All posts by : chebby

Hello everyone,

Heart failure (HF) is a chronic, progressive condition in which the heart cannot effectively circulate enough blood to meet the body’s needs. It occurs due to structural or functional issues that disrupt the heart’s ability to fill or eject blood properly. The pathophysiology of HF involves neurohormonal activation, including the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system, leading to fluid retention, vasoconstriction, and myocardial remodeling (McDonagh et al., 2021).

Janessa’s symptoms, such as shortness of breath, weakness, and dizziness, may suggest HF, as reduced cardiac output and impaired tissue perfusion contribute to these manifestations. However, the absence of lung congestion and the presence of pale mucous membranes are not typical HF symptoms. HF is often associated with pulmonary congestion, which presents crackles on auscultation and symptoms like orthopnea or paroxysmal nocturnal dyspnea. The finding of pale mucous membranes suggests a different underlying cause such as anemia.

While HF may partially explain Janessa’s symptoms, the lack of fluid retention, including edema or pulmonary congestion, makes it a less likely primary diagnosis. However, anemia and HF can coexist, as anemia increases cardiac workload and reduces oxygen delivery, exacerbating HF symptoms (Groenewegen et al., 2020).

For my peers assigned asthma, you might suggest that Janessa’s shortness of breath is due to airway obstruction and inflammation. However, her clear lung sounds and absence of wheezing do not strongly support an asthma diagnosis.

Diagnostic testing that would be most appropriate to investigate HF:

• B-type Natriuretic Peptide: Elevated levels indicate HF.
• Echocardiogram: This assesses left ventricular ejection fraction (LVEF) and structural abnormalities.
• Electrocardiogram: Identifies arrhythmias or ischemic changes.
• Chest X-ray: Detects pulmonary congestion or cardiomegaly.
• Complete Blood Count: Evaluates for anemia, which may contribute to her symptoms.
• Serum Electrolytes and Renal Function Tests: Assess complications related to HF, such as hyponatremia or kidney dysfunction.

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.1929

McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., … & Anker, S. D. (2021). 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 42(36), 3599-3726. https://doi.org/10.1093/eurheartj/ehab368

Describe your first clinical experience for the week

• Did you face any challenges, any success? If so, what were they?
• Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
• Mention the health promotion intervention for this patient.
• What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
• Support your plan of care with the current peer-reviewed research guideline.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:

• Describe the project you propose.
• Identify the stakeholders impacted by this project.
• Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.
• Identify the technologies required to implement this project and explain why.
• Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.
• Use APA format and include a title page and reference page.
• Use the Turnitin Drafts to check your match percentage before submitting your work.

De-Prescribing and  taper from a medication safely or transition to a new medication 

 two key insights you had from the scholarly resources you selected. Describe a leader whom you have seen use such behaviors and skills, or a situation where you have seen these behaviors and skills used in practice 

Please ensure that the Discussion includes more than 400 words with scholarly articles, and the plagiarism level must remain below 20%.

Case Study 2: Antibiotic Stewardship in a Pediatric Patient with Pneumonia

Objective: Explore appropriate antibiotic selection, dosing, and resistance concerns in pediatric care.

Patient Profile:

• Age: 6
• Gender: Female
• Weight: 44 lbs (20 kg)
• Medical History: Recurrent ear infections, no known drug allergies
• Current Medications: None
• Diagnosis: Community-Acquired Pneumonia (CAP)

Instructions for Students:

1. Identify the most likely pathogens causing pneumonia in this age group and discuss antibiotic options.
2. Select an appropriate antibiotic regimen, including dosing, route, and frequency, based on guidelines for pediatric CAP.
3. Evaluate the risk of antibiotic resistance and the importance of antibiotic stewardship in this case.
4. Monitor: Define what clinical signs/symptoms and laboratory findings should be monitored to ensure the therapy is effective.
5. Adjust: Outline any considerations if the patient fails to respond to first-line therapy or develops adverse effects.
6. Counsel: Provide key teaching points for parents on the correct use of antibiotics, potential side effects, and the importance of completing the prescribed course.

In 1-2 pages, you will answer the questions provided following the case scenario. You must use current evidence-based resources to support your answers. Follow APA guidelines. Follow the grading rubric.