Case Study: Chronic Hypertension

Female was admitted to inpatient care with a diagnosis of chronic hypertension with severe features and started on Labetalol 200 mg po q 8 hours. She was monitored for 3 days and her BP stabilized at 130/78. Fetal testing was reassuring. She was discharged home on hospital day 3 on Labetalol and was to be seen twice weekly for BP checks, and was instructed to take her BP at home twice daily. Safety of medications was discussed in-depth with her. Signs/symptoms of PIH were reviewed with her. Two weeks later she had po nifedipine added. She subsequently delivered a healthy baby girl at 39 weeks gestation. She was discharged home on above medications (as she was breastfeeding) and continued meds for hypertension past her 6-week postpartum appointment. She was referred to her primary care provider for continuing care.

Purpose of this case study is to address the significantly different standards of labs and vital signs for pregnant patients. 

· Based on the case study above, complete a comprehensive well-woman exam

· What is your primary diagnosis? Explain.

· What are two other differential diagnoses? Explain.

· What additional questions you would ask the patient? Explain your reasons for asking the additional questions

· Then, what types of symptoms you would ask for? Be specific and provide examples. (Note: When asking questions, consider sociocultural factors that might influence your question decisions.)

· Lastly, explain which treatment options and diagnostic tests you might recommend

Question 1

In 200-250 words,  Discuss what resources are often necessary for nonacute care for cardiorespiratory issues. Explain how they support patient independence and decrease readmission.

Question 2

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.

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.

At the completion of your intervention, you will produce a 5–8 minute video discussion script of your care coordination intervention for a peer-reviewed media platform.
As an advanced practice health care provider, it’s likely that you will be asked to give a presentation at some point in your career. Now that you have completed this project, it’s time to disseminate the outcomes in the form of a recorded professional presentation. A professional presentation style requires the confidence and ability to convey the right image that you want your audience to see. Unfortunately, it’s easy to miss some of the opportunities available to help you present yourself in the best possible light and, as a result, enjoy the success you deserve. Remember to be forthright about what happened during the project and about how data were collected and analyzed, and present the findings so stakeholders and external parties clearly understand the steps in the process. By completing this final activity, you can help others recreate this type of project and enhance outcomes in other patient care settings.

Assessment Instructions

In Assessment 3, you will build on the work you completed in Assessments 1 and 2.
Assignment Summary
This assessment requires you to prepare a 5–8 minute video discussion script of your care coordination intervention. Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@Capella.edu to request accommodations. If you are unable to record a video, please contact your faculty member as soon as possible to explore options for completing the assessment.
You have completed the intervention and achieved enhanced outcomes. Now you need to disseminate your findings and provide recommendations to sustain the results of your intervention. You have been asked by nursing leadership to produce a scholarly video for a peer-reviewed media platform. The video will include 5–8 minutes of scholarly discussion covering the topics listed below.
Grading Criteria
The numbered assignment instructions outlined below correspond to the grading criteria in the Disseminating the Evidence Scholarly Video Media Submission Scoring Guide, so be sure to address each point. You may also want to review the performance level descriptions for each criterion to see how your work will be assessed.

1. Analyze care coordination efforts related to clinical priorities based on a PICOT question.
   • Provide the PICOT question and a brief introduction of the issues.
2. Describe the change in practice related to services and resources that will be available for the interprofessional care coordination team.
   • Describe the key care coordination efforts.
3. Explain efforts to build stakeholder engagement within the interprofessional team.
   • How did you lead the change in practice?
   • Summarize how you encouraged and built stakeholder engagement.
4. Recommend next steps that that support thoughtful resource utilization and a safe environment in care coordination.
   • Propose how you will sustain the current outcomes with the coordinated care interprofessional team.
   • Make recommendations on moving forward that support thoughtful resource utilization and a safe environment.
5. Produce a video that provides insight, understanding, and reflective thought about care coordination.
6. Communicate audibly and professionally, using proper grammar and including a reference list formatted in current APA style.
7. Important Note: but do address each scoring guide criterion in the video, including a discussion of authors in the literature who support the ideas presented. Please submit a separate APA-formatted reference list for the resources discussed in your reflection.
   Additional Requirements

• Written communication: Write clearly, accurately, and professionally, incorporating sources appropriately.
• APA guidelines: Resources and citations are formatted according to current APA Style and Format. When appropriate, use APA-formatted headings.

For this assignment imagine you are riding in an elevator with an influential player in public health (e.g. Margaret Chen, Bill Gates, the president of the World Bank). This person, recognizing that you are a student, turns to you and asks you for your opinion about a particular disease control program.

You’ve got your iPad or tablet with you. What will you say?

The purpose in the project is to be able to communicate epidemiological information in a succinct manner so that it captures the attention of the audience. You will prepare an “elevator pitch” to “sell” your topic. During your pitch you will need to use two figures (no more or less than two). These figures will be either be a table or a graph showing temporal or spatial comparisons.

Your presentation must be less than 2­minutes. You will be trying to convince potential stakeholders or funding agencies that colorectal cancer is a problem and it needs immediate attention. Consider how you will convince someone that this condition is underfunded or needs more funding.

Required Elements

1. The Hook:

a. Your hook is a statement or question that opens your presentation to grab the attention of a potential stakeholder. Make sure your hook is catchy. This statement needs to drawn in the stakeholder for the rest of your presentation.

2. Content:

a. In your presentation you need to summarize the facts and pertinent epidemiological information in a clear and concise way.

b. The content needs to focus on a specific goal. In this case getting funding,

more funding, or immediate attention for your specific condition.

3. Graphics:

a. Utilize two graphics that support your pitch.

b. Each graphic should be easy to read.

4. Organization:

a. Organize your thoughts and only include the most important impactful information.

b. The pitch should build to and end with a request. What are asking for (funding, more funding, needs immediate attention, etc…)?

5. Professionalism/Communication

a. Make sure your pitch is geared towards the correct audience.

b. Use words that are impactful, but that everyone understands.

c. Stay within the time limit of 2 minutes.

Guidelines for Submission: The presentation must be 2 minutes or shorter.