DUE TUESDAY 01/10/2017 —> ADVANCE NURSING PRACTICE 1

 

Assignment 2: Case Study Analysis and Care Plan Creation

Click here (I COPIED AND PAST IT ON BELOW)  to download and analyze the case study for this week. Create a holistic care plan for disease prevention, health promotion, and acute care of the patient in the clinical case. Your care plan should be based on current evidence and nursing standards of care.

 

CASE STUDY

 

Week 2: Respiratory Clinical Case

 

Patient Setting:

 

65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily.  She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.

 

HPI

 

Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no seizure activity since initiation of therapy.

 

 

 

PMH

 

History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.

 

 

 

Past Surgical History

 

None

 

 

 

Family/Social History

 

Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF

 

Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.

 

 

 

Medication History

 

Theophylline SR Capsules 300 mg PO BID

 

Albuterol inhaler, PRN

 

Phenytoin SR capsules 300 mg PO QHS

 

HTCZ 50 mg PO BID

 

Enalapril 5 mg PO BID

 

Allergies

 

NKDA

 

ROS

 

Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.

 

Physical exam

 

BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”

 

VS after Albuterol breathing treatment – BP 134/79, HR 80, RR 18

 

Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.

 

Laboratory and Diagnostic Testing

 

Na – 134

 

K – 4.9

 

Cl – 100

 

BUN – 21

 

Cr – 1.2

 

Glu – 110

 

ALT – 24

 

AST – 27

 

Total Chol – 190

 

CBC – WNL

 

Theophylline – 6.2

 

Phenytoin – 17

 

Chest Xray – Blunting of the right and left costophrenic angles

 

Peak Flow – 75/min; after albuterol – 102/min

 

FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%

 

 

Visit the South University Online Library and research for current scholarly evidence (no older than 5 years) to support your nursing actions. In addition, consider visiting government sites such as the CDC, WHO, AHRQ, and Healthy People 2020. Provide a detailed scientific rationale justifying the inclusion of this evidence in your plan.

Next determine the ICD-10 classification (diagnoses). The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM) is the official system used in the United States to classify and assign codes to health conditions and related information.

Click here to access the codes.

https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx?generalError=Thank+you+for+your+interest+in+the+Medicare+Coverage+Database.+You+may+only+view+the+page+you+attempted+to+access+via+normal+usage+of+the+Medicare+Coverage+Database.

 

 

I PUT IT AT THE END OF THIS POST

Click here to download the care plan template to help you design a holistic patient care plan. The care plan example provided here is meant only as a frame of reference for you to build your care plan. You are expected to develop a comprehensive care plan based on your assessment, diagnosis, and advanced nursing interventions. Reflect on what you have learned about care plans through independent research and peer discussions and incorporate the knowledge that you have gained into your patient’s care plan.

Format

Your care plan should be formatted as a Microsoft Word document. Follow the current APA edition style. Your paper should be 2 pages excluding the title page and references and in 12pt font.

Name your document: SU_NSG6001_W2_A2_LastName_FirstInitial.doc.

Submit your document to the W2 Assignment 2 Dropbox by Tuesday, January 10, 2017.

Assignment 2 Grading Criteria	Maximum Points
Subjective Data The submission included the patient’s interpretation of current medical problem. It included chief complaint, history of present illness, current medications and reason prescribed, past medical history, family history, and review of systems.	15
Objective Data The submission included measurements and observations obtained by the nurse practitioner. It included head to toe physical examination as well as laboratory and diagnostic testing results and interpretation (especially those that pertain to the diagnosis).	15
Assessment The submission included at least three priority diagnoses. Each diagnosis was supported by documentation in subjective and objective notes and free of essential omissions. All diagnoses were documented using acceptable terminologies and current ICD-10 codes.	15
Plan of Care Plan included diagnostic and therapeutic (pharmacologic and non-pharmacologic) management as well as education and counseling provided. The plan was supported by evidence/guidelines, and the follow-up plans were noted.	20
APA Used APA standards consistently and accurately when citing in the SOAP note and reference page. Utilized proper format with coversheet and header.	10
Total	75

 

 

SAMPLE (OR TEMPLETE) FOR THE WORK

 

Title of Plan of Care

 

Name

 

South University Online

 

Faculty Name

 

NSG 6001

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**Please delete this statement and anything in italics prior to submission to shorten the length of your paper.

 

Patient Initials ______

 

Subjective Data: (Information the patient tells you regarding themselves: Biased Information):

 

Chief Compliant: (In patient’s exact words)

 

History of Present Illness: (Analysis of current problems in chronologic order using symptom analysis [onset, location, frequency, quality, quantity, aggravating/alleviating factors, associated symptoms and treatments tried]).

 

PMH/Medical/Surgical History: (Includes medications and why taking, allergies, other major medical problems, immunizations, injuries, hospitalizations, surgeries, psychiatric history, obstetric and history sexual history).

 

Significant Family History: (Includes family members and specific inheritable diseases).

 

Social History: (Includes home living situation, marital history, cultural background, health habits, lifestyle/recreation, religious practices, educational background, occupational history, financial security and family history of violence).

 

Review of Symptoms: (Review each body system –This section you should place POSITIVE for… information in the beginning then state Denies…). – General:; Integumentary:; Head:; Eyes:  ; ENT:; Cardiovascular:; Respiratory: ; Gastrointestinal:; Genitourinary:; Musculoskeletal:; Neurological:; Endocrine:; Hematologic:; Psychologic: .

 

Objective Data:

 

Vital Signs:  BP – ; P ; R ; T ; Wt. ; Ht. ; BMI .

 

Physical Assessment Findings: (Includes full head to toe review)  

 

HEENT:

 

Lymph Nodes:

 

Carotids:

 

Lungs:

 

Heart:

 

Abdomen:

 

Genital/Pelvic:

 

Rectum:

 

Extremities/Pulses:

 

Neurologic:

 

Laboratory and Diagnostic Test Results: (Include result and interpretation.)

 

 

 

Assessment: (Include at least 3 priority diagnosis with ICD-10 codes.  Please place in order of priority.)

 

Plan of Care: (Addressing each dx with diagnostic and therapeutic management as well as education and counseling provided).

References

 

Pick from Questions 1 or 2 (Only answer one of the two questions) Thanks 

Due Date is August, Tuesday 9 2016

Discussion Question 1

There is no right or wrong answer for this ethical question; however, you will need to discuss an ethical consideration or dilemma of the APRN. Please remember what is correct for one person may not be correct for another. Look at the Nuremburg Code (US Department of Health & Human Services, 2005; Washington, 2012) as it was the major start of ethics in research and that can carry over to nursing practice.

US Department of Health & Human Services. (2005). The Nuremberg code. Retrieved from http://www.hhs.gov/ohrp/archive/
           nurcode.html

Washington, H. A. (2012). Non-consenting adults. Retrieved from http://www.slate.com/articles/health_and_science/new_
           scientist/2012/01/the_nuremberg_code_set_up_to_protect_the_human_subjects_of_research_is_being_routinely_
           ignored_.html

In this week’s lecture material, ethical considerations of the advanced practice nurse have been discussed. Please expand on the following points:

• Choose a potential ethical dilemma that you may face in your chosen advanced practice nursing role.
• Describe the situation and potential solutions, including collaboration methods with other healthcare professionals.
• Examine the potential cost and benefits to your solution.
• Predict who would potentially oppose your stance. Support your stance with current research (minimum of one research article)

Discussion Question 2

There is no right or wrong answer for this ethical question; however, you will need to discuss an ethical consideration or dilemma of the APRN. Please remember what is correct for one person may not be correct for another. Look at the Nuremburg Code (US Department of Health & Human Services, 2005; Washington, 2012) as it was the major start of ethics in research and that can carry over to nursing practice.

US Department of Health & Human Services. (2005). The Nuremberg code. Retrieved from http://www.hhs.gov/ohrp/archive/
           nurcode.html

Washington, H. A. (2012). Non-consenting adults. Retrieved from http://www.slate.com/articles/health_and_science/new_
           scientist/2012/01/the_nuremberg_code_set_up_to_protect_the_human_subjects_of_research_is_being_routinely_
           ignored_.html

Review the American Nurses Association (ANA) Code of Ethics and the ANA Code of Ethics for Nurses with Interpretive Statements (ANA, 2011a, 2011b) and identify one barrier to ethical practice. Please expand on the following points:

• Choose a potential barrier to ethical practice that you may face in your chosen advanced practice nursing role.
• Discuss if there is a relationship between your personal beliefs and values and this barrier.
• Describe at least one mechanism to overcome the barrier discussed.
• Examine the potential cost and benefits to this barrier.

American Nurses Association. (2011a). Code of ethics. Retrieved from http://www.nursingworld.org/Mobile/Code-of-Ethics

American Nurses Association. (2011b). Code of ethics for nurses with interpretive statements. Retrieved from http://www.
           nursingworld.org/code-of-ethics-preface

 

 

  I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT. BETWEEN 150-200 WORDS

 

A vulnerable population is a group that is more likely going to develop health-related problems.   They are more likely to have problems accessing health care, and are more likely to have shorter life spans and poorer outcomes.   Not all persons that are at risk for poor health are vulnerable.   To be vulnerable, there must be aggravating factors that place them at greater risk for on-going poor health.

 

 

The more risk factors, the more vulnerable.   Nurses must identify risk factors that are amendable to intervention (Maurer & Smith, 2013, p. 528) .

At risk populations are sometimes associated with   people that exibit concerns with communication, medical, independence, supervision, and transportation services.   The key is based on understanding how a person functions on a daily basis (Minnesota Department of Health, 2016) .     At risk populations would be those with cancer, people with transplants, people with HIV, pregnancy, and diabetes.   Some groups that would be   considered vulnerable would be   the econmical disadvantaged, racial and ethnic minorities, the uninsured -low income children, the elderly, the mentally ill,   and the homeless.  

In L&D, we see a group that is vulnerable, the pregnant homeless woman.     There is a pattern that typically follows; no support system, substance abuse issues, and   mental health issues.     This group has a hard time advocating for themselves due to the systems many hurdles and also the mear fact, these women tend to have mental health unstabilites.   Substance abuse further complicates their plight.   We have services in place to help them find a living situation that would be in their best interest, however, they are still able to accept or decline help.   We see this population coming in to the OB triage frequently to obtain some prenatal care, which is better than none.   It is frightening for them, they know their child will be taken away from them, they also may fear repurcutions of their drug use concerning their baby.     In South Carolina, drug abuse by a pregnant woman is the toughest in the nation.   In 1997, a South Carolina court ruled that expectant mothers who use drugs can be convicted of child abuse, dozens of women in that state have faced charges due to their drug abuse (“Pregnant and homeless,” 2001) .   Being part of this vulnerable population puts the woman and unborn baby at-risk.   These women fall through the cracks without proper advocacy.   There is so much that needs to be done to help this woman find success in her life, it is overwhelming for the nurse and professionals trained in this area, we can only imagine how heavy this burden must be for the woman when she stands alone.

Amy Winehouse had borderline personality disorder, this was her vulnerability, this made her susceptible to self-destructive behaviors.   Freddy Mercury (Queen) was a member of an at-risk population, he was a gay man with HIV.   This made his body vulnerable to AIDS.   Amy and Freddy lost their lives due to their vulnerability and at-risk factors.   We all carry our histories in our bodies.

 

References

Maurer, F. A., & Smith, C. M. (2013). Vulnerable populations. In Community/public health nursing practice (5th ed., pp. 527-551). [Elsevier]. http://dx.doi.org/978-1-4557-0762-1

Minnesota Department of Health. (2016). http://www.health.state.mn.us/oep/responsesystems/atriskdef.html

Pregnant and homeless. (2001). Retrieved from http://www.nhchc.org/wp-content/uploads/2011/10/preg.pdf

 

 

Create a presentation that you might share with a professional society/organization or a group of fellow students who have expressed interest in healthcare operations management as a career choice. You will not actually be required to present this to a group, but prepare the project so that it would be acceptable for an audience of that nature.

 

This portfolio project will be an amalgamation of all previous assignments; it will consist of visual representations of the following elements:

 

• A review of internships or volunteer opportunities

 

• A summary of professional certifications

 

• A summary of the major points on project management covered in your Module 5 Critical Thinking assignment

 

• A summary of the major points on process

 

• A self-created image to illustrate the Define-Measure-Analyze-Improve-Control model used for quality management (you can use Smart Art located within Microsoft products or use any online tool to create the image); provide a brief description of each element contained in the image

 

• A self-created process map/flowchart illustrating the inputs, outputs, and steps of a process of your choosing

 

All content slides should include brief audio/voice-over commentary via VoiceThread; this feature allows you to add further commentary, just as you would in a real presentation.

 

Your presentation should contain approximately 15 content slides, with additional slides for the title of the presentation and references. Your presentation must support your claims by including at least four appropriate references and be formatted according to CSU-Global Guide to Writing and APA Requirements.

 

Familiarize yourself with the VoiceThread site. Note that you will need to sign up for an individual free account.

Shipments of meat, meat by-products, and other ingredients are mixed together in several filling lines at a pet food canning factory. Management suspects that, although the average amount filled in the can of pet food is usually the same, the variability of the cans filled in Line A is much greater than that of Line B. The following sample data are obtained from filling 8-ounce cans. Assuming that the population variances are unequal, at the .05 level of significance, is there evidence of a difference between the average weights of cans filled on the two lines?

line a / line b 
8.005/7.997 x value
.012/.005 s value
11/16 N vale

a. If you use the 5% level of significance, what is the value of p? 
A) 2.09
B) .0586
C) .0038
D) .0293

b. What is the decision at the 5% level of significance? 
A) Fail to reject the null hypothesis: conclude that the lines are not different. 
B) Reject the null hypothesis and conclude the lines are different. 
C) Reject the alternate hypothesis and conclude Line A is different. 
D) Fail to reject the alternate hypothesis and conclude that both lines are different. 

 

c. This example is what type of test? 
A) One sample test of means. 
B) Two sample test of means. 
C) Paired t-test. 
D) Test of proportions.