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Case Study

Heart Failure

Patient Profile

M.G. is a 77 year old woman who saw her health care provider for dyspnea. She is now being admitted to the hospital for acute heart failure. She was diagnosed once before with heart failure 6 years ago. She is currently taking the following medications:

Furosemide 40mg po daily

Potassium chloride 20meq po daily

Enalapril 10mg po BID

Subjective data

Was taking furosemide at home but ran out two days ago and has not been able to refill her prescription

Complains of difficulty breathing; had to “sleep in the chair” last night

Has some swelling in her feet that is worse than usual

Objective Data

Physical examination

· Temp 98.4 F, pulse 92 irreg., resp. 24 labored, blood pressure 144/86, oxygen saturation 89% on Room air

· Ht. 5’5”, wt. 170 lbs.

· Alert and oriented to person, place, and time

· Fine crackles bilateral lower lobes

· Shortness of breath with minimal exertion

· S1 and S2 without murmur or extra heart sounds

· Capillary refill sluggish in lower extremities, normal in upper extremities

· 2+ pitting edema bilateral lower extremities

Interprofessional Care

Admission orders include: 

· Oxygen 2L/ nasal cannula

· Furosemide 40mg intravenous BID

· Enalapril 10mg po BID

· ECG now

· Vital signs with SPO2 q 4 hrs

· 2 gm sodium diet

· Strict I&O

· Daily weight

Answer the following questions thoroughly and cite resources appropriately in APA format.

Describe a plan for implementing these orders. 

Based on M.G.’s clinical manifestations, what type of heart failure do you suspect? Support your answer

What assessment data will you use to determine the effectiveness of the provider’s orders?

What is the rationale for the oxygen, IV furosemide, and enalapril?

What are the priority nursing diagnoses for this patient? (list at least 3)

What other orders might you anticipate for this patient?

Think about plans for discharge, what are your primary concerns for this patient?

Any other information you need or would like about this patient?

Week 3 Contemporary Issue Position Essay

Choose a case from the AMA Journal of Ethics Case Index and take a position. For this assignment you will evaluate the ethical arguments for or against the issue. Identify the potential legal arguments (consider current federal guidelines), indicate any potential professional code conflicts you foresee, and support your position with an explanation of your own ethical/moral foundation.

In your 2-3 page paper:

• Identify the issue and state your ethical position.
• How might this scenario play out or impact you in your role as a nurse practitioner? 
• Defend your position with legal, ethical, and professional evidence.
• As part of your position, propose strategies and solutions for addressing the issues.
• What other ethical issues does this case bring to light, if any?

Support your position with at least one scholarly source (it may be your text).  Be sure to cite the article you choose, use APA format, and include a title page and reference page.

Review the rubric for further information on how your assignment will be graded.

Due: Sunday, 11:59 p.m. (Pacific time)

Points: 60

video and answer 

Nursing Case study and pamphlet due 10/30/2020 

Case study

A few weeks ago you were hired as Director of Patient Education for a regional medical center

located in the Midwest. The medical center includes three community hospitals ranging from 175 to

321 beds, four outpatient clinics, and five centers of excellence. The five centers of excellence are

located at two of the hospitals and focus on heart disease, cancer care, care of the aging,

neuromuscular disorders, and women’s health.

In your position you are responsible for coordinating patient education across the medical

center, including all programs and print materials. Your staff includes three BSN-prepared nurses,

one located at each of the hospitals. As one of your initial steps in this new position, you have

completed an assessment of the current educational offerings and staff satisfaction with the quality

of the current programs. One area of need stands out: The professional staff report that a growing

number of patients have been joining online social networking sites. One staff member said, “I think

they are all helping each other get online.” These patients are now raising new and sometimes

difficult questions about treatment options. None of the staff has explored any of the online sites,

and they are afraid to join for fear that they could become involved in some sort of violation of the

Health Insurance Portability and Accountability Act (HIPAA).

Discussion Questions

1. 400 words. Describe how you would develop a staff education program and create an outline of key points that you would include.

2. 200 words Develop a patient handout that the staff can use to educate patients on the effective use of

online social media materials. Within the pamphlet speak on key information regarding the program and the benefits of various form of social media in health promotion and disease prevention. Include pictures in the pamphlet to appeal to your customers. 

A template is provided as an attachment. 

4 discussion

APA

References

Free plagiarism 

Due date 11/23/2020

Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.

It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions.

To Prepare:

• Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.
• Consider how key regulations may impact nursing practice.
• Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion..

 Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected. 

APA format

3 resources  at least in the recent 5 years

1 page

REPLY1

NIH means, National Institute of Health while CAM means, Complimentary and Alternative Medicine Complementary and alternative medicine (CAM) are health care approaches that are used outside the typical western practice. These two approaches are different, complementary is referred to when conventional medicine and another approach is used together, while alternative does not use conventional medicine. (NIH, 2017)Complementary practice includes the use of natural products and mind/body practices. Natural products that are used include herbs, probiotics, vitamins, and minerals. Mind and body practices include yoga, meditation, acupuncture, relaxation techniques chi, hypnotherapy, chiropractic, and osteopathic manipulation therapy. (NIH, 2017). The typical person who uses CAM balances their health through equalization of mind, body, and spirit. (Falvo, 2011). The users of CAM aim in preventing or treating illness and promoting health. Health care professionals who hold degrees in D.O. (doctor of osteopathy) or M.D. (medical doctors) with alliance with other professionals such as psychologists, registered nurses and physical therapists practices conventional medicine. CAM describes a wide range of ambiguous modalities such as herb, meditation which users can administer alone, such as massage, homeopathy and acupuncture that requires involving a practitioner.

CAM is used by people of all backgrounds according to NIH website. However, among adults’ women with higher incomes and level of education tend to use CAM more than men. High usage rates in female is due to nature of being more health conscious and are more likely to take part in preventive health care. Furthermore, in most families, women act as head of healthcare thus leading high usage rates of CAM among families. Majority of CAM users tend to be 35 years and above though its popular among all age groups. In most research studies, a positive association is observed between the CAM use, education and income as well. Einsberg study reported the CAM usage rate as 14% for those lacking high school educations, 37% for the high school graduates and 49% for college, degree and higher levels (Mackenzie et al., 2003).

References:

Falvo, D. R. (2011). Effective patient education: A guide to increased adherence (4th ed.). Sudbury (Massachusetts): Jones and Bartlett.

NIH. (2017). The Use of Complementary and Alternative Medicine in the United States. Retrieved from https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm

Mackenzie, E. R., Taylor, L., Bloom, B. S., Hufford, D. J., & Johnson, J. C. (2003). Ethnic minority use of complementary and alternative medicine (CAM): a national probability survey of CAM utilizers. Alternative therapies in health and medicine, 9(4), 50-57.

Wai Fan, K. (2005). National center for complementary and alternative medicine website. Journal of the Medical Library Association, 93(3), 410.

REPLY2

Complementary and alternative medicine (CAM) are health care approaches that are used outside the typical western practice. These two approaches are different, complementary is referred to when conventional medicine and another approach is used together, while alternative does not use conventional medicine. (NIH, 2017)Complementary practice includes the use of natural products and mind/body practices. Natural products that are used include herbs, probiotics, vitamins, and minerals. Mind and body practices include yoga, meditation, acupuncture, relaxation techniques chi, hypnotherapy, chiropractic, and osteopathic manipulation therapy. (NIH, 2017) The typical person who uses CAM balances their health through equalization of mind, body, and spirit. (Falvo, 2011)

According to, American nurse today, a study was conducted that found aromatherapy helpful in reducing nurse stress in the workplace. (Reynolds, 2018) Aromatherapy uses extracted aromatic essences from plants to balance, complement, and promote the health of body and mind. Nurses participated in a stress test in which stress levels were measured before, during and after diffusing essential oils. Stress was measured using a perceived stress scale(PSS), in which was tested 2 weeks before the intervention, and then over the next 4 weeks during (nebulized diffusers placed at the nurse’s station), and then after 4 weeks after the diffusers were removed. A reduction of stress levels was revealed compared to baseline to during and after aromatherapy. (Reynolds, 2018)

Falvo, D. R. (2011). Effective patient education: A guide to increased adherence (4th ed.). Sudbury (Massachusetts): Jones and Bartlett.

NIH. (2017). The Use of Complementary and Alternative Medicine in the United States. Retrieved from https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm

Reynolds, J. (2018). Using aromatherapy in the clinical setting: Making sense of scents. American Nurse Today, 13(6). Retrieved from https://www.americannursetoday.com/aromatherapy-clinical-setting/.

For this Assignment, select a local or state health care policy or legislation that was enacted in the last 5 years. Then:

1. Summarize the policy or legislation.
2. Analyze at least one strength and one weakness of the policy or legislation.
3. Discuss the impact of the policy or legislation for all stakeholders, both providers and consumers.

Page length: 3-4 pages exclusive of cover page and references.

Support your paper with a minimum of three scholarly references.

1) Minimum 7 full pages (Follow the 3 x 3 rule: minimum three paragraphs per part)

               Part 1: Minimum 1 page

              Part 2: minimum 1 page

              Part 3: minimum 1 page

              Part 4: minimum 1 page 

              Part 5: Minimum 1 page

              Part 6: minimum 1 page

              Part 7: minimum 1 page

Submit 1 document per part

2)¨******APA norms, please use headers

          All paragraphs must be narrative and cited in the text- each paragraphs

          Bulleted responses are not accepted

          Dont write in the first person 

          Dont copy and pase the questions.

          Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

         Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references per part not older than 5 years

5) Identify your answer with the numbers, according to the question.

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc 

__________________________________________________________________________________

Part 1:

1. Explain the planning process of community health improvement. 

2. Choose one of the models / tools for community health planning discussed in your book and explain it. (Please, mention which model / tool you chose).  (See chapter 1 and 2).

Part 2:  

1. Mention at least three benefits of massage physical level and explain them

2. Mention at least 3 contraindications of massage and explain them

2. Have you ever had a massage? 

a. What type of massage? Please, tell about your experience. 

 Part 3:  

1. To best understand the concepts of ethics, define the following terms:

• Utilitarianism
• Egoism
• Relativism
• Absolutism

2.List two of the functions of a gerontological nurse regardless of practice setting.

 Part 4:  

1. Complete the following Quiz:

http://www.educationplanner.org/students/self-assessments/learning-styles-quiz.shtml

and check this page:

https://serc.carleton.edu/NAGTWorkshops/certop/vignettes.html

2.  How does your learning style compare to your teaching style? 

 Part 5:  

Using the hierarchical order of Bloom’s taxonomy for the cognitive domain, 

1. develop a learning objective related to a selected nursing course for each of the six categories of cognitive skills: knowledge, comprehension, application, analysis, synthesis, and evaluation. 

Part 6:  

Research topic: Nursing professional care in the prevention of infections associated with health care in intensive care units.

Problem question: What is the nursing professional’s care in preventing infections associated with health care in an adult Intensive Care Unit, according to the scientific literature review?

Appropriate data collection is a critical component in obtaining useful data for your research. Using your proposed research topic and research questions, 

1. Explain your plan for data collection (See image data collection ). 

2. Discuss potential issues in your data collection plan and your plans to overcome these challenges. 

Part 7:  

Watch the interactive video on ethical research from the nurse’s perspective using the directions below. Conducting research with strong ethical principles is a critical component of being an effective nurse researcher. 

1. What did you learn from participating in the interactive lessons on ethical principles in research? 

2. Are ethics in research clear cut, or do you think there are some gray areas? Explain your answer. 

3. How will you ensure that your research is conducted in an ethical manner? What potential challenges might you face?

Part 7:  

Evidence-based practice (EBP) is an important topic in healthcare organizations. 

1. How do you think you could apply EBP in your current nursing practice? Please provide 2 examples.

Case Study: Urinary Tract Infection

You are working in an extended care facility when M.Z.’s daughter brings her mother in for a week’s stay while she goes on a planned vacation. M.Z. is an 89-year-old widow with a 4-day history of non- localized abdominal pain, incontinence, new-onset mental confusion, and loose stools. Her most current vital signs are 118/60, 88, 18, 98.4° F (37.4° C). The medical director ordered a post void catheterization, which yielded 100mL of cloudy urine that had a strong odor, and several lab tests on admission. Urine culture and sensitivity results are pending; the other results are shown in the chart.

Chart View Laboratory Test Results:

Complete metabolic panel: Within normal limits except for the following results:

 BUN 25mg/dL Sodium 131mEq/L

 Potassium 3.2mEq/L

White blood cell count 11,000/mm3

Urinalysis Appearance Cloudy Odor Foul

 pH 6.9

 Protein Negative

 Nitrites Positive

 Crystals Negative

WBCs 6 per low-power field

 RBCs 3

1. What condition do the lab reports point toward?
2. Which assessment findings are typical of an older adult with the condition in Question 1?
3. Considering her history and laboratory results, what other condition is a possibility?

4.The medical director makes rounds and writes orders to start an IV of D5 ½NS at 75mL/hr. and insert a Foley catheter to gravity drainage. Because M.Z. is unable to take oral medications, the medical director orders ciprofloxacin (Cipro) 400mg q12h IV piggyback (IVPB). Are the type of fluid and rate appropriate for M.Z.’s age and condition? Explain.

 5. While the IVPB ciprofloxacin is being administered, which adverse effects might occur?

6. You enter the room to start the IV infusion and insert the Foley catheter and find that the nursing assistive personnel (NAP) has taken M.Z. to the bathroom for a bowel movement. M.Z. asks you to help her, and, as you open the door, you observe her wiping herself from back to front. What do you need to do at this time?

7. Because M.Z. has been having diarrhea, what special instructions should you give the NAP assigned to give basic care to M.Z.?

Case Study Progress:

 The next day, you are the nurse assigned to M.Z.’s care. You notice that the NAP emptying the gravity drain is not wearing personal protection devices. You also observe that the drainage port of the drainage bag was contaminated during the process because the NAP allowed it to touch the floor.

8. What issues need to be considered in protecting M.Z.’s safety? Describe your actions in working with the nursing assistant.

9. As you assess M.Z., you notice that her catheter tubing is not secured. Why does the tubing need to be secured, and where is the correct place for the catheter tubing?

10. What changes, if any, will be made to the antibiotic therapy?