What is the rationale for immediately starting BF on oxygen? Keeping in mind BF’s health history and presenting complaints, what are the most important areas you need to evaluate during your physical assessment?

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Nursing case study

Respiratory Case Study:

Scenario: BF, a 31 year-old man who lives in a small mountain town in West Virginia, is highly allergic to dust and pollen and has a history of mild asthma.  BF’s wife drove him to the emergency room when his wheezing was unresponsive to his fluticasone/salmeterol (Advair) inhaler, he was unable to lie down, and he began to use accessory muscles to breathe.  BF is immediately started on 4L of oxygen by nasal cannula and intravenous (IV) D5W at 75 mL/hr.  A set of arterial blood gases (ABG) is sent to the laboratory.  BF appears anxious and says that he is short of breath.

 

Chart:

Vital signs:

BP                          152/84

Pulse                     124 bpm

Resp rate             42 breaths/min

Temp                    100.® F

 

Discussion topics:

  1. What is the rationale for immediately starting BF on oxygen?
  2. Keeping in mind BF’s health history and presenting complaints, what are the most important areas you need to evaluate during your physical assessment?

Chart:

ABGs

pH          7.31

Paco2    48

HCO3     26

Pao2      55

 

Chart:

Medication Orders:

Albuterol 2.5mg plus ipratropium 250 mcg nebulizer treatment stat

Albuterol (Ventolin) inhaler 2 puffs po q4hrs

Metaproterenol sulfate (Alupent) 0.4% nebulizer treatment q3hrs

Fluticasone (Flovent HFA) MDI: 220 mcg, 1 puff twice daily

 

  1. What is the rationale for the albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT (immediately)?
  2. Indicate the drug classification and expected outcome BF should experience with using metaproterenol sulfate (Alupent) and Fluticasone (Flovent).

You assess BF and find that he has diminished lung sounds with inspiratory and expiratory wheezing in all lung fields with a nonproductive cough and accessory muscle use.  His skin is pale, warm, and dry.  The electrocardiogram shows sinus tachycardia without ectopy.  He is alert and oriented x4 spheres.  He appears anxious and is sitting upright, leaning over the bedside table, and continuing to complain of shortness of breath.

  1. What is your primary nursing goal at this time?
  2. You will need to monitor BF closely for the next few hours. What is the most serious complication to anticipate?
  3. Identify four signs and symptoms of this complication you will assess for in BF.
  4. When combination inhalation aerosols are prescribed without specific instructions for the sequence of administration, you need to be aware of the recommendations for safe drug administration. Describe the correct sequence for administering BF’s treatments.
  5. What are your responsibilities for administering aerosol therapy?

 

After several hours and aerosol treatments, BF’s wheezing and dyspnea resolve, and he is able to expectorate his secretions.  The provider discusses BF’s asthma management with him; BF says he has had several asthma attacks over the last few weeks.  The provider discharges BF with a prescription for oral steroid “burst” (prednisone 40 mg/day X 5 days), fluticasone/salmeterol (Advair HFA 230/21) two inhalations every morning and evening, albuterol (Proventil) metered-dose inhaler (MDI) two puffs q6h as needed (prn) with spacer, and montelukast (Singulair) 10 mg daily each evening.  He instructs BF to call the pulmonary clinic for follow-up with a pulmonary specialist.

  1. What is the rationale for BF being on the oral steroid burst?
  2. How does montelukast (Singulair) differ from other asthma medications?

BF state that h had taken his Advair that morning, then again when he started to feel short of breath.  He states, “It did not help,” and wants to know why he has to remain on it.  Is fluticasone/salmeterol (Advair) appropriate for use during an acute asthma attack? Explain.

  1. Based on this information, what specific issue do you need to address in discharge teaching with BF?

You ask BF to demonstrate the use of his MDI.  He vigorously shakes the canister, holds the aerosolizer at an angle (pointing toward his cheek) in front of his mouth, and squeezes the canister as he takes a quick, deep breath.

  1. What common mistakes has BF made when using the inhaler?
  2. You review the proper use of an MDI with BF and possible side effects he may experience, including hoarseness, dry mouth, white spots in the oral cavity, coughing, and headaches. What actions can you teach him to prevent or diminish the incidence of these effects? Select all that apply:
    1. Decrease his fluid intake
    2. Use a spacer on the inhaler
    3. Use the inhaler only as prescribed
    4. Rinse out his mouth immediately after using the inhaler
    5. Clean the spacer in the dishwasher on “hot cycle with heated dry” daily

 

The health care provider suspects Mrs. Pelletier has osteoporosis. What are her risk factors for osteoporosis? What studies could be done to support the diagnosis of osteoporosis? Mrs. Pelletier’s diagnostic testing yielded a bone density T-score of -3. What does this mean?

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OSTEOPOROSIS

Use the Osteoporosis case study to complete the assignment. Review the client profile, subjective date, objective data and diagnostic studies to complete the case study in Sherpath. After completing the case study, use the information to answer the following discussion questions.

The health care provider suspects the client has osteoporosis. What are her risk factors for osteoporosis?
What studies could be done to support the diagnosis of osteoporosis?
What clinical manifestations of osteoporosis does the client present with?
The client is prescribed alendronate. What instructions will you provide the client in regards to taking this medication?
What nutritional teaching is important of the client with her new diagnosis of osteoporosis?
What other teaching is appropriate for this client?
Answer the questions and format in an essay style paper. Introduce the client prior to answering the questions. Your conclusion is the evaluation of the teaching plan. It is required that you use APA format for your essay and references.Case Study
Musculoskeletal Problems
Case Study: Osteoporosis
approx 30 min
Patient Profile

Mrs. Pelletier is a 75-year-old female who presents to the health care provider’s office for back pain. She has a history of hypertension, Crohn’s disease, and hypothyroidism. She is currently taking the following medications:

Metoprolol 50 mg PO twice daily
Sulfasalazine 500 mg PO twice daily
Prednisolone 5 mg PO twice daily
Levothyroxine 75 mcg PO daily,/li>
Subjective Data

Has had some mid-back pain for the past week, which is worse when standing or walking and is relieved a little by lying down
Her back pain at the moment is a level 4, on a 1 to 10 scale
Denies any recent injury to her back
Broke her wrist a few months ago, but doesn’t know how
Her Crohn’s disease just ‘flared up’ a couple of weeks ago
Lactose intolerant
Objective Data

Temperature 98.2° F, pulse 74, respirations 16, blood pressure 130/78
Height 5 feet 3 inches, Weight 100 lb, BMI 17.7 kg/m2
Kyphosis of the spine

Question 1
The health care provider suspects Mrs. Pelletier has osteoporosis. What are her risk factors for osteoporosis?

Mrs. Pelletier’s risk factors for developing osteoporosis are her gender (female), age (>65 yr), low body weight, Crohn’s disease (due to malabsorption problems), nontraumatic fracture of her wrist, and use of corticosteroids for her Crohn’s disease and levothyroxine for her hypothyroidism.

Question 2
What studies could be done to support the diagnosis of osteoporosis?

Bone mineral density (BMD) measurements are typically used to assess the mass of bone or how tightly the bone is packed. Types of BMD studies include quantitative ultrasound (QUS) and dual-energy x-ray absorptiometry (DEXA).

Question 3
Mrs. Pelletier’s diagnostic testing yielded a bone density T-score of -3. What does this mean?

A T-score of -3 means that Mrs. Pelletier’s BMD is 3 standard deviations below the mean BMD of young adult. Any score greater than 2.5 standard deviations is defined as osteoporosis.

Question 4
Mrs. Pelletier is prescribed alendronate. What instructions should Mrs. Pelletier receive regarding taking this medication?

There are gastrointestinal side effects associated with taking bisphosphonates such as alendronate including dyspepsia, abdominal pain, and the most common one, esophageal irritation or esophagitis. To decrease these side effects, teach Mrs. Pelletier to take her alendronate with a full glass of plain water 30 minutes before food or other medications, and to remain upright for at least 30 minutes after taking it.

Question 5
What nutritional teaching is important for Mrs. Pelletier with her new diagnosis of osteoporosis?

Treatment of osteoporosis focuses on adequate calcium intake. Teach Mrs. Pelletier to take calcium 1500 mg/day. Due to Mrs. Pelletier’s lactose intolerance, she is not able to consume dairy products to get her daily calcium intake. Foods that are high in calcium that do not have lactose include almonds, sardines, salmon, turnip greens, and spinach. Supplemental calcium is likely if dietary intake of calcium is inadequate. Vitamin D is also necessary for calcium absorption and function and may have a role in bone formation. The recommended dosage for postmenopausal women is 800-1000 IU/day.

Question 6
What other teaching is appropriate for Mrs. Pelletier?

Moderate amounts of exercise are important to build up and maintain bone mass. The best exercises are weight-bearing exercises that force the individual to work against gravity. Exercises that are low impact, such as walking, hiking, weight training, and dancing, are recommended to avoid stress fractures associated with high-impact activities. Review with her general measures to reduce her risk of falling, including getting up slowly, wearing well-fitting shoes, removing any loose rugs in the house, making sure all of the walkways are kept clear, using grab bars and nonskid mats in the bathroom, and having appropriate lighting, particularly at nighttime.

Analyse the epidemiology of Acute Kidney Injury. Discuss underlying pathophysiological processes which lead to Acute Kidney Injury.

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Assessment and Management of Patients with Acute Kidney Injury

1. Analyse the epidemiology of Acute Kidney Injury.

2. Discuss underlying pathophysiological processes which lead to Acute Kidney Injury.

What is something new you learned while listening to the webinar that may change your practice as an advanced practice nurse. What is something new you learned when completing the learning activity that may change your practice as an advanced practice nurse.

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ADHD Assessment

Application of Learning Activity:

Review the assessment below and think about either your own child, someone in your family or someone that you know.

https://chadd.org/wp-content/uploads/2019/01/ADHD_Parent_Initial.pdf

Student Time Allocation:  Approximately 6 hours each

  • Webinar attendance – 1 hour
  • Suggested readings – 2 hours
  • Application of learning (independent field experiences) – 2 hours
  • Debrief including written reflection– 1 hour

 

Debrief

Answer the Following Questions:

  1. What is something new you learned while listening to the webinar that may change your practice as an advanced practice nurse.
  2. What is something new you learned when completing the learning activity that may change your practice as an advanced practice nurse.
  3. Reflect on how you will apply what you have learned to educating nursing students or if you are in a professional development role, nursing and hospital staff.

Student Documentation of Learning:

  • Students will enter the Direct Care Application Activities on the Practicum Log
  • Students will attend or engage with all of the following:
    • Webinar
    • Assigned Reading
    • Field experiences to put learning into practice
    • Debrief to include written Reflection
  • Student will complete the above questions on this document and upload this document along with the practicum log to get credit for the webinar.

What is something new you learned while listening to the webinar that may change your practice as an advanced practice nurse? What is something new you learned when completing the learning activity that may change your practice as an advanced practice nurse?

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Cognitive Assessment

Part 2 – Reflective Questions

Reflect upon learning achieved and insights gained through this activity; respond to the following questions:

 

  1. What is something new you learned while listening to the webinar that may change your practice as an advanced practice nurse?

 

 

  1. What is something new you learned when completing the learning activity that may change your practice as an advanced practice nurse?

 

 

  1. Reflect on how you will apply what you have learned in your current or future setting.

 

Introduce your issue. Identify both sides of the issue. Provide an issue definition. Discuss the significance of the issue for nursing. Briefly summarize your findings and give directions for future research, or recommendations for further study.

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Issue paper in Nursing

An issue paper differs from a position paper or a discussion paper in that an issue paper consists of a balanced view of a situation or dilemma in which both sides of the situation are clearly articulated. Because authors will often disagree about the kinds of solutions that should be implemented in remedying the situation or dilemma, you are expected to provide an overview of the various points of view found in the literature regarding how this issue should be resolved. Based on your literature review, you will be expected to discuss how you believe this issue should be resolved and provide your own rationale.

Writing an Issue Paper

Searching The Literature

In writing an issue paper you will be expected to search for a variety of literature resources. you may also use the online Library from another University if you have access), and you may also use the Internet to search through any of the online scholarly databases. In addition, there are many links to articles and online databases in this resources site which you may use.

Defining the Issue

Once you have a sound understanding of your topic, you will need to clearly define the issue. Recall that an issue has two sides so your definition of the issue should include a balanced view.

For example: The electronic patient record has many advantages such as a time saver, clarity, and accessibility, but it also comes with the challenges associated with security, increased financial costs, and implementation problems. Your issue statement might be: Even though there are significant benefits to an electronic record, not every health region has the financial resources to implement the proper security protocols necessary to ensure patient privacy.

Framework of Your Issue Paper

Introduction

Introduce your issue.

Identify both sides of the issue.

Provide an issue definition.

Discuss the significance of the issue for nursing.

Body of Paper

Describe your own opinions and beliefs about this issue.

Analysis of the issue is completed through discussion of appropriate frameworks.

Barriers to resolution are identified.

Possible resolution strategies are explored.

Conclusion

Briefly summarize your findings and give directions for future research, or recommendations for further study.

[Reference: Pryor, J. (2004). Guidelines on writing a philosphy paper. Princeton University.]

Analyse the assessment data of the community using the chosen community assessment model. Provide a concise analysis of the assessment data. From your analysis you have the opportunity to formulate several community diagnoses. Write one clearly written community diagnoses.

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Community Assessment and Diagnosis |

The purpose of this assignment is to provide students with an opportunity to conduct a partial community assessment and diagnose one area of need for health promotion related to an identified population.

Assignment Guidelines

The paper will begin with an overview of your selected population, providing the reader with a rational for the importance of the health assessment and will include demographic details to provide context for this work. Students will then conduct an assessment using either the Population Health Promotion Model or the Canadian Community as Partner Model. The student will provide rational outlining why the selected model was chosen before discussing either 3 determinants of health or 3 segments from the community assessment wheel. An analysis of the assessment data will be included. Assessment data will form the basis of a community diagnosis. This diagnosis will shape the basis for your health promotion program in Assignment 4. In Assignment 3 students will:

Describe and provide the rationale for the selected population/group you have chosen.

Include relevant demographic and epidemiological data.

Outline the assessment methods used:

Population Health Promotion Model, provide the rationale for your choice, select 3 determinants of health, and complete an assessment in relation to the group.

OR

Canadian Community-as-Partner Model, provide the rationale for your choice, select 3 segments from the community assessment wheel, and complete an assessment in relation to the group.

Analyse the assessment data of the community using the chosen community assessment model. Provide a concise analysis of the assessment data.

From your analysis you have the opportunity to formulate several community diagnoses. Write one clearly written community diagnoses. Outline if it is a wellness or deficit diagnosis. The community diagnosis will frame your work in Assignment 4).

Provide rationale for the community diagnosis supported by the analysis of the assessment data for the community.

Briefly discuss the first-line treatment recommendations from JNC8, and the AHA/ACC for a patient with no other major comorbidities. What are the recommended medications to start this specific patient on? Provide the drug class, generic & trade name, and initial starting dose.

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Week 3

Mrs. Lyons is a 57-year-old African American female who recently developed headaches and had an elevated blood pressure reading at her work health fair. When she had her blood pressure taken at the health fair the reading was 168/99. She has gone back to the drug store 3 other times to take her blood pressure. The readings have been: 145/90, 150/89, 140/88. At the health fair she was told her BMI is elevated. Her cholesterol levels were also done at the health fair. The results were: total cholesterol level of 250, LDL 138, HDL 48, and Triglycerides 170.

She has not been to see a primary care provider in over 5 years. At her last office visit, which was 5 years ago, her blood pressure was (135/95). Her LDL and triglycerides were also elevated at that time. The patient was supposed to monitor her blood pressure at home and trial diet and lifestyle changes. She was supposed to return for a follow-up with her blood pressure log and for a recheck of her labs. She, unfortunately, did not do this.

Today in the clinic her vital signs are:
BP 146/92, HR 90, Temp 98.4, RR 12, O2 98%, Height 5’5, Weight 220 lbs, BMI 36.6

She is not currently taking any medications. She has NKDA. Family history: her brother and sister both have been diagnosed with hypertension and DM. Diagnoses for the patient are HTN, Obesity, and Hyperlipidemia.

Q1. Briefly discuss the first-line treatment recommendations from JNC8, and the AHA/ACC for a patient with no other major comorbidities.

Q2. What are the recommended medications to start this specific patient on? Provide the drug class, generic & trade name, and initial starting dose.

Q3. Discuss the mechanism of action of each of the drugs you listed.

Q4. Discuss the side effect profile of each medication you listed.

Q5. Are there any interactions between any of the medications you prescribed?

Q6. What other non-pharmacological interventions would be suggested?

What do you want to find out? Why did you choose that topic? Why is the topic important and up to date? How does the topic relate to working life and usability in working life? How does the topic promote and support your own professional skills?

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Communicative difficulties in adolescents with autism spectrum disorders and their effects on their integration within the mainstream

Summary:
Choose a nursing research topic / theme that interest you, which could also be a suitable topic for your thesis. Search for previous research information related to the topic / theme and use it as a basis for writing a theme analysis. The theme analysis is written according to the writing instructions of the thesis report. The length of the analysis is 4 pages (+ cover page).

Head over the topic analysis according to the headings below and reflect on your chosen topic and implementation using the questions provided. Don’t just answer the questions; write fluent text under the headings. The questions will only help you in your reflection.

1. Justification for the choice of topic

What do you want to find out?

Why did you choose that topic?

Why is the topic important and up to date?

How does the topic relate to working life and usability in working life?

How does the topic promote and support your own professional skills?

2. Background and previous literature

What are the key concepts related to the topic / theme?

How do the concepts relate to each other, ie what are the relationships between the concepts? -> Draw a concept map of the concepts as an appendix to the topic analysis.

What previous research has been done on the subject?

Find at least three to five related studies and describe how the studies relate to the topic.

3. Research

How could your chosen topic / theme be approached from a research perspective?

What research method could be suitable for researching the topic?

4. Ethical and reliability considerations

What ethical issues and aspects are related to your chosen topic / theme?

What kind of reliability issues and aspects are related to the topic / theme?

References

Carefully mark all the references you use and make the citations in the text according to the reporting guidelines. In addition to research data, use research method literature as sources.

Explain how each competency and essential that you selected aligns with critical thinking and clinical decision-making. Provide examples of how improvements in these areas will impact patient outcomes. Explain how developing the competencies and essentials will impact/improve your work.

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Summative assessment: Competencies and Essentials of a Baccalaureate prepared-Nurse

Nurses use critical thinking skills to analyze data to make important decisions. Think about the competencies you selected to develop in Week 1. How would improving these professional competencies impact critical thinking and clinical decision-making?

Using the 2 competencies and the 2 essentials from the Week 1 worksheet, develop a 12- to 15-slide presentation with detailed speaker notes.

Note: If you are not familiar with creating Microsoft PowerPoint® presentations, review How to Make a Presentation under this week’s Learning Activities.

Include an overview of the QSEN Competencies and the AACN Baccalaureate Essentials. Do the following:

Explain how each competency and essential that you selected aligns with critical thinking and clinical decision-making.
Provide examples of how improvements in these areas will impact patient outcomes.
Explain how developing the competencies and essentials will impact/improve your work.

Include at least 2 scholarly resources from the University of Phoenix Library.