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

PLEASE FOLLOW THE INSTRUCTIONS BELOW

4 REFERENCES

In your role, you must understand group processes and stages of formation, as this will help you develop groups and determine an individual’s appropriateness for group therapy. Whether you are at the beginning stages of group formation or facilitating a session for a developed group, it is important to consider factors that may influence individual client progress. For this Assignment, as you examine the video Group Therapy: A Live Demonstration in this week’s Learning Resources, consider the group’s processes, stages of formation, and other factors that might impact the effectiveness of group therapy for clients.

Learning Objectives

Students will:

• Analyze group processes and stages of formation
• Analyze curative factors of groups
• Analyze the impact of curative factors on client progress
• Recommend strategies for managing intragroup conflict

To prepare:

• Review this week’s Learning Resources and reflect on the insights they provide on group processes.
• View the media, Group Therapy: A Live Demonstration, and consider the group dynamics.

The Assignment

In a 2- to 3-page paper, address the following:

• Explain the group’s processes and stage of formation.
• Explain curative factors that occurred in the group. Include how these factors might impact client progress.
• Explain intragroup conflict that occurred and recommend strategies for managing the conflict. Support your recommendations with evidence-based literature

Week 2 Project

Assessing and Planning Care for an Elderly Person

In order to gain an insight into the world of elder adults, it is important to understand how they view themselves and the values they hold. Additionally it is important to assess and determine his/her needs and establish appropriate interventions for this individual.

In a Microsoft Word document of 4-5 pages formatted in APA style, you will discuss your interview of an older adult. This person cannot be a patient in your clinical setting. You can use a friend, family member, or co-worker. The older adult must be age 65 years or older.
There are two parts to this assignment – the psychosocial interview component and the functional assessment.

Interview

Download the patient questionnaire (attached). Use this format to record the person’s responses.

·  Include 2–3 questions of your own to get a complete picture of the older adult.

·  Summarize your findings.

·  Include the questionnaire with responses in the Appendix of your paper.

Assessment

After gaining permission, conduct a physical and mental functional assessment of the older adult you have chosen. Review your readings for the process of a functional assessment.

·  Use these tools to complete a comprehensive assessment of your patient. Search the Internet for resources on these tools.

o  Tinetti Balance and Gait Evaluation

o  Katz Index of Activities of Daily Living

o  Assessment of Home Safety

o  The Barthel Index

o  Do not include a name on each tool, but do include professional or other designation, and age. Your name should also be identified on the tool.

§  Include these tools in the Appendix.

·  Based on your assessment:

o  Compare and contrast the age-related changes of the older person you interviewed and assessed with those identified in this week’s reading assignment.

o  Identify at least 4–6 preliminary issues.

o  Identify three alterations in health that you would propose and describe them.

o  Identify a minimum of three comprehensive interventions for each alteration.

o  Integrate cultural considerations in your interventions.

Please note that the title and reference pages should not be included in the total page count of your paper.

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

Week 2 Discussion

Post your initial response to the topic below.

Topic 

Review the four recommendations in the IOM report The Future of Nursing: Leading Change, Advancing Health and find your state’s action coalition.

·  Discuss your state’s action coalition’s work as it aligns with these four recommendations. Is each recommendation being addressed?

·  Based on your analysis of the website, how would you describe your state’s (Florida) progress toward meeting the IOM recommendations?

As in all assignments, cite your sources in your work and provide references for the citations in APA format. Support your work, using your course lectures and textbook readings. Helpful APA guides and resources are available in the  University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style.

 Select a current or proposed health care policy that is designed to improve a specific population’s access to quality, cost-effective health care. In a paper of 1,000-1,250 words, include the following:

1. Explain the policy and how it is designed to improve cost-effectiveness and health care equity for the population. Is the policy financially sound? Why or why not? How does the policy account for any relevant ethical, legal, and political factors and the nursing perceptive one must consider when implementing it?
2. To what state, federal, global health policies or goals is this particular policy related? How well do you think the policy is designed to achieve those goals?
3. Finally, discuss the advocacy strategies you would employ on behalf of your population to ensure they have access to the benefits of the policy. Explain, from a Christian perspective, the professional and moral obligation of advanced registered nurse to advocate for and promote health and prevent disease among diverse populations.

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

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.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MS Nursing: Public Health

MS Nursing: Education

MS Nursing: Acute Care Nurse Practitioner

MS Nursing: Family Nurse Practitioner

MS Nursing: Health Care Quality and Patient Safety

2.1: Examine financially sound health care policy that incorporates the nursing perspective and relevant ethical, legal, and political factors.

2.2: Determine advocacy strategies for improving access, quality, and cost-effective health care for diverse populations.

4.2: Integrate appropriate state, federal, and global health policies and goals into the design of equitable health care for populations.

4.3: Examine the professional and moral obligation of master’s-prepared nurses to respect human dignity and advance the common good through working to promote health and prevent disease among diverse populations from a Christian perspective.