Mrs. J. history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

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

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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. Mrs. J. history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

Subjective Data

Is very anxious and asks whether she is going to die.
Denies pain but says she feels like she cannot get enough air.
Says her heart feels like it is \”running away.\”
Reports that she is exhausted and cannot eat or drink by herself.
Objective Data

Height 175 cm; Weight 95.5kg.
Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
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.
Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention

The following medications administered through drug therapy control her symptoms:

IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/ NC
Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.\’s situation. Include the following:

Describe the clinical manifestations present in Mrs. J.
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.
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.
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.
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.
Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale. Mrs. J. history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)
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. Mrs. J. history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

Please follow the rubric to answer everything required in the Lumbar Puncture Procedure Recommendation for Newborns paper.

• VERY IMPORTANT: Critique of each research study:

The critique of each of the research studies (total of 2 studies to be located using Cochrane, cinahl or pubmed please) should include: purpose of the study, study design, description of study sample, results of study, description of how results relevant to the recommended revision.

Assessment of an Advanced Practice Procedure

The purpose of this assignment is for the student to identify and review a procedure that NNPs (and/or neonatologists) perform in their NICU where they work as an RN and suggest improvements to the procedure based on the most current evidence for practice (i.e. research studies).

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Steps in the process:

1. Identify a procedure of interest Lumbar Puncture
2. Identify the existing policy for the procedure that is used by NNPs and neonatologists in the student’s NICU. My current policy does not use any type of pain medication like lidocaine when performing a Lumbar puncture on infant and only gives sucrose (sugar water with pacifier dips).
3. Explore the medical literature to identify ways that the procedure could be improved/updated (with the result of improved patient care/safety). Lumbar Puncture Procedure Recommendation for Newborns

I need literature that is no more than 5 years old the oldest it can be in 2015. The one specific recommendation I want to change in my policy is for lidocaine or analgesia for pain during the lumbar procedure

4. Make ONE SPECIFIC recommendation for policy change for the procedure with support from the current medical literature (two research studies published within the past 5 years that BOTH support the student’s recommendation). An example of a research study is a randomized controlled trial. Do not use None of the following are research studies: quality improvement reports, clinical guidelines/bundles, reports of evidence-based practice projects, meta-analyses. A major part of your grade for this assignment is your ability to identify current research, critique the research, and make an informed recommendation about the need for procedure revision. Because you are being evaluated, you may not ask your instructor to preview your research studies for appropriateness. If you are unclear on what constitutes a research study, refer back to your research text book from N5366. Lumbar Puncture Procedure Recommendation for Newborns

 

 

Lumbar Puncture Procedure Recommendation for Newborns Assignment Rubric

	Points possible	Points earned
Procedure ·         Brief description of procedure (a few sentences, not a list of the steps of the procedure) ·         Rationale for choosing procedure ·         Identify the providers’ current source for the selected procedure (unit-based policy or published guideline with reference) [NOTE: Do not include the actual procedure or steps in the procedure in this paper.]	20
Recommendation for Revision ·         Identify the (one) revision being recommended with rationale. ·         Critique of each research study: The critique of each of the research studies (total of 2 studies) should include: purpose of the study, study design, description of study sample, results of study, description of how results relevant to the recommended revision. Lumbar Puncture Procedure Recommendation for Newborns NOTE: BOTH studies must support the ONE revision being recommended.	50
Conclusion Summarize with a paragraph which includes the recommended revision with rationale and support from the two research studies critiqued in prior section.	20
Format  NOTE: This section is not percentage correct, but instead, reflects points deducted for each error. Title page from N5204 course used. Paper in 12 pt Times New Roman font throughout Use the headings in this rubric for the paper: Procedure, Recommendation for Revision, Conclusion Paper in  7th edition APA format including title page, headings citations, and reference list Sources cited properly. Lumbar Puncture Procedure Recommendation for Newborns Paper free of errors. Writing organized, clear, and free of grammatical and spelling errors. Paper 3-4 pages in length excluding title page and reference list (pages in excess of 4 will not be evaluated toward grade).	10
Total Lumbar Puncture Procedure Recommendation for Newborns	100

 

Epidemiological Designs

Epidemiological Designs. For this question, read the assigned research article, linked below, which represents an epidemiological research design. Then, conduct a critical analysis of this article, analyzing the strengths, limitations, and tendencies of epidemiological method.
Descriptive Epidemiology of Chronic Hypertension, Gestational Hypertension, and Preeclampsia in New York State, 1995-2004. Epidemiological Designs

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In your response, respond to the items below.
• Identify and define the epidemiologic design used.
• Identify the data collection and analysis techniques used in the study.
• Discuss the strengths and weaknesses of this report.
• Identify ethical concerns you discerned in the article.
• Discuss how epidemiologic designs can be used to evaluate health outcomes and services in an EBP.

Discussion Guidelines: Support your responses with credible or scholarly academic references, using proper APA style citations. The Scholarly, Peer Reviewed, and Other Credible Sources table offers additional guidance on appropriate source types, and the In-Text Citation Helper: A Guide to Making APA In-Text Citations tutorial can clarify further questions you might have on APA. Assigned course readings and Ashford University Library resources are preferred. In your first post, provide a substantive exposition that illustrates a well-reasoned and thoughtful response to the topic, is factually correct, provides examples, and demonstrates a clear connection to the readings.

Guided Response: In your responses to at least two of your peers, provide constructive feedback adding to the critical analysis of the article reviewed. Your response must display reflective thought that illustrates an understanding of the topic under discussion and be supported with relevant evidence. Epidemiological Designs

Planned Change in a Department or Unit

Assignment: Application: Planned Change in a Department or Unit

For this Assignment, you propose a change at the department or unit level and develop a plan for guiding the change effort. Book required: Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins. To prepare:Planned Change in a Department or Unit

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1. Review Chapter 8 in the course text. Focus on Kurt Lewin’s change theory, and contrast it with other classic change models and strategies. 2. Reflect on problems, inefficiencies, and critical issues within a specific department, unit, or area in your organization or one with which you are familiar. Select one issue as a focal point for this assignment, and consider a change that could be made to address the issue. 3. Think about how the change would align with the organization’s mission, vision, and values as well as relevant professional standards. 4. Using one of the change models or strategies discussed in Chapter 8, begin formulating a plan for implementing the change within the department/unit. Outline the steps that you and/or others should follow to facilitate the change effort. Align these steps to the change model or strategy you selected. 5. Determine who should be involved in initiating and managing the change. Consider the skills and characteristics that are necessary to facilitate this change effort. To complete: Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following:

1. Identify a problem, inefficiency, or issue within a specific department/unit. 2. Describe a specific, realistic change that could be made to address the issue. 3. Summarize how the change would align with the organization’s mission, vision, and values as well as relevant professional standards. 4. Identify a change model or strategy to guide your planning for implementing the change. Provide a rationale for your selection. 5. Outline the steps that you and/or others would follow to facilitate the change. Align these steps to your selected change model or strategy. 6. Explain who would be involved in initiating and managing this change. Describe the skills and characteristics that would be necessary to facilitate the change effort. Planned Change in a Department or Unit