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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?

 

Select a state regulation from a state of your choice on one of the following topics.  Prepare an annotated copy of the regulation including the sections you reviewed to answer the questions in the following format: 

Prepare a 3-4 pages response addressing all information in the following table. Highlight five to six notable parts to the regulations.  For each of the parts describe how the patient, provider, product developer, health care organization, and payer may be impacted. Remember to write in narrative format except for titles. Use citations and attach the notated regulation.  The instructor will set up a conference area to select one of the following or suggest your own with the approval of the instructor. No more than 3 students for each topic. First-come. First-served. The topics are as follows:

                                   ****Topic Chosen*****

1. Sexually transmitted diseases are reportable under state regulation.  What diseases and what regulations ensure this reporting properly.

****SEE ATTACHMENT TO SEE HOW ASSIGNMENT SHOULD LOOK********

Student Name:

Type your name here.

Assignment #3 Title:

Provide a short name and the official title of the State Laws associated with your topic.

Agency Responsible:

Identify the state agency and subunit (such as a bureau or office) responsible for oversight/enforcement of the rules.

Incentives and Enforcement:

What enforcement and penalties are described if noted regulations are violated?

 Is there training for personnel or technical Assistance?

Key Aspect of the Regulation #1:

How does this section of the regulation impact

-payers/insurers/health plans,

-health care professionals,

-health provider organizations,

– health product developers?

Key Aspect of the Regulation #2:

Key Aspect of the Regulation #3:

Key Aspect of the Regulation #4:

Key Aspect of the Regulation #5:

Notated Copy of the Rules:

Attach the copy of the regulation that you have marked up.  Underline, highlight or note key sections. Mark them (1), (2), (3), etc. You may use technology to mark up in PDF or print, handwrite and scan the rules. Attach when you submit the assignment.

All sections of Assignment #3 are required.

The grading rubric for this assignment appears below, if you opened the Assignment in the Assignment Folder. It can be opened by clicking on the ‘Written Assignment Rubric’ tab in the lower right corner of the screen, if you opened the Assignment in Content.

REPLY 1( this first is about what I wrote in prompt week 6 nurs435)

Maria,

Nice work sharing how you would apply the collaboration model to this scenario. You incorporated the asking questions aspect well in your response. This week we read about the 3-2-1 approach that could be used in your scenario or even in personal conflicts as well. Share with us your thoughts on this approach and how it could help to resolve conflicts.

REPLY2

For this discussion, I chose to review the conflict scenario from Tina Chavez’s GSE DP. Specifically, I chose to focus on conflict scenario one. In this scenario, a group of four students are assigned a project that has to be completed by everyone. About one week into the project, the group is told that another student has been added to the group. The new student states that he can improve the project, but all original group members believe that their work is already good enough. Since everyone has to participate the new student is given a new task, but the new student does not want to do the task and leaves. 

In this scenario, it would be appropriate to use conflict resolution model. I would use the Triangle of Satisfaction Model. The Triangle of Satisfaction Model is used to examine interests as they fundamental to the field of conflict resolution. When this conflict resolution model is used, it is used to examine the parties’s wants, needs, and concerns, or interests. It would be appropriate for each student’s interests to be examined. In this case, their common interest is to earn a good grade on the project. The new student wants to participate as well. This is one of the interests that he has, so common ground should be found to ensure everyone participates. If I were in the group I would invite the new student to participate and contribute ideas. 

 

This last discussion board is due by Wednesday, 11:59pm.

In 2019, Police Officer Amber Guyger was convicted of the murder of Botham Jean in a 2017 case in which she entered his apartment and shot him thinking he was an intruder in her own nearby apartment, according to her testimony.  Guyger was convicted and sentenced to 10 years in prison.  The younger brother of Botham spoke in court after the conviction was read stating that he forgave Guyger and requested that he be allowed to hug her, which he did. 

Here is a video news report on it: LINK (Links to an external site.).

Here is a video of Tervor Noah’s comment and views on the case: LINK (Links to an external site.).

[1] What is your response to what Brandt Jean, brother of the murdered Botham Jean, did in court?  Do you believe forgiving someone who has deeply wronged us is a moral duty or is the act of forgiving something extra that goes above and beyond what is one’s duty?  Explain your answer.

[2] What is your response to the analysis and commentary of Trevor Noah on the Guyger case?  Based on what Trevor says and based on the NPR Podcast interview with Jemar Tisby, what do you think about the question of “whether the public expects black victims to provide forgiveness to white perpetrators” (NPR Podcast 2019, link (Links to an external site.))?

[3] Please share any of your final thoughts on this course for this semester and what you would say is the most important thing you learned.

Severe vs Moderate pain:

A patient put on their call light. When you go to their room to see what they need they state that they have pain. You ask them to rate it on a numeric pain scale and they report it to be a 9/10. You understand this is moderate to severe pain. When you look in their medical administration record, they have a PRN order for both 650 mg acetaminophen and 1mg morphine IV.

1. Which medication would you decide is more appropriate for this patient?
2. What will you monitor this patient for after you administer the medication?

Acetaminophen overdose:

A patient comes to the ED after her family found her at home with two empty bottles of acetaminophen and a note stating she no longer wished to live.

1. What do you anticipate will be ordered to help reverse the effects of the acetaminophen? Describe its mechanism of Action.
2. What will you monitor? Include laboratory studies and signs and symptoms of organ failure.

Identify a common perceptual, neurological, or cognitive issue and discuss contributing factors. Outline steps for prevention or health promotion for the patient and family.

Due Date: Wednesday 4

  

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. 

Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF)

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)

Differential Diagnosis: Peripheral Vascular Disease (PVD)

Plan:

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP – not available.

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).

Questions:

1.    According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.    Does he need medication(s) given his history of MI?

 

Discussion 2: Can Technology + Behavior Be Diffused?

The biological understanding of health and disease has evolved from miasmas (vaporous exhalation formerly believed to cause disease) to germs to individual risk factors tied to specific diseases. Now you are challenged by the knowledge that many people get chronic illnesses without having the known critical risk factors (e.g., smoking) that some may try to avoid in an effort to be healthy. The scientific revolution in health creates an even bigger challenge.

Stress and inflammatory processes are sometimes seen to be critical factors affecting our biology. The stress response helps us get out of the path of the oncoming car or shelters us from falling debris in an earthquake. But if we turn it on while we are stuck in traffic, angry at the boss, experiencing financial difficulties, or dealing with another rejection, it does not benefit us. While some may cope better than others, those who are economically less fortunate and have to cope with issues of poverty may be less able to withstand stressful encounters. Today, health and illness tend to follow a socioeconomic gradient, in which people in lower socioeconomic groups tend to have higher mortality than those in higher socioeconomic groups. In general, those lower down the ladder of income, success, and wealth will exhibit lower health outcomes than those higher up. Societies with a bigger gap between rich and poor do worse in health outcomes overall than societies with a smaller gap because there is more unhealthy stress in unequal societies (United Health Foundation, 2013).

There are exceptions to the gradient in health that present learning opportunities. For example, Latinos or Hispanics appear to have better health outcomes in the U.S. than non-Latino whites, a concept termed the Hispanic Paradox (New America Media, 2012). Reasons for this disparity are debated. One point of view is that the social support Latinos or Hispanics offer one another can counteract some of the adverse effects of having lower socioeconomic status.

For this Discussion, you consider how cultural and economic factors influence those biologic mechanisms that can result in disease for specific segments of the population. You also propose possible policy solutions to reduce the burden of disease.

To prepare for this Discussion, review the Learning Resources. Consider how the determinants of health you have learned about in this class can improve or worsen health for individuals and populations.

Post a brief description of a population segment (by race, ethnicity, economic status, geographical location, etc.). Then, explain the relationship between health inequality/inequities and common biological or behavioral risk factors that have been linked to a particular disease in that population segment. Finally, describe the relationship between health inequality/inequities and life expectancy for that population. Expand on your insights utilizing the Learning Resources.