NR 508 Week 2 Discussions 1
NR 508 Week 2 Discussions 1
discussion part two
cynthia has been prescribed a plethora of medications. how will you properly monitor each medication for efficacy and toxicity? are you concerned with any drug-drug interactions? if so, what are they, and what is the mechanism of the interaction? NR 508 Week 2 Discussions 1
discussion part one
cynthia is a 65-year-old african american female who presents to the clinic for a check-up. her last examination was ~5 years ago. she has no specific, significant, or urgent complaint. she explains that her only issues are thirst, fatigue, and leg numbness and tingling, which is beginning to occur more often. you decide to do a physical exam, as well as draw labs and receive the following results: NR 508 Week 2 Discussions 1
social history: no smoking or alcohol consumption.
gen: well nourished, slightly obese female
vs: bp 180/103 hr 73 rr 13 t 98.4 weight 90 kg, height 5’6”
heent: perrla
cor: rrr, nmrg
chest: cta
neuro: monofilament test shows decreased peripheral sensation
ext: normal
laboratory (fasting):
na 139 meq/l
k 3.8 meq/l
alt 34 u/l
ca 9.1 mg/dl
cl 102 mmol/l
hco3 22 meq/l
ast 39 u/l
tp 6 g/dl
bun 33 mg/dl
scr 2.0 mg/dl
alb 4.1 g/dl
cholesterol 254 mg/dl
bg 300 mg/dl
tsh 0.12 mu/ml
ua: sg 1.013 mg/24h, ph 6.5, +++ protein
what are the major problems in this patient, and what diagnoses do these values indicate? NR 508 Week 2 Discussions 1
additionally, what is your assessment and pharmacological plan for each of these problems including the medication, dose, and mechanism of action?
discussion part three
given cynthia’s increased creatinine and renal deterioration, metformin is probably not optimal in this case. therefore, upon subsequent visits, you decide to start her on a sulfonylurea. she reappears in your clinic fairly soon thereafter with complaints of shakiness, sweating, chills, clamminess, lightheadedness, and a moderately severe headache.
• what is the diagnosis given these symptoms and the medications she is currently taking from parts one and two, and how would you proceed? NR 508 Week 2 Discussions 1
• at this point, please also be sure to also provide an accurate summary of cynthia’s medication plan.
Description
437
Part 1 (3 pages)
Cross Cultural Considerations for the Interview and Physical Assessment Process
Watch the Cross-Cultural Considerations for the Interview and Physical Assessment Process video
Play
Discuss the demographics for the area in which you live
Choose one ethic group in your area NR 508 Week 2 Discussions 1
Develop a list of rationales of appropriate cross-cultural considerations that relate to the interview and physical assessment process
- Discuss three health promotion opportunities that relate to protective and predictive factors within your chosen ethnic
Read Chapters 1-3 and Chapter 12 change to chapter 12 in Jarvis, C. (2018). Physical examination and health assessment (8th ed.). St. Louis, MO: Saunders.
Part 2 (3 pages)
Health History
Watch the health history video:
Play Video
Complete the History Assignment for Tina Jones before completing the health history assignment. Your assignment requirements will be based on the findings in the Shadow Health assessments. NR 508 Week 2 Discussions 1
Reminder – You must submit the assessment to receive credit for the activity. Assessments that have not been submitted cannot be verified as complete.
In the health history, Tina informed you about her acute foot pain resulting from her infected wound:
o Identify two SMART goals for Tina
o Identify two evidence-based practice nursing interventions, with rationales for each that relate to this assessment.
o If you were to perform this exam within tight time constraints, what tasks, questions and assessments should you identify as priorities for Tina? NR 508 Week 2 Discussions 1
- o Provide relevant examples from personal nursing practice related to taking a health history.
Include a minimum of two references to support your evidence-based plan. Support your discussion and opinions with facts, relevant examples from personal nursing practice, and at least two citations from the reading or peer-reviewed professional nursing literature. Remember to use APA 7th edition formatting for all discussion posts and reference citations. NR 508 Week 2 Discussions 1
Read Chapters 4-12 change to 4-12 in Jarvis, C. (2018). Physical examination and health assessment (8th ed.). St. Louis, MO: Saunders. ?
Part 3 (3 pages)
Nutritional Assessment
Complete a Nutritional Assessment, using a tool of your choice (such as the Nestle Mini Nutritional Assessment Tool noted blow), on two members of a selected family (one between the age 5-17years and a second aged 21-59). Collect and summarize at least 8 objective and 4 subjective elements for each person.
Create an actual or potential problem list, including 4 problems, for both individuals, include 2 health promotion teaching opportunities you would suggest for 1 problem for each individual; a total of 16 objective (8 for each individual) and 8 subjective (4 for each individual) elements, a total of 8 problems (4 for each individual), and 4 health promotion teaching opportunities (2 for each person) for one of the problems for each individual. NR 508 Week 2 Discussions 1
Nestle Nutrition Assessment.pdf
Read Chapters 1-3 and Chapter 12 Jarvis, C. (2018). Physical examination and health assessment (8th ed.). St. Louis, MO: Saunders
Baccalaureate Generalist – Nutritional Assessment
Description: The baccalaureate-graduate nurse is skilled in completing nutritional assessments across the lifespan.
Course Competency(ies): 1) Perform assessments of individuals throughout the lifespan and include spiritual, social, cultural, psychological and physical components. 2) Differentiate between normal and abnormal assessment findings. 4) Synthesize assessment findings using the Digital Clinical Experience (DCE) and in written format using standardized terminology. 5) Demonstrate effective communication with individuals, families and interdisciplinary team members. NR 508 Week 2 Discussions 1
QSEN Competency(ies): 1) Patient-Centered Care 3) Evidenced-Based Practice
Part 4 (3 pages)
- HEENT/Skin, Hair & Nails Activity
Watch the HEENT/Skin, Hair & Nails video
Play Video
Complete the HEENT Assignment and Skin, Hair, & Nails Assignment for Tina Jones before completing the discussion question. Base your response to the discussion on the findings in the Shadow Health assessments.
Reminder – You must submit the assessment to receive credit for the activity.
After your HEENT and Skin, Hair, & Nails assessment of Tina:
o Discuss what would you include in your end of shift report that relate to the HEENT assessment and the Skin, Hair & Nails assessment performed. NR 508 Week 2 Discussions 1
o Identify four SMART goals for Tina: 2 SMART goals for HEENT, 2 SMART goals for skin, hair and nails.
o Discuss four evidence-based practice nursing interventions (2 for HEENT and 2 for skin, hair, nails), with rationales for each that relate to this assessment (one for each SMART Goal).
Read Chapters 13-18 in Jarvis, C. (2018). Physical examination and health assessment (8th ed.). St. Louis, MO: Saunders. ?
Part 5 (3 pages)
Respiratory Assessment Activity
Watch the respiratory assessment activity video:
Play Video
Complete the Respiratory Assignment for Tina Jones, including the Sounds Lab, before completing this assignment. Base your discussion/findings for this assignment upon the findings in the Shadow Health assessments.
After your respiratory assessment of Tina, differentiate the expected (normal) findings to the findings of Tina Jones’ breathing pattern-discuss this in your assignment.
Reminder – You must submit the assessment to receive credit for the activity.
Discuss a care plan for Tina based on your assessment findings to include a NANDA nursing diagnosis with three NIC’s and three NOC’s NR 508 Week 2 Discussions 1
Read Chapters 4, 19 & 32 In Jarvis, C. (2018). Physical examination and health assessment (8th ed.). St. Louis, MO: Saunders.
Part 6 (3 pages)
Cardiovascular and Chest Pain Assessment Activity
Complete the Cardiovascular Assignment for Tina Jones and the focused exam: Chest Pain on Brian Foster before completing the assignment. Base your assignment discussion on the findings in the Shadow Health assessments.
After completing the assessments:
Watch the cardiovascular and chest pain assessment activity video (click on the image):
Reminder – You must submit the assessments for both activities to receive credit for the activity.
Discuss the priority questions and assessments that you perform for Brian’s chest pain; include at least 3 questions.
Discuss the priority questions and assessments that you perform for Tina’s cardiovascular assessment include at least 3 questions.
Detail the differences in your approach to the cardiovascular/chest pain assessments and questioning with Tina and Brian. Discuss a care plan for Brian based on your assessment findings to include a NANDA nursing diagnosis with three NIC’s and three NOC’s. NR 508 Week 2 Discussions 1
Play Video
Read Chapters 20-21 in Jarvis, C. (2018). Physical examination and health assessment (8th ed.). St. Louis, MO: Saunders.
Part 7 (3 pages)
Abdominal Assessment and Abnormal Pain Activity
Watch the abdominal and abnormal pain assessment activity video. NR 508 Week 2 Discussions 1
Play Video
Complete the Abdominal Assessment for Tina Jones and the focused exam: Abnormal Pain on Ester Parks before completing this assignment. Base your assignment discussion on the findings in the Shadow Health assessments.
Discuss your assessment findings for Tina
Discuss your assessment findings for Esther
Reminder – You must submit the assessments for both activities to receive credit for the activity
Identify three SMART goals for Tina based upon your abdominal assessment NR 508 Week 2 Discussions 1
Identify three SMART goals for Ester based upon your abnormal pain assessment
Describe three priority health promotion opportunities for Tina with rationale
Describe three priority health promotion opportunities for Esther
Read Chapters 22, 25-27 in Jarvis, C. (2018). Physical examination and health assessment (8th ed.). St. Louis, MO: Elsevier.
Part 8 (3 pages)
Musculoskeletal and Neurological Assessment Activity
After your musculoskeletal and neurological assessment of Tina discuss the following in your assignment:
Watch the musculoskeletal and neurological assessment activity video. NR 508 Week 2 Discussions 1
Play Video
Remember to submit your musculoskeletal assessment and neurological assessment.
Discuss your musculoskeletal assessment findings.
Discuss your neurological assessment findings.
Discuss what would you include in your end of shift report that relates to your assessment findings for your musculoskeletal assessment.
Discuss what would you include in your end of shift report that relates to your assessment findings for your neurological assessment.
Discuss what tasks, questions and assessment are priorities in your musculoskeletal exam of Tina if you were to perform this assessment with tight time constraints.
Discuss what tasks, questions and assessment are priorities in your neurological exam of Tina if you were to perform this assessment with tight time constraints.
Discuss three patient education/health promotion opportunities for Tina that relate to the musculoskeletal system.
Discuss three patient education/health promotion topics for Tina that relate to the neurological system.
Read Chapters 23-24 In Jarvis, C. (2018). Physical examination and health assessment (8th ed.). St. Louis, MO: Elsevier.
Part 9 (3 pages)
Pediatric Health Assessment Activity
After your pediatric assessment of Danny Rivera discuss the following in your assignment:
Watch the pediatric health assessment activity video
Play Video
After your pediatric assessment of Danny Rivera discuss the following in your assignment:
Remember to submit your pediatric assessment.
Discuss your pediatric assessment findings to include what abnormal findings did you identify?
Discuss how the adult and child assessment differ to include the following:
o Communication
o Approach for obtaining objective data from a pediatric client
o Approach for obtaining subjective data from a pediatric client
Discuss the role of the parent/caregiver in the care of the child throughout the pediatric age range.
Describe three patient education/health promotion opportunities for Danny related to your assessment findings.
Read Chapter 29 in Jarvis, C. (2018). Physical examination and health assessment (8h ed.). St. Louis, MO: Elsevier.
Part 10 (3 pages)
Hospital Discharge
Evidence-based discharge teaching is critical in promoting health and impacting readmissions. Complete the Hospital Discharge Activity in Shadow Health.
Create an audio/visual presentation using PowerPoint in VoiceThread in which you provide discharge instructions for Tina. In this patient-centered final project you will provide Tina with education about effective self-care to prevent readmission. Remember to use accessible, professional language demonstrating caring behaviors with use of therapeutic communication as you anticipate any questions or concerns Tina might have.
Be sure to include specific tools and resources (such as apps, support groups, handouts, credible web sources) to support health promotion and the management of her care. Use a minimum of four scholarly references to cite the current evidence-based practices to support your content. Please view the VoiceThread Guide in this module for instructions.
Watch the hospital discharge activity video:
Play Video
Include discharge teaching with evidence-based practice (EBP) instructions and specific resources for the following six areas:
Diabetes – Include diet and nutrition, exercise, blood glucose monitoring (signs and symptoms of hypo/hyperglycemia), and preventing complications (infections, dehydration)
Asthma – Include EBP about identifying and avoiding triggers, long-term management, and management of exacerbations
Wound care – Include EBP about monitoring and cleansing her wound with bid dressing changes
Activity – Include EBP about activity level, ambulation, use of air boot, and injury prevention (modifying environment)
Medications – Include instructions about indications, side effects (how to monitor and manage), and administration.
albuterol MDI 2 puffs every four hours as needed
insulin glargine 10 units subcutaneous at bedtime
metformin 850 mg by mouth twice a day
- linezolid 600 mg PO Q12hours for 10 days
oxycodone 5 mg/acetaminophen 500 mg by mouth three times a day as needed for pain
promethazine 25 mg every four hours as needed for nausea
insulin lispo sliding scale for blood glucose as following:
70-130=0 units
131-180=2 units
- 181-240=4 units
241-300=6 units
301-350=8 units
351-400=10 units and call your doctor
6. Follow up – Include information about preventative and routine health care recommendation exams/appointments and when to seek urgent medical care (going to ER or notifying primary care provider).
Part 11 (3 pages)
Physical Assessment Reflection Activity
Please consider your learning and growth in this course that you base on your own personal self-reflection. Write a reflective journal discussing significant, intriguing details, including the “Aha!” factors from your virtual simulation experience. Provide at least six specific examples and learning moments from the weekly physical assessment and self-reflection activities. Discuss how this practice experience changed your knowledge, skills, or attitudes. When appropriate, rich use of figurative language and imagery to convey ideas.
Watch the physical assessment reflection activity video:
Play Video
You do not need to use references for this reflection activity. Please use APA 7th edition formatting for your essay.
Washington students must submit a video of each assessment completed in Shadow Healt