

Neurotransmitter receptors have two responses, rapid and slow. The rapid response is facilitated with the use of ion gated channels and happens within milliseconds and is referred to as an ionotropic receptor (Berk, Lodish, & Zipursky, 2000). Ion gated channels are responsible for the electrical excitation of neurons by facilitating the conversion of ion flux from chemical signals to across the membrane that are responsible for memory and attention (Li, Liu, & Wong, 2014). Ion gated channel allow specific ions to pass through the membrane to bind a ligand (Li, Liu, & Wong, 2014). The slow post synaptic response is facilitated with the use of G protein couple receptors that indirectly monitor the opening and closing of ion channels which occur at slower rates over seconds to minutes and is considered a metabotropic receptor (Berk, Lodish, & Zipursky, 2000).  G coupled proteins are responsible for the psychological responses to hormones as well as neurotransmitters (Kobilka, Rassmussen, & Rosenbaum, 2014). Interactions between g protein coupled receptors and ion gated channels involve different dopamine receptors including D5-GABAa, D1-NMDA, and D2-AMPA (Li, Liu, & Wong, 2014). G protein coupled receptors bind ligand and activates the membrane protein that interacts with ion channel (Li, Liu, & Wong, 2014).

Epigenetics

Epigenetics refers to the change that can be made to alter gene expression activity without making any changes to the sequencing of DNA by outside factors, and has been found to be passed on to future generations (Weinhold, 2006). Epigenetics can be done with a few processes, one of them being methylation which will delete one of the two alleles present on a gene (Weinhold, 2006). Although it may seem that this could be helpful in ridding of certain conditions, it has been found that it can also predispose the affected population with other medical and mental health concerns (Weinhold, 2006). Changes to genes may be caused by different factors, including chemical and environmental. One study by Michael Skinner at the University of Washington exposed pregnant rats to high levels of methoxychlor (insecticide) and fungicide vinclozolin and found that in male pups born from the affected mothers, they showed that for the next four generations there was decreased sperm production and infertility due to the exposure of chemicals and changes to gene expression (Weinhold, 2006).

Medication Prescription Awareness

It is important for a prescriber to be aware of the short-term and long-term goals of medication prescribing to patients. One thing to consider is the effects within the body, and how that certain medication is going to be beneficial or possibly harmful in the present or future. Opioids are a good example of a medication that can have good effects, with increased tolerance, and possibly detrimental consequences. Many patients with pain management issues end up having to take an opioid for pain relief, however, tolerance to opioids can happen quickly, and this unfortunately will lead to addiction however that is not the primary concern. A primary concern with prescribing opioids and the increased tolerance quickly achieved, the resort would be to increase the pain medication to achieve pain relief. This however can lead to consequential effects such as respiratory depression, coma, and possibly even death (Christie & Morgan, 2011). Over prescribing, or adding an additional opioid or other type of medication such as a benzodiazepine could increase the risk for injury therefore the prescriber must ensure that medications being prescribed will not do harm versus good.

References:

Berg, K. A., & Clarke, W. P. (2018). Making sense of pharmacology: Inverse agonism and functional selectivity. International Journal of Neuropsychopharmacology, 21(10), 962-977. doi:10.1093/ijnp/pyy071

Berk, A., Lodish, H., & Zipursky, S. (2000). Molecular Cell Biology 4th edition. ., .: W H Freeman &.

Kobilka, B. K., Rasmussen, S. G., & Rosenbaum, D. M. (2009, May 21). The structure and function of g-protein-coupled receptors. Retrieved March 11, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967846/

Li, S., Liu, F., & Wong, A. H. (2014, May 9). Ligand-gated ion channel interacting proteins and their role in neuroprotection. Retrieved March 11, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023026/

Weinhold, B. (2006, March). Epigenetics: The science of change. Retrieved March 11, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1392256/