1. Detached Retina

Mr. Gray, a 65-year-old man, was in an automobile accident in which he suffered a concussion. Soon after he was released, he noticed what he described as a “gray spot” in his field of vision. At first he ignored it, thinking it would go away, but the spot seemed to darken and spread over his visual field. He didn’t report any pain with the problem. On calling his physician, he was advised to go to the nearest hospital immediately. A detached retina was diagnosed.

After treatment, he regained most of his normal sight back. Five years later, he began having problems again. The central area of his visual field was becoming blurred, and he was losing his depth perception. An initial eye examination revealed neovascularization in both eyes.

• Question 1:  Relate the patient history and circumstances of the injury and the signs and symptoms related to the pathophysiology of this condition.
• Question 2: Discuss the treatments available for the patient.
• Question 3: Relate the symptoms and signs to those of macular degeneration.
• Question 4: Discuss the treatment available and the prognosis for recovering his normal vision.

Resources to assist you:

https://www.youtube.com/watch?v=3m__6QS8U_8

https://www.youtube.com/watch?v=hZe7VxtuQB0

https://www.youtube.com/watch?v=ozZQIZ_52YY

1. Cardiovascular Accident

Mr. Quinn, age 64 years, developed a severe headache several hours ago that has not responded to acetaminophen. Now his speech is slurred, and his right arm and the right side of his face feel numb. He is very anxious and is transported to the hospital. Mr. Quinn has a history of smoking and arteriosclerosis, and there is family history of CVA and diabetes. Assessment at the hospital indicated weakness on the right side, including facial asymmetry and a blood pressure of 220/110 Hg mm. A CT scan showed damaged tissue on the left side of the brain, and an angiogram indicated narrowing of the carotid arteries and middle cerebral arteries, with occlusion of the left middle cerebral artery.

• Question 1:  Discuss the pathophysiology related to CVA due to thrombus vs. embolus. Describe the stages in the development of an atheroma.
• Question 2: Explain the predisposing factors in this case, and relate Mr. Quinn’s initial signs to the pathological changes.
• Question 3: Discuss the treatments available after first aid for stroke patients and the patient’s prognosis.

Resources to help you:

https://www.youtube.com/watch?v=QIAI6KOwKII&t=16s

https://www.youtube.com/watch?v=U8s427-tv58

https://www.youtube.com/watch?v=qCvV11R2lgg&t=7s

1. Parkinson Disease

Mr. Nimmo, age 66, has noticed excessive fatigue, muscle aches, and weakness in his legs for some time. His hands were shaking slightly, although his wife reported that the shaking appeared to stop when he fell asleep. Some unintentional head movements were also apparent. He remembers that his grandfather died in his mid-60s after suffering for years from a condition with similar symptoms. After several tests and the elimination of some other neuromuscular conditions, a diagnosis of Parkinson’s disease was made for Mr. Nimmo.

• Question 1: Discuss the pathophysiology of Parkinson’s disease and how it differs from other neuromuscular conditions affecting older adults.
• Question 2: Discuss the usual progression of the disease as the pathophysiology develops further. Indicate additional manifestations that will be noticeable.
• Question 3: Describe the complications that frequently develop, including the rationale for each and the early indications of each problem.
• Question 4: Discuss the treatments available to this patient.

 An important consideration when working with patients is their cultural background. Understanding an individual’s culture and personal experiences provides insight into who the person is and where he or she may progress in the future. Culture helps to establish a sense of identity, as well as to set values, behaviors, and purpose for individuals within a society. Culture may also contribute to a divide between specific interpretations of cultural behavior and societal norms. What one culture may deem as appropriate another culture may find inappropriate. As a result, it is important for advanced practice nurses to remain aware of cultural considerations and interpretations of behavior for diagnosis, especially with reference to substance-related disorders. At the same time, PMHNPs must balance their professional and legal responsibilities for assessment and diagnosis with such cultural considerations and interpretations.

Post a brief description of the two nurse-sensitive indicators of quality that you selected. Analyze the influence of early quality improvement theories and philosophies on the development of the quality indicators you selected. Be specific. Then, cite the two (2) nursing research articles you selected, and explain how these indicators may influence your practice setting. Be specific and provide examples.

 Work with your preceptor to perform a needs assessment of the organization and community for your practicum. Review the needs assessment to identify possible project topics. In preparation for the capstone change project proposal, compile a list of three to five possible topics for your project and submit to the assignment instructor in the digital classroom.