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, 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. 

Every family has to come to a decision regarding end of life at some point.  In the case of the COVID pandemic, families are making this painful decision at a moment when they are not even able to visit with the patient.

In my ER, a patient came in from a memory care facility where multiple residents tested positive for COVID, including my patient.  When he arrived his sats were at 68% and we was on a non-rebreather.  We switched him over to a high flow oxygen and his O2 went up to 95%.  He had Alzheimer’s and communication was difficult.  There was no DNR in place for him and I contacted his daughter, who is his proxy, to let her know his current situation.  The admitting doctor spoke to her and they decided to put in DNR in place.  I Facetimed with her so she could say goodbye to her father.  It was the most heartbreaking thing I have ever done.  When we brought him up to the ICU he was stitched over to a nasal cannula at 2 liters and passed away shortly afterwards.  The family was unable to visit with him before he passed because he was COVID positive.

There was discussion about hospitals considering DNR for COVID patients so that staff is not put at risk because of PPE shortages (Masson, 2020).   Hospitals such as Northwestern Memorial Hospital in Chicago, are considering placing orders regardless of family and patient wishes (Masson, 2020).  This is an uncertain time, where we really don’t know where the disease process will go.  In another study it was found approximately 77% of participants believed the decision about DNR should a team decision which consists of the physician, nurse, patient, and the families (Tajari et al., 2018).  Many of these decisions are made when the patient is critical. 

In finding the CPR decision aid for patients and their families on the Ottawa Hospital Research Institute site, this is a useful tool in aiding with this painful decision.  The tool went into detail about what occurs during CPR and lets families know what the outcomes would be and the small chance of a normal life.  There is an honest paragraph about the side effects of CPR such as broken bones, punctured lungs, and impaired mental function (OHRI, 2019).  When discussing this with families and the patient it is important to have an honest discussion so an informed decision can be made.  I will use this aid for work because it’s important to have open communication about the reality of life.

Tajari, M., Jalali, R., Vafaee, K.  Attitudes of patients’ relatives in the end stage of life about do not resuscitate order. Journal of Family Medicine and Primary Care.  Doi: 10.4103/jfmpc.jfmpc_144_18:10.4103.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259503/?report=printable

Masson, G.  (2020) Hospitals consider do-not-resuscitate order for all COVID-19 patients.  https://www.beckershospitalreview.com/public-health/we-re-going-to-be-coding-dead-people-hospitals-consider-do-not-resuscitate-order-for-all-covid-19-patients.html

The Ottawa Hospital Research Institute. (2019) Patient Decision Aids.  https://decisionaid.ohri.ca/

“Is the spread of infection more controlled in a hospital setting or long- term setting?”

Assignment: Workplace Environment Assessment

Clearly, diagnosis is a critical aspect of healthcare. However, the ultimate purpose of a diagnosis is the development and application of a series of treatments or protocols. Isolated recognition of a health issue does little to resolve it.

In this module’s Discussion, you applied the Clark Healthy Workplace Inventory to diagnose potential problems with the civility of your organization. In this Portfolio Assignment, you will continue to analyze the results and apply published research to the development of a proposed treatment for any issues uncovered by the assessment.

To Prepare:

• Review the Resources and examine the Clark Healthy Workplace Inventory, found on page 20 of Clark (2015).
• Review the Work Environment Assessment Template.
• Reflect on the output of your Discussion post regarding your evaluation of workplace civility and the feedback received from colleagues.
• Select and review one or more of the following articles found in the Resources:
  • Clark, Olender, Cardoni, and Kenski (2011)
  • Clark (2018)
  • Clark (2015)
  • Griffin and Clark (2014)

The Assignment (3-6 pages total):

Part 1: Work Environment Assessment (1-2 pages)

• Review the Work Environment Assessment Template you completed for this Module’s Discussion.
• Describe the results of the Work Environment Assessment you completed on your workplace.
• Identify two things that surprised you about the results and one idea you believed prior to conducting the Assessment that was confirmed.
• Explain what the results of the Assessment suggest about the health and civility of your workplace.

Part 2: Reviewing the Literature (1-2 pages)

• Briefly describe the theory or concept presented in the article(s) you selected.
• Explain how the theory or concept presented in the article(s) relates to the results of your Work Environment Assessment.
• Explain how your organization could apply the theory highlighted in your selected article(s) to improve organizational health and/or create stronger work teams. Be specific and provide examples.

Part 3: Evidence-Based Strategies to Create High-Performance Interprofessional Teams (1–2 pages)

• Recommend at least two strategies, supported in the literature, that can be implemented to address any shortcomings revealed in your Work Environment Assessment.
• Recommend at least two strategies that can be implemented to bolster successful practices revealed in your Work Environment Assessment.

Assignment: Workplace Environment Assessment

Clearly, diagnosis is a critical aspect of healthcare. However, the ultimate purpose of a diagnosis is the development and application of a series of treatments or protocols. Isolated recognition of a health issue does little to resolve it.

In this module’s Discussion, you applied the Clark Healthy Workplace Inventory to diagnose potential problems with the civility of your organization. In this Portfolio Assignment, you will continue to analyze the results and apply published research to the development of a proposed treatment for any issues uncovered by the assessment.

To Prepare:

• Review the Resources and examine the Clark Healthy Workplace Inventory, found on page 20 of Clark (2015).
• Review the Work Environment Assessment Template.
• Reflect on the output of your Discussion post regarding your evaluation of workplace civility and the feedback received from colleagues.
• Select and review one or more of the following articles found in the Resources:
  • Clark, Olender, Cardoni, and Kenski (2011)
  • Clark (2018)
  • Clark (2015)
  • Griffin and Clark (2014)

The Assignment (3-6 pages total):

Part 1: Work Environment Assessment (1-2 pages)

• Review the Work Environment Assessment Template you completed for this Module’s Discussion.
• Describe the results of the Work Environment Assessment you completed on your workplace.
• Identify two things that surprised you about the results and one idea you believed prior to conducting the Assessment that was confirmed.
• Explain what the results of the Assessment suggest about the health and civility of your workplace.

Part 2: Reviewing the Literature (1-2 pages)

• Briefly describe the theory or concept presented in the article(s) you selected.
• Explain how the theory or concept presented in the article(s) relates to the results of your Work Environment Assessment.
• Explain how your organization could apply the theory highlighted in your selected article(s) to improve organizational health and/or create stronger work teams. Be specific and provide examples.

Part 3: Evidence-Based Strategies to Create High-Performance Interprofessional Teams (1–2 pages)

• Recommend at least two strategies, supported in the literature, that can be implemented to address any shortcomings revealed in your Work Environment Assessment.
• Recommend at least two strategies that can be implemented to bolster successful practices revealed in your Work Environment Assessment.