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 a

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 850 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, and abstract is required.

Respond on two different days who selected a different scenario than you, in one or more of the following ways: Share insights on how the factor you selected impacts the disorder your colleague identi

Respond on two different days who selected a different scenario than you, in one or more of the following ways:

Share insights on how the factor you selected impacts the disorder your colleague identified.

Ask a probing question regarding the disorder that your colleague identified.

Suggest an alternative disorder for the scenario your colleague selected.

                                                                Main Post

Scenario 3:

Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-producing cough. She denies any rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Maria has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.

Acute Cough

     Coughs are the body’s way of clearing airways via forceful expiration.  Inflammation, inhaled particles, accumulated mucus, or foreign bodies stimulate a cough reflex by irritant receptor stimulation in the airway.  An acute cough is classified as lasting 2-3 weeks, and chronic cough is greater than three weeks in a non-smoker. Frequent cough causes are allergic rhinitis, upper respiratory infections, pneumonia, aspiration, pulmonary embolus, and congestive heart failure.  Due to the above-listed scenario, this cough would be diagnosed as acute cough due to timeframe, cough characteristics, and patient history (Huether & McCance, 2019).

Green Sputum

     Sputum contains immune cells and white blood cells from the lower respiratory tract that protect the airway from infections.  Sputum can be clear or colored.  Color sputum may be yellow, white, green, red or blood-tinged, or pink.  Neutrophils are white blood cells that can take on a green color.  This color sputum can be indicative of bacterial infections of the lower respiratory tract.  Pneumonia and cystic fibrosis can produce this color sputum.  To indeed rule out something benign, a sputum culture would need to be obtained and tested (Verywell Health, 2019).  At three weeks in, it would likely be premature to order cultures with limited symptoms. 

Treatment

     Due to the timeframe of cough and only accompanying symptom being green sputum, as a practitioner, I would prescribe an expectorant and schedule a follow up if symptoms persist or worsen.  Teaching should include that adverse effects of expectorants might be GI upset, headache, drowsiness, and dizziness.  Advise patient that expectorants are designed to be short-term (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Additional home treat to loosen secretions would be a humidifier, staying adequately hydrated and warm salt water gargles if sore throat should appear (Barkley, 2018).

Patient Factors- Behavior and Age

          Maria is an otherwise, healthy 36-year-old female.  Due to her age and symptom status, Maria would be treated conservatively.  Maria is a non-smoker and takes no prescribed medications.  Further investigation would be required if she was a smoker, currently on prescriptions medications, had current disease processes that may factor into the treatment plan.

References

Arcangelo,  V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.).  (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams  & Wilkins.

Barkley, T.  (2018).  Adult-gerontology primary care nurse practitioner.  West Hollywood, CA:  Barkley & Associates.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Verywell Health.  (2019). What causes the amount of sputum to increase?  Retrieved from https://www.verywellhealth.com/what-is-sputum-2249192

In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making. A critical component of any policy design is evaluation of the results. How comfortable are you

In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making. A critical component of any policy design is evaluation of the results. How comfortable are you with the thought of becoming involved with such matters?

Some nurses may be hesitant to get involved with policy evaluation. The preference may be to focus on the care and well-being of their patients; some nurses may feel ill-equipped to enter the realm of policy and political activities. However, as you have examined previously, who better to advocate for patients and effective programs and polices than nurses? Already patient advocates in interactions with doctors and leadership, why not with government and regulatory agencies?

In this Discussion, you will reflect on the role of professional nurses in policy evaluation.

To Prepare:

• In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making.
• Review the Resources and reflect on the role of professional nurses in policy evaluation.

Post an explanation of at least two opportunities that currently exist for RNs and APRNs to actively participate in policy review.Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities. Be specific and provide examples.

4 to 4 References

After reading QSEN Competencies – Definitions and Pre-Licensure KSAs and The Essentials of Baccalaureate Education for Professional Nursing Practice, write a 2-3 page paper describing the following: T

After reading QSEN Competencies – Definitions and Pre-Licensure KSAs and The Essentials of Baccalaureate Education for Professional Nursing Practice, write a 2-3 page paper describing the following:

1. The competencies you believe are your strengths and why.
2. The competencies you believe are those needing more development and why.
3. Based on this assessment, identify actions you can take now to respond to areas needing development. Module 1 Professional Practice Assessment Grading RubricScoring Rubric: Professional Practice AssessmentCriteriaPossible PointsStrong competencies -5Competencies needing development-5Action plan-5Competencies based on reading-3Accurate grammar and spelling, running head APA -2Late penalty (10% / day) – 2 pts Total -20

Part 1: Comprehensive Client Family Assessment Create a comprehensive client assessment for your selected client family that addresses (without violating HIPAA regulations) the following: Demographic

Part 1: Comprehensive Client Family Assessment

Create a comprehensive client assessment for your selected client family that addresses (without violating HIPAA regulations) the following:

• Demographic information
• Presenting problem
• History or present illness
• Past psychiatric history
• Medical history
• Substance use history
• Developmental history
• Family psychiatric history
• Psychosocial history
• History of abuse and/or trauma
• Review of systems
• Physical assessment
• Mental status exam
• Differential diagnosis
• Case formulation
• Treatment plan

Part 2: Family Genogram

Develop a genogram for the client family you selected. The genogram should extend back at least three generations (parents, grandparents, and great grandparents).Select a client family that you have observed or counseled at your practicum site.

• Review pages 137–142 of Wheeler (2014) and the Hernandez Family Genogram video in this week’s Learning Resources.
• Reflect on elements of writing a comprehensive client assessment and creating a genogram for the client you selected.

The Assignment

Part 1: Comprehensive Client Family Assessment

Create a comprehensive client assessment for your selected client family that addresses (without violating HIPAA regulations) the following:

• Demographic information
• Presenting problem
• History or present illness
• Past psychiatric history
• Medical history
• Substance use history
• Developmental history
• Family psychiatric history
• Psychosocial history
• History of abuse and/or trauma
• Review of systems
• Physical assessment
• Mental status exam
• Differential diagnosis
• Case formulation
• Treatment plan

Part 2: Family Genogram

Develop a genogram for the client family you selected. The genogram should extend back at least three generations (parents, grandparents, and great grandparents).