CASE STUDY 1

Case Study #1 – Cardiac

 This case study is meant to be completed individually.  Please place questions and answers into a Word document and upload into the drop box when complete.  APA formatting is not necessary, but you must cite your work and avoid copy/pasting from any source…paraphrase!

Mr. Jones is a 52-year-old obese man with a medical history of gastric reflux and degenerative arthritis.  He arrives at the emergency department with his wife. They had been to dinner and a movie. During the movie Mr. Jones began experiencing excruciating chest pain that radiated to his jaw and left arm.  He appears short of breath and diaphoretic. He reaches the registration window when he suddenly collapses. The nurses place him on a stretcher. He has no pulse, and the monitor reveals ventricular tachycardia.  He was successfully converted to sinus rhythm after one minute of CPR and one defib/shock at 300 joules.

Mr. Jones regains consciousness after his rhythm converts.  He has a blood pressure of 130/92, a heart rate of 112, and a respiratory rate of 24.  O2 is immediately started at 3 liters/minute. Three 18 g IV’s are started, lab work is drawn (CPK-MB, Troponin, CBC, PT, PTT, type and screen & Chem 21) and a 12-lead EKG is preformed. He still complains of chest pain (8/10) and nausea. Sublingual NTG 1/150 gr is given.  The 12-lead EKG reveals sinus tachycardia, a PR interval of 0.24, and 3 mm ST-segment elevation in leads V2, V3, & V4. 

After being admitted to the CCU Mr. Jones complains of chest pain continuing at 8/10. Mr. Jones is given IV morphine 4mg and a nitroglycerin gtt.  This drip was started 10 mcg/min and titrated up every 3-5 minutes until the pain was relieved at 50 mcg/min.  His blood pressure drops to 84/40.  He is pale and diaphoretic.  He is prepared for a percutaneous coronary intervention (PCI) and taken to the cardiac cath lab.

Questions

  1. What classic signs and symptoms did Mr. Jones experience which would indicate myocardial infarction (MI)? What are the specific pathophysiological reasons for each of these signs and symptoms?
  2. What ECG changes indicate myocardial injury? According to the ECG, which coronary arteries were experiencing occlusion and subsequently what area of the heart was being affected? (List the type of change and the coronary artery most often associated with changes in V2, V3, and V4.
  3. What are three things the nurse can do to speed up the time between admission and intervention? 
  4. How is a heparin drip calculated and what is the nurses’ role in maintaining this medication?
  5. If the blood pressure drops while the patient is receiving nitroglycerin, should the nitro be shut off completely?
  6. Why is morphine the drug of choice for cardiac pain?
  7. With this type of MI, an intra-aortic balloon pump may be inserted.  What are the two main functions of the IABP?
  8. What are three differences between CKMB’s and Troponin blood tests?
  9. After the angioplasty and stent placement, Mr. Jones is admitted to the CCU for monitoring.  What are the nursing considerations and assessment priorities for a patient with an arterial sheathe in place?
  10. Once admitted to the CCU, what nursing diagnosis would be the top priority? (The diagnosis must include the “related to” and “as evidenced by”). 
  11. After angioplasty, the patient begins experiencing frequent PVC’s.  What does this indicate and what should be done about it?
  12. If the patient begins to experience chest pain post angioplasty, what is the first thing the nurse should do?
  13. Patient teaching should consist of education about risk factors and lifestyle modifications.  What are three things the nurse could teach Mr. Jones about prior to discharge?
  14. Mr. Jones is going to be discharged on Plavix, Lopressor, Zocor, and Aspirin.  List one teaching point for each of these medications.
  15. Discuss the American Association of Critical Care Nurses (AACN) Synergy Model and how this concept would be important in this patient’s care.

Pneumonia in 12 years old

  

Instructions: Select one of the topic mentioned below and discuses filling the attached form.

Topics: 

Pneumonia in 12 years old

Requirements

Ø The discussion must address the topic

Ø Rationale must be provided

Ø Use at least 600 words (no included 1st page or references in the 600 words)

Ø May use examples from your nursing practice

Ø Formatted and cited in current APA 7

Ø Use 3 academic sources, not older than 5 years. Not Websites are allowed.

Ø Plagiarism is NOT permitted

Health Promotions Presentation

due @10am 11-12-23

COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT

Based on the YMH Boston Vignette 5 video, post answers to the following questions:

  • What did the practitioner do well? In what areas can the practitioner improve?
  • At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
  • What would be your next question, and why?

Then, address the following. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.

  • Explain why a thorough psychiatric assessment of a child/adolescent is important.
  • Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
  • Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
  • Explain the role parents/guardians play in assessment.

Support your response with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Discussion

Purpose

The purpose of this assignment is to discuss the healthcare policy of the APN profession and how Transformational Leadership can help to influence policy changes. This week’s assignment focuses on the APN as a Health Policy Leader, one of the nine NONPF NP competencies.  Students will analyze how health policy may affect NP practice and how Transformational Leadership can help to influence policy changes.

Preparing the Discussion

Criteria for Content 

· Explanation of how healthcare policy can impact the advanced practice nurse profession 

· Explanation of why advocacy is considered an essential component of the advance practice nurse's role

· Discuss the four pillars of Transformational leadership and the effect they may have on influencing policy change

· A scholarly resource must be used for EACH discussion question each week.

Psych 2

  

Discussion 2

Discuss how a comprehensive clinical assessment presents a unique opportunity for intervention in the psychotherapeutic context.

Two scholarly sources references are required unless stated otherwise by your professor. 

The student provides a substantive response to the discussion question or topic 

Here are the categories of the new discussion rubric:

Initial Post relevance to the topic of discussion, applicability, and insight. (20%)

Quality of Written Communication Appropriateness of audience and words choice is specific, purposeful, dynamic, and varied. Grammar, spelling, punctuation. (20%)

Inclusion of APNA standards essentials explored in the discussion as well as the role-specific competencies as applicable.(10%)

Rigor, currency, and relevance of the scholarly references. (Use articles that are below 5 years). (20%)

nursing

 According to the textbook, nurses in various settings are adopting a research-based (or evidence-based) practice that incorporates research findings into their decisions and interactions with patients. How do you see this being applied in your workplace? In addition, how can you strive to make spirituality and self-care a practice for your patients as well as yourself? How does this practice align with the Christian worldview? 

SOAP note iron deficiency Anemia

Please see the attachment for the instructions

Discuss the role nurse plays in COVID vaccination mandate, telemedicine, and prescription drug pricing as advocates in the healthcare system.

 

Nurses are well positioned for reforming health care in ways that promote a healthier public and reduce healthcare cost. Discuss the role nurse plays in COVID vaccination mandate, telemedicine, and prescription drug pricing as advocates in the healthcare system.

The discussion must address the topic.

Rationale must be provided

May use examples from your nursing practice

150 words minimum (excluding the reference)

Minimum of two references in APA format within the last five years published

s4,2

Write 2-3 pages applicable to your capstone project. Identify the stakeholders (use fictitious names for stakeholders) that will play a major part with your study and integrate with your project.

Topics to include:

  1. Roles of stakeholders
  2. Identify your stakeholders – are they supportive to your project?
  3. List of stakeholders who will be interested in the results of your project
  4. Promoting stakeholder participation
  5. Possible concerns/barriers from stakeholders
  6. Strategies that you will use to gain support and assistance from your stakeholders

Expectations

  • US sources and topic is (nurse retention).
  • Length: 2-3  pages
  • Format: APA 7th ed.
  • Research: At least one peer reviewed reference within the last 5 years