Cardiorespiratory Complexities NRS 410V
Summary of Current Course Content Knowledge
Academic engagement through active participation in instructional activities related to the course objectives is paramount to your success in this course and future courses. Through interaction with your instructor and classmates, you will explore the course material and be provided with the best opportunity for objective and competency mastery. To begin this class, review the course objectives for each Topic, and then answer the following questions as this will help guide your instructor for course instruction.
- Which weekly objectives do you have prior knowledge of and to what extent?
- Which weekly objectives do you have no prior knowledge of?
- What course-related topics would you like to discuss with your instructor and classmates? What questions or concerns do you have about this course?
Objectives:
- Evaluate functions of the cardiac and respiratory systems based on findings.
- Develop a health promotion with a restoration teaching plan for a patient with cardiorespiratory complexities. Cardiorespiratory Complexities NRS 410V
- Develop a method for patient education to prevent hospital readmission.
NRS 410V Topic 1 DQ 1
Identify a cardiac or respiratory dysfunction and its cause. Outline the key steps necessary to prevent the dysfunction and improve health status.
NRS 410V Topic 1 DQ 2
Discuss what resources are available for chronic cardiorespiratory issues to support patient independence and prevent readmission. Explain how readmission affects reimbursement. What implications does readmission have on the hospital, and on the patient?
Case Study: Mrs. J.
Assessment Description
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
- Is very anxious and asks whether she is going to die.
- Denies pain but says she feels like she cannot get enough air.
- Says her heart feels like it is “running away.”
- Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
- Height 175 cm; Weight 95.5kg.
- Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
- 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.
- Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
- Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
- IV furosemide (Lasix)
- Enalapril (Vasotec)
- Metoprolol (Lopressor)
- IV morphine sulphate (Morphine)
- Inhaled short-acting bronchodilator (ProAir HFA)
- Inhaled corticosteroid (Flovent HFA)
- Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:
- Describe the subjective and objective clinical manifestations present in Mrs. J.
- Describe four cardiovascular conditions in which Mrs. J is at risk, and that may lead to heart failure. What can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions?
- By following the nursing process, were the interventions at the time of admissions beneficial for Mrs. J? Would you change any of the interventions to ensure patient independence and prevent readmission?
- Explain each of the seven medications listed in the scenario above. Include the classification, the action, and the rationale for each of these. 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.
- Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence and prevent readmission.
- Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits.
You are required to cite a minimum of three 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.
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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Case Study: Mrs. J. Sample Excerpt
Clinical Manifestations in Mrs. J.
COPD causes increasing airflow restriction accompanied by an aberrant inflammatory reaction to the lungs to irritating particles or gases. In this case, Mrs. J is a smoker and continues smoking. Inflammation occurs in the airways, lung parenchyma, and pulmonary vasculature. Inflammation in the pulmonary vasculature leads to the possible rupture of vessels and the bloody sputum she coughs.
Hinkle and Cheever (2018) explain that changes and constriction of the airways occur due to inflammatory processes and the body’s attempts to heal itself. Changes in the proximal airways, trachea, and bronchi include an elevation in the number of goblet cells and an enlargement of the submucosal glands, both of which contribute to mucus hypersecretion. This can be shown by the bloody sputum she coughs.
In the peripheral airways, the bronchioles, inflammation produces obstructive bronchiolitis. This accounts for the fact that she says she feels like she cannot get enough air. This continuing injury-and-repair process leads to scar tissue development and constriction of the airway. The breakdown of the alveolar wall results in a reduction in elastic recoil (Hinkle & Cheever, 2018). The chronic inflammatory process affects the pulmonary vasculature, causing thickening of the artery lining, which leads to pulmonary hypertension.
Nursing Interventions for Mrs. J. And the Rationale For Each Of The Medications Listed
Furosemide treats edema caused by congestive heart failure exacerbation, liver failure, renal failure, and hypertension. According to Seifert (2019), it acts primarily by reducing electrolyte reabsorption from the kidneys and increasing water excretion from the body. In patients with profound congestive heart failure and poor clinical response to standard antihypertensive medications, enalapril therapy improves cardiac function as measured by a decrease in both preload and afterload, as well as long-term clinical status (Seifert, 2019).
In patients with congestive heart failure, enalapril enhances cardiac output and stroke volume while lowering pulmonary capillary wedge pressure. Metoprolol is used to treat heart failure, atrial fibrillation, and high blood pressure (Seifert, 2019). All of the indications for metoprolol are associated with cardiovascular disease.
Morphine sulfate is an opioid agonist used to relieve pain not relieved by non-narcotic analgesics. Salbutamol is prescribed to treat; bronchospasm, chronic bronchitis, obstructive airway ailments, and chronic bronchopulmonary disorders, wherein bronchospasm is a confounding factor. Fluticasone propionate is an inhaler that has been licensed for the treatment and prevention of asthma and therefore was not necessary.
According to Seifert (2019), in therapeutic settings, oxygen therapy is used to treat various forms of anoxia, hypoxia, or dyspnea, as well as any other disease states or situations that limit the efficiency of gas exchange and oxygen consumption, such as respiratory ailments. The goal of oxygen treatment is to achieve hyperoxia to lessen the level of hypoxia-induced tissue damage and dysfunction.
Cardiovascular Conditions That Cause Heart Failure
Heart failure can occur abruptly (acute) or gradually (chronic). It can damage either one or both sides of the heart. Heart failure is usually triggered by another medical issue that destroys the heart. Coronary artery disease, heart inflammation, high blood pressure, and cardiomyopathy are the cardiovascular conditions that lead to heart failure. … Place Your Order Here for Full Solution.
References
Fialová, D., Kummer I., Držaić M., & & Leppee, M. (2018). Ageism in medication use in older patients. In Contemporary Perspectives On Ageism (pp. 213-240). Springer, Cham.
Groenewegen, A., Rutten, F. H., Mosterd, A., & Hoes, A. W. (2020). Epidemiology of heart failure. European Journal of Heart Failure, 22(8), 1342–1356. https://doi.org/10.1002/ejhf.1858
Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth’s textbook of medical-Surgical Nursing. Wolters Kluwer.
Seifert, R. (2019). Basic knowledge of pharmacology. Springer International Publishing. https://doi.org /10.1007/978-3-030-18899-3
Viniol, C., & Vogelmeier, C. F. (2018). Exacerbations of COPD. European Respiratory Review: An Official Journal of the European Respiratory Society, 27(147), 170103. https://doi.org/10.1183/16000617.0103-2017
Vitacca, M., & Paneroni, M. (2018). Rehabilitation of patients with coexisting COPD and heart failure. COPD Journal of Chronic Obstructive Pulmonary Disease, 15(3), 231–237. https://doi.org/10.1080/15412555.2018.1468427
Case Study: Mrs. J. Resources
- Pathophysiology: Clinical Applications for Client Health
Read Chapter 1 in Pathophysiology: Clinical Applications for Client Health.
Pathophysiology: Clinical Applications for Client Health (Second Edition)
Editor: Grand Canyon University
© 2022 Grand Canyon University. All Rights Reserved. No part of this eBook may be
reproduced, in any form or by any means, without permission in writing from the publisher.
Photography credits and illustrations: Grand Canyon University, Copyright © 2022.
Authors: Angel Falkner, Sue Z. Green, Andrea Johnson, Jeannie Randall, and Stacey Whitney
- Acute Myocardial Infarction
Read “Acute Myocardial Infarction,” by Reed, Rossi and Cannon, from The Lancet (2017).
- Congestive Heart Failure and Congenital Defects
Read “Congestive Heart Failure and Congenital Defects,” located on the American Heart Association website.
- Evaluating the Effectiveness of an Online Cardiac Rehabilitation Resource (www.svhhearthealth.com.au) in Improving Knowledge and Confidence for Patients With Newly Diagnosed Cardiac Conditions: A Pre-Experimental Pilot Study
Read “Evaluating the Effectiveness of an Online Cardiac Rehabilitation Resource (www.svhhearthealth.com.au) in Improving Knowledge and Confidence for Patients With Newly Diagnosed Cardiac Conditions: A Pre-Experimental Pilot Study,” by Molan, Emmanuel, Langley and Holloway, from Heart, Lung and Circulation, 2019. Cardiorespiratory Complexities NRS 410V
- GOLD Initiative for Chronic Obstructive Lung Disease
Explore the Global Initiative for Chronic Obstructive Lung Disease (GOLD) website.
- Identifying Self-Care Practices in Heart Failure Patients
Read “Identifying Self-Care Practices in Heart Failure Patients”, by Koster, J, from The Nursing Voice, 9(1) (2021).
- Patient Perceived Impact of Nurse-Led Self-Management Interventions for COPD: A Systematic Review of Qualitative Research
Read “Patient Perceived Impact of Nurse-Led Self-Management Interventions for COPD: A Systematic Review of Qualitative Research,” by Baker and Fatoye, from International Journal of Nursing Studies (2019).
- Nurseslabs-For All Your Nursing Needs
Refer to the nurseslabs.com website for pharmacology support in completing the assignment for the topic 1 case study.
- Optional- A Nursing Care of Patients After Cardiac Arrest in the Course of Myocardial Infarction
For additional information, the following is recommended:
“A Nursing Care of Patients After Cardiac Arrest in the Course of Myocardial Infarction,” by Kaminska and Krzeminska, from Journal of Education, Health and Sport (2018).
https://doaj.org/article/39ac6a139c46478997596aa30cf17811?
- Optional- Atrial Fibrillation Symptom Perception
For additional information, the following is recommended:
“Atrial Fibrillation Symptom Perception,” by Streur, from Journal for Nurse Practitioners (2019).
- Optional- Exploring New Pathways and Emerging Data for Better Control and Management in the Personalized Treatment of Severe Asthma
For additional information, the following is recommended:
“Exploring New Pathways and Emerging Data for Better Control and Management in the Personalized Treatment of Severe Asthma,” by Bernstein, D.I., Journal of Managed Care Medicine, 23(1) (2020).
- Optional- Ludwig’s Angina: a Multidisciplinary Concern
For additional information, the following is recommended:
“Ludwig’s Angina: A Multidisciplinary Concern,” by Parker and Mortimore, from British Journal of Nursing (2019).
Cardiorespiratory Complexities NRS 410V Case Study: Mrs. J. Rubric
Rubric Criteria
Clinical Manifestations of Patient
Criteria Description
Description of subjective and objective clinical manifestations
Cardiovascular Conditions Leading to Heart Failure and Interventions
Criteria Description
Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure. Explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the presented conditions.
Evaluation of Nursing Interventions at Admissions
Criteria Description
Description of the benefit of the intervention at the time of admission using the nursing process. Explanation of any changes to the interventions to ensure patient independence and prevent readmission.
Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions
Criteria Description
Explanation of seven medications listed in the scenario, including the classification, action, and rationale for each. Discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions.
Health Promotion and Restoration Teaching Plan
Criteria Description
Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications. Explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission.
COPD Triggers and Options for Smoking Cessation
Criteria Description
Discussion of options for smoking offered considering patient’s current and long-term tobacco use. Outline of COPD triggers that can increase exacerbation frequency, resulting in readmission.
Thesis, Position, or Purpose
Criteria Description
Communicates reason for writing and demonstrates awareness of audience.
Development, Structure, and Conclusion
Criteria Description
Advances position or purpose throughout writing; conclusion aligns to and evolves from development.
Evidence
Criteria Description
Selects and integrates evidence to support and advance position/purpose; considers other perspectives.
Mechanics of Writing
Criteria Description
Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.
Format/Documentation
Criteria Description
Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.
WEEK 2 NRS 410 Case Study: Mr. M.
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 Mr. M., 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
Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no known allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.
Case Scenario
Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.
Objective Data
- Temperature: 37.1 degrees C
- BP 123/78 HR 93 RR 22 Pox 99%
- Denies pain
- Height: 69.5 inches; Weight 87 kg
Laboratory Results
- WBC: 19.2 (1,000/uL)
- Lymphocytes 6700 (cells/uL)
- CT Head shows no changes since previous scan
- Urinalysis positive for moderate amount of leukocytes and cloudy
- Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mr. M.’s situation. Include the following:
- Describe the subjective and objective clinical manifestations present in Mr. M.
- Based on the information presented in the case scenario, state what primary and secondary medical diagnoses should be considered for Mr. M. Formulate a nursing diagnosis from the medical diagnosis and explain why these should be considered and what data is provided for support.
- What abnormalities would you expect to find and why when performing your nursing assessment using the identified primary and secondary medical diagnoses.
- Describe the physical, psychological, and emotional effects Mr. M.’s current health status may have on him. Discuss the impact it can have on his family.
- Discuss what interventions can be put into place to support Mr. M. and his family.
- Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide a rationale for each.
You are required to cite a minimum of three 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.
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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
RUBRIC
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Case Study: Mr. M. – Rubric
Rubric Criteria
Clinical Manifestations of Mr. M.
Criteria Description
Clinical Manifestations of Mr. M.
- Target
Subjective and objective clinical manifestations are thorough.
Diagnoses and Secondary Diagnoses
Criteria Description
Diagnoses and Secondary Diagnoses
- Target
Discussion on what primary and secondary medical diagnoses should be considered, nursing diagnosis formulated from the medical diagnosis, and rationale and data that supports the medical and nursing diagnoses are thorough.
Explanation of Expected Abnormalities During Nursing Assessment
Criteria Description
Explanation of Expected Abnormalities During Nursing Assessment
- Target
A thorough discussion of abnormalities a nurse would expect to find during a nursing assessment is presented. Strong rationale and evidence are provided for support.
Health Status Effect on Physical, Psychological, and Emotional Aspects of Patient and Family
Criteria Description
Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family.
- Target
Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family is thorough.
Interventions for Support
Criteria Description
Discussion of interventions that can be put into place to support patient and his family
- Target
Discussion of interventions that can be put into place to support the patient and his family is thorough.
Actual or Potential Problems Based on Condition
Criteria Description
Discussion and rationale of four or more actual or potential problems faced by the patient
- Target
Discussion and rationale of four or more actual or potential problems faced by the patient are thorough.
Discussion and rationale of four or more actual or potential problems faced by the patient are omitted.
Thesis, Position, or Purpose
Criteria Description
Communicates reason for writing and demonstrates awareness of audience.
- Target
The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.
- Acceptable
The thesis, position, or purpose is not discernible. No awareness of the appropriate audience is evident.
Development, Structure, and Conclusion
Criteria Description
Advances position or purpose throughout writing; conclusion aligns to and evolves from development.
- Target
The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.
No advancement of the thesis, position, or purpose is evident. Connections between paragraphs are missing or inappropriate. No conclusion is offered.
Evidence
Criteria Description
Selects and integrates evidence to support and advance position/purpose; considers other perspectives.
- Target
Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered.
Evidence to support the thesis, position, or purpose is absent. The writing relies entirely on the perspective of the writer.
Mechanics of Writing
Criteria Description
Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.
- Target
No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.
Format/Documentation
Criteria Description
Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.
RESOURCES
Pathophysiology: Clinical Applications for Client Health
Read Chapter 2 in Pathophysiology: Clinical Applications for Client Health.
View Resource
Cost-Effectiveness of Emergent MRI During Stroke Alert to Diagnose Stroke Mimics: Single-Center Experience
Read “Cost-Effectiveness of Emergent MRI During Stroke Alert to Diagnose Stroke Mimics: Single-Center Experience,” by Kapoor, Sha
… Read More
Couples Coping in the Community After the Stroke of a Spouse: A Scoping Review
Read “Couples Coping in the Community After the Stroke of a Spouse: A Scoping Review,” by Ramazanu, Alie, and Vico Chung, from
… Read More
Long-Term Effects on Survival After a 1-Year Multifactorial Vascular Risk Factor Intervention After Stroke or TIA: Secondary Analysis of a Randomized Controlled Trial, a 7-Year Follow-Up Study
Read “Long-Term Effects on Survival After a 1-Year Multifactorial Vascular Risk Factor Intervention After Stroke or TIA: Secondary An
… Read More
This Is Not Only About Memory: A Systematic Review on Neuropsychology Heterogeneity in Alzheimer’s Disease
Read “This Is Not Only About Memory: A Systematic Review on Neuropsychology Heterogeneity in Alzheimer’s Disease,” by Martorelli,
… Read More
This Is Our Life Now. Our New Normal: A Qualitative Study of the Unmet Needs of Carers of Stroke Survivors
Read “‘This Is Our Life Now. Our New Normal’: A Qualitative Study of the Unmet Needs of Carers of Stroke Survivors,” by Denham et
… Read More
Optional- Disentangling Heterogeneity in Alzheimer’s Disease and Related Dementias Using Data-Driven Methods
For additional information, the following is recommended:
“Disentangling Heterogeneity in Alzheimer’s Disease and Relate
… Read More
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0006322320300500
Optional- Suicidal Ideation and Traumatic Exposure Should Not Be Neglected in Epileptic Patients: A Multidimensional Comparison of the Psychiatric Profile of Patients Suffering From Epilepsy and Patients Suffering From Psychogenic Nonepileptic Seizures
For additional information, the following is recommended:
“Suicidal Ideation and Traumatic Exposure Should Not Be Neglected in
… Read More
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509224/
NRS 410 Week 3 Mr C Case Study
Case Study: Mr. C.
Requires Lopeswrite
Assessment Description
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 Mr. C., 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
Mr. C., a 32-year-old single male, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, even as a small child, gaining approximately 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control by restricting dietary sodium. Mr. C. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.
Objective Data:
- Height: 68 inches; weight 134.5 kg
- BP: 172/98, HR 88, RR 26
- 3+ pitting edema bilateral feet and ankles
- Fasting blood glucose: 146 mg/dL
- Total cholesterol: 250 mg/dL
- Triglycerides: 312 mg/dL
- HDL: 30 mg/dL
- Serum creatinine 1.8 mg/dL
- BUN 32 mg/dl
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:
- Describe the subjective and objective clinical manifestations present in Mr. C.
- Describe the potential health risks for obesity that are of concern for Mr. C. Explain whether bariatric surgery is an appropriate intervention.
- Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems you can identify from the functional health patterns and provide the rationale for each. (Functional health patterns include health-perception, health-management, nutritional, metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)
- Explain the stages of renal disease that leads to end-stage renal disease (ESRD). What factors contributed to Mr. C’s ESRD?
- Consider ESRD prevention and health promotion opportunities. Describe what type of patient education for ESRD should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.
- Explain the type of resources available for ESRD patients for nonacute care and the type of multidisciplinary approach that would be beneficial for these patients. Include aspects such as devices, transportation, living conditions, return-to-employment issues.
You are required to cite a minimum of three 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.
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.
Case Study: Mr. C. – Rubric
Rubric Criteria
Clinical Manifestations of Mr. C.
Criteria Description
Detail of subjective and objective clinical manifestations.
Potential Health Risks for Obesity and Bariatric Surgery
Criteria Description
Discussion of the potential health risks for obesity and the appropriateness of bariatric surgery as an intervention.
Functional Health Patterns
Criteria Description
Discussion of at least five actual or potential problems identified from the functional health patterns assessment, and rationale for each.
Staging and Contributing Factors of End-Stage Renal Disease (ESRD)
Criteria Description
Explanation of the stages of renal disease that lead to end-stage renal disease (ESRD), and what factors contributed to the patient’s ESRD.
Health Promotion and Prevention Opportunities for ESRD
Criteria Description
Description of patient education for the prevention and health promotion opportunities for ESRD, including preventing future events, health restoration, and avoidance of deterioration of renal status.
Resources for ESRD Patients for Nonacute Care and Multidisciplinary Approach
Criteria Description
Explanation of the types of resources available for ESRD patients for nonacute care, and the benefit of a multidisciplinary approach including aspects such as devices, transportation, living conditions, return-to-employment issues.
Thesis, Position, or Purpose
Criteria Description
Communicates reason for writing and demonstrates awareness of audience.
The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.
Development, Structure, and Conclusion
Criteria Description
Advances position or purpose throughout writing; conclusion aligns to and evolves from development.
The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.
Evidence
Criteria Description
Selects and integrates evidence to support and advance position/purpose; considers other perspectives.
Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered.
Mechanics of Writing
Criteria Description
Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.
No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.
Format/Documentation
Criteria Description
Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.
No errors in formatting or documentation are present.
RESOURCES
Pathophysiology: Clinical Applications for Client Health
Read Chapter 3 in Pathophysiology: Clinical Applications for Client Health. Note: Table 3.4 is incorrect, and should say low protein diet instead of high protein diet. … Read More
View Resource
Acute Kidney Failure
Read “Acute Kidney Failure,” located on the Mayo Clinic website.
https://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-20369048
Chronic Kidney Disease (CKD) Symptoms and Causes
Read “Chronic Kidney Disease (CKD) Symptoms and Causes ,” located on the National Kidney Foundation website (2022).
https://www.kidney.org/atoz/content/about-chronic-kidney-disease
Estimated Glomerular Filtration Rate Decline and Risk of End-Stage Renal Disease in Type 2 Diabetes
Read “Estimated Glomerular Filtration Rate Decline and Risk of End-Stage Renal Disease in Type 2 Diabetes,” by Megumi et al., fro
… Read More
Kidney Failure (Symptoms, Signs, Stages, Causes, Treatment, and Life Expectancy)
Read “Kidney Failure (Symptoms, Signs, Stages, Causes, Treatment, and Life Expectancy),” by Wedro, located on the MedicineNet web
… Read More
https://www.medicinenet.com/kidney_failure/article.htm
Nephrotoxicity of Iodinated Contrast Media: From Pathophysiology to Prevention Strategies
Read” Nephrotoxicity of Iodinated Contrast Media: From Pathophysiology to Prevention Strategies,” by Faucon, Bobrie, and Clement,
… Read More
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0720048X19300993
Optional- Ascites: A Common Problem in People With Cirrhosis
For additional information, the following is recommended:
“Ascites: A Common Problem in People With Cirrhosis,” by Chalasan
… Read More
Optional- Changes in Glomerular Filtration Rate and Outcomes in Patients With Atrial Fibrillation
For additional information, the following is recommended:
“Changes in Glomerular Filtration Rate and Outcomes in Patients With
… Read More
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0002870317304052
Optional- Management of Hypertriglyceridemia Induced Acute Pancreatitis
For additional information, the following is recommended:
“Management of Hypertriglyceridemia Induced Acute Pancreatitis,”
… Read More
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=130921988&site=eds-live&scope=site
Optional- Pathophysiological, Molecular and Therapeutic Issues of Nonalcoholic Fatty Liver Disease: An Overview
For additional information, the following is recommended:
“Pathophysiological, Molecular and Therapeutic Issues of Nonalcoholic
… Read More
Optional- Recurrent Acute Pancreatitis During a Ketogenic Diet—A Case Report and Literature Review
For additional information, the following is recommended:
“Recurrent Acute Pancreatitis During a Ketogenic Diet—A Case R
… Read More
Optional- Screening and Management of Hepatitis C: Use Education to Dispel the Myths About the Disease and Increase Screening and Treatment
For additional information, the following is recommended:
“Screening and Management of Hepatitis C: Use Educat
… Read More
Optional- Social Determinants of Health: Understanding the Basics and Their Impact on Chronic Kidney Disease
For additional information, the following is recommended:
“Social Determinants of Health: Understanding the Basics and Their Im
… Read More
Optional- Using Learning Science to Optimize Chronic Kidney Disease Education for Patients and Providers
For additional information, the following is recommended:
“Using Learning Science to Optimize Chronic Kidney Disease Education
… Read More
Optional- Variceal Bleeding in Alcoholic Liver Cirrhosis – A Short Review
For additional information, the following is recommended:
“Variceal Bleeding in Alcoholic Liver Cirrhosis – A Short Revie
… Read More
Case Study: Mr. C Example
Describe the subjective and objective clinical manifestations present in Mr. C.
Based on his weight and height, Mr. C has a body mass index (BMI) of 47.9, making him morbidly obese and at risk for developing type 2 diabetes, diabetes and coronary heart disease. His pulse rate, blood pressure, and breathing all point to high blood pressure, stage 2, which he is aware of and tries to control by reducing the sodium in his diet, but this persists despite his efforts. Diabetes is likely given his high BMI and fasting blood glucose (FBS) level of 146 mg/dL. Mr. C has hyperlipidemia, as evidenced by his lipid panel results of 250 mg/dL for cholesterol, 30 mg/dL for HDL, and 312 mg/dL for triglycerides. The blood creatinine level is 1.8 mg/dL, a BUN of 32 mg/dL, and 3+ pitting edema in both feet and ankles. He admits he has been overweight since childhood, increasing his risk for diabetes, depression, and cardiovascular illnesses.
Describe the potential health risks for obesity that are of concern for Mr. C. Explain whether bariatric surgery is an appropriate intervention.
Mr. C’s weight increases his risk for numerous diseases and conditions, such as type 2 diabetes, stroke, coronary heart disease, hypertension, sleep apnea, osteoarthritis, fatty liver disease, and chronic renal disease. He may be a suitable candidate for bariatric surgery, which can help him lose weight and retake control of his health. Eligibility criteria for bariatric surgery include a BMI of 40 or more, the absence of any medical or psychological issues of any severity, age between 18 and 65, and abstinence from substance abuse or abstinence from alcohol and tobacco use for three months before the procedure. (Sudlow et al., 2020) Patients must also adhere to a healthy lifestyle by eating well, taking their medications as prescribed, exercising regularly, joining a support group, and keeping their scheduled appointments. Mr. C’s weight loss will have further health benefits, as metabolic surgery is an effective treatment for sleep apnea, hypertension, obesity, and diabetes (Sudlow et al., 2020). Mr. C will benefit from bariatric surgery because it addresses more than just his weight and includes behavioral modification and mental health counseling.
Mr. C’s Functional Health Patterns
Health awareness: Mr. C. thinks his weight is a problem and wants to learn more about bariatric surgery. However, he does not seem to realize how his weight affects his wellness and the risks he will be taking. He has a history of hypertension and sleep apnea but seems unconcerned about either. His lack of awareness underestimates the seriousness of his health problem.
Health-Management: Mr. C is taking a low-sodium diet in a bid to manage his elevated blood pressure. His blood pressure and diabetes are not adequately addressed, and he is not taking any medications. For the past six months, he has also seen increased pruritus and shortness of breath with activities. He needs to better manage his health by learning to keep his weight, blood pressure, and sugar levels in check.
Nutritional: Mr. C.’s total triglyceride, cholesterol, and HDL levels are all outside of acceptable ranges, and his FBS is also high, 146 mg/dL. He has put on around 100 lbs in the last 2–3 years due to bad eating habits and inactivity. He needs to consult a nutritionist to create a diet to help him reach his goals.
Metabolic: Mr. C. may be diabetic since his FBS level is 146 mg/dL, which is high. His HDL, cholesterol, and triglyceride levels are all elevated, indicating a metabolic condition. He has to be evaluated further to identify and treat any metabolic problems accordingly.
Activity-Exercise: Mr. C. has severe edema in both ankles and notes that his shortness of breath worsens with physical exertion. Even if he wanted to, he would be unable to engage in physical activity due to this, which may lead to further weight gain and negative consequences for his health. He has to collaborate with his medical staff to create a healthy fitness regimen that will help enhance his health.
Explain the stages of renal disease that leads to end-stage renal disease (ESRD). What factors contributed to Mr. C’s ESRD?
ESRD occurs progressively over five distinct phases. The initial phase is kidney damage, but with a normal glomerular filtration rate of over 90 ml/min (Martinusen et al., 2020). The second stage progresses with kidney damage, but the FGR is decreased mildly to 60 to 89 ml/min. Stage three has a moderately decreased GFR of 30 to 59 ml/min, while the fourth stage presents a GFR of 15 to 29 ml/min (Martinusen et al., 2020). The last stage has a GFR of less than 15 ml/min, indicating kidney failures.
A convergence of events caused Mr. C’s ESRD. His hypertension and diabetes, which can lead to kidney damage if left untreated, had a history of being inadequately managed. His increased levels of serum creatinine and BUN suggested renal injury. In addition, he was overweight and had high cholesterol, all of which are risk factors for developing kidney disease. All of these factors probably contributed to Mr. C’s ESRD.
ESRD Health Promotion and Prevention
Despite the lack of a cure for ESRD, treatment options such as kidney transplants and renal dialysis are available to patients. According to Andreoni (2021), kidney transplants are safe for patients of any age, provided they are devoid of cancer and infections and have accessibility to psychological evaluations to address any issues that may occur. As the GFR drops below 15 ml/min and the kidney function drops to between 85 and 90%, dialysis becomes a viable treatment option for ESRD (Andreoni, 2021). Hence, Mr. C has to know that sticking to his dialysis regimen is crucial for keeping his body free of hazardous wastes. As his kidneys cannot filter out all the toxins in his blood, he needs guidance on altering his diet to help. Mr. C should consume more protein and less potassium, salt, and phosphorus. He also has to learn why he must start and maintain a regular exercise program as a person with ESRD.
Resources for ESRD Patients for Nonacute Care and Multidisciplinary Approach
Group therapy and multidisciplinary approaches involving nephrologists, nutritionists, doctors, and emergency resources are available to ESRD patients. Patients with ESRD can get strength and encouragement from their peers and role models by participating in a support group (Evans et al., 2021). Their healthcare givers are invaluable resources for teaching them about their renal health, ESRD risk factors, and symptoms. Dietitians educate and support patients in adopting a diet that slows or stops renal deterioration. Dialysis machines and other essential supplies are available at dialysis clinics or can be provided for home use (Evans et al., 2021). With the help of a social worker, the patient’s health insurance can provide for other essential resources like transport and housing. Social workers are crucial in facilitating their return to the workforce and realizing their potential.
Conclusion
The illness processes highlighted by Mr. C’s case study span various conditions caused by obesity and poor lifestyle choices. He can lessen his risk of many diseases by having bariatric surgery. If he eats well and continues to have ESRD, he can choose between dialysis and a kidney transplant. The case study demonstrates that nurses may improve treatment for ESRD patients by listening to the client’s perspectives and teaching them about their condition and the resources available for enhancing their health.
References
Andreoni, A. (2021). Kidney transplant program specific reporting and transplant metrics. Current Opinion in Organ Transplantation, 27(1), 70–74. https://doi.org/10.1097/mot.0000000000000947
Evans, M., Lewis, D., Morgan, R., Yousef, Z., Patel, C., & Strain, D. (2021). A narrative review of chronic kidney disease in clinical practice: Current challenges and future perspectives. Advances in Therapy, 39(1), 33–43. https://doi.org/10.1007/s12325-021-01927-z
Martinusen, D., Marin, G., Cheng, E., & Lau, W. (2020). Chronic kidney disease and end-stage renal disease. Renal Medicine and Clinical Pharmacy, 45–115. https://doi.org/10.1007/978-3-030-37655-0_4
Sudlow, A., Pournaras, J., & Osborne, A. (2020). Bariatric surgery. Surgery (Oxford). https://doi.org/10.1016/j.mpsur.2020.08.00
NRS 410 Week 4 Benchmark – Nursing Process: Approach to Care
Benchmark
Requires Lopeswrite
Assessment Description
The nursing process is a tool that puts knowledge into practice. By utilizing this systematic problem-solving method, nurses can determine the health care needs of an individual and provide personalized care.
Write a paper (1,750-2,000 words) on cancer and approach to care based on the utilization of the nursing process. Include the following in your paper:
- Describe the different types of diagnostic methods utilized to identify possibility of cancer. Explain the numeric and Tumor, Node, Metastasized (TNM) method of staging of cancer after the confirmed diagnosis.
- Describe at least three complications of cancer, the side effects of treatment, and methods to lessen physical and psychological effects.
- Discuss what factors contribute to the yearly incidence and mortality rates of various cancers in Americans.
- Explain what the American Cancer Society (ACS) might provide for education and support. What ACS services could a nurse recommend for these patients and why?
- Explain how the nursing process is utilized to provide safe and effective care for cancer patients across the life span. Your explanation should include each of the five phases demonstrating the delivery of holistic and patient-focused care.
- How does an interdisciplinary research approach (which includes liberal arts, science studies, mathematics, social and physical sciences), build on the foundational nursing knowledge related to cancer research?
You are required to cite a minimum of four 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.
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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
RN-BSN
1.1: Incorporate liberal arts and science studies into nursing knowledge.
3.1 Utilize the nursing process to provide safe and effective care for patients across the life span.
RUBRIC
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Benchmark – Nursing Process: Approach to Care – Rubric
Rubric Criteria
Diagnosis and Staging of Cancer
Criteria Description
Description of the different types of diagnostic methods utilized to identify possibility of cancer. Explanation of the Tumor, Node, Metastasized (TNM) method of staging cancer after confirmed diagnosis.
Complications of Cancer, Side Effects of Treatment, and Methods to Lessen Effects
Criteria Description
Description of at least three complications of cancer, the side effects of treatment, and methods to lessen physical and psychological effects.
Factors Contributing to Incident and Mortality Rates of Various Cancers in Americans
Criteria Description
Discussion of factors contributing to the yearly incidence and mortality rates of various cancers in Americans.
American Cancer Society (ACS)
Criteria Description
Explanation of what the American Cancer Society (ACS) might provide for education and support including what ACS services a nurse could recommend for patients and why for each service.
Utilization of Nursing Process Across the Life Span (B)
Criteria Description
Explanation of the utilization of the nursing process to provide safe and effective care for patients across the lifespan, including each of the five phases, demonstrating a holistic and patient-focused care. (C3.1)
Contribution of Liberal Arts and Science Studies to Nursing Knowledge (B)
Criteria Description
Explanation of an interdisciplinary research approach that builds on the foundational nursing knowledge related to cancer research (C1.1).
Explanation of how an interdisciplinary research approach that builds on the foundational nursing knowledge related to cancer research is thorough.
Thesis, Position, or Purpose
Criteria Description
Communicates reason for writing and demonstrates awareness of audience.
The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.
Development, Structure, and Conclusion
Criteria Description
Advances position or purpose throughout writing; conclusion aligns to and evolves from development.
The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.
Evidence
Criteria Description
Selects and integrates evidence to support and advance position/purpose; considers other perspectives.
Mechanics of Writing
Criteria Description
Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.
Format/Documentation
Criteria Description
Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.
No errors in formatting or documentation are present.
RESOURCES
Pathophysiology: Clinical Applications for Client Health
Read Chapter 4 in Pathophysiology: Clinical Applications for Client Health.
View Resource
Antibiotics – Seven Wonders of the Microbe World
View “Antibiotics – Seven Wonders of the Microbe World,” by OpenLearn from the Open University (2011), located on the YouTube web
… Read More
Basic Genetics
Explore the Basic Genetics page of the Genetic Science Learning Center/University of Utah website.
http://learn.genetics.utah.edu/content/basics/
Biologic Therapies for Cancer
Read, “Biological Therapies for Cancer,” located on the National Cancer Institute website.
https://www.cancer.gov/about-cancer/treatment/types/immunotherapy/bio-therapies-fact-sheet
Breast Health Services
Explore the Breast Health Services page of the Johns Hopkins Medicine website.
https://www.hopkinsmedicine.org/breast-health-services/index.html#treatment
Epstein-Barr Virus Incidental Expression in Bone Marrow Cells: A Study of 230 Consecutive Bone Marrow Biopsy Samples
Read “Epstein-Barr Virus Incidental Expression in Bone Marrow Cells: A Study of 230 Consecutive Bone Marrow Biopsy Samples,” by F
… Read More
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0046817719300541
Global Trends in Anaphylaxis Epidemiology and Clinical Implications
Read “Global Trends in Anaphylaxis Epidemiology and Clinical Implications,” by Turner, Campbell, Motosue, and Campbell, from
… Read More
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152797/
Idiopathic Anaphylaxis: What You Do Not Know May Hurt You
Read “Idiopathic Anaphylaxis: What You Do Not Know May Hurt You,” by Chan and John, from Journal of the America
… Read More
The Immune System
View “The Immune System,” located on the Howard Hughes Medical Institute (HHMI) website.
https://www.biointeractive.org/classroom-resources/immune-system
Infectious Diseases
Explore the multimedia on Infectious Disease page of the Johns Hopkins Medicine website.
https://www.hopkinsmedicine.org/infectious-diseases/
Management and Outcomes of Patients Presenting With Sepsis and Septic Shock to the Emergency Department During Nursing Handover: A Retrospective Cohort Study
Read “Management and Outcomes of Patients Presenting With Sepsis and Septic Shock to the Emergency Department During Nursing Handover
… Read More
American Cancer Society (ACS)
Explore the American Cancer Society (ACS) website.
Visualizing Gene-Expression Patterns
View “Visualizing Gene-Expression Patterns,” located on the Howard Hughes Medical Institute (HHMI) website.
https://www.biointeractive.org/classroom-resources/visualizing-geneexpression-patterns
Optional- A Descriptive, Cross-Sectional Study Examining Treatment Burden in People Living With HIV
For additional information, the following is recommended:
“A Descriptive, Cross-Sectional Study Examining Treatment Burden in
… Read More
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0897189718306839
Optional- Genetic and Immune Determinants of Immune Activation in HIV-Exposed Seronegative Individuals and Their Role in Protection Against HIV Infection
For additional information, the following is recommended:
“Genetic and Immune Determinants of Immune Activation in HIV-Ex
… Read More
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1567134817304392
Optional- Inflammation and Repair
Explore the Inflammation and Repair page of the Pathology Guy website.
http://www.pathguy.com/lectures/inflamma.htm
Optional- Emergency Department Sepsis Huddles: Achieving Excellence for Sepsis Benchmarks in New York State
For additional information, the following is recommended:
“Emergency Department Sepsis Huddles: Achieving Excellence for Sepsi
… Read More
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0735675719300853