Rubric attached below
Paper must be in APA format
Needs 3 pages excluding title and reference pages
Topic: Pressure Ulcer
Please review rubric
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 clinical manifestations present in Mrs. J. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.
You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
Comment using your own words but please provide at least one reference for each comment.
Do a half page for discussion #1 and another half page for discussion #2 for a total of one page.
Provide the comment for each discussion separate.
I need a positive argument based in this discussion question. Respond to this argument in one or more of the following ways:
Ask a probing question, substantiated with additional background information, evidence or research.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Use references
Mission, Vision, and Personal Goals
I have been a nurse for five years and spent a great deal of time thinking about my future role in nursing. I debated the pros and cons from the available list of master’s degree specialty tracks in nursing. At first, I thought that I might do nursing leadership as I enjoy leadership, but I changed my mind after realizing that I could lead change in any master’s degree role. I am passionate about psychiatry and decided on the psychiatric mental health nurse practitioner specialty track.
Over the course of a few months, I researched different universities and was drawn to Walden University. I liked that they offered a master’s degree in my specialty track as many universities have moved to the doctorate level. Also, I noticed that Walden had all the required accreditations that I was looking for in a university. After reading the Walden School of Nursing (SON) mission and vision statement, I realized that we have commonalities. According to the Walden University SON (2012), their mission is to thoroughly prepare graduates to transform society. The mission statement speaks to me as I would like to transform individuals and the community by providing high quality, cost effective, and relevant care.
Also, the Walden University program outcomes state that graduates will “apply their learning to specific problems and challenges in their workplace and professional settings” (Walden University, 2011, para. 5). This statement aligns with my objectives. I would like to earn more than a degree; I would like to apply knowledge gained, synthesize new practices, and implement it into nursing practice.
Incorporation of Social Change
Positive social change is a process for improving the daily lives of individuals, communities, and society. According to Walden University (2011), positive social change results in an enhancement of human and social conditions. I concur with this position and I would like to do the same in my community. I have taken my nursing practice as far as I can with my current education and scope. My plan for positive social change in my future practice is to look at an individual holistically to figure out how I can address social conditions preventing effective treatment. For example, “stable housing has been linked to recovery from addictions” (Knickman & Kovner, 2015, p. 165). This statement validates an existing hypothesis synthesized in my daily nursing practice. A lack of housing for chemically dependent individuals results in frequent inpatient readmissions. Positive social change will occur if the above-mentioned social condition can be addressed.
References
Knickman, J. R., & Kovner, A. R. (2015). Health Care Delivery in the United States (11th ed.). New York, NY: Springer Publishing.
Walden University. (2011). Student publications: Vision, mission, and goals. Retrieved from http://catalog.waldenu.edu
Walden University College of Health Sciences. (2012). About the school. Retrieved from http://www.waldenu.edu/colleges-schools/school-of-nursing/about
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