Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities and you may need to discuss the other diseases impact on the pathophysiology and care of the patient.  Three (3) resources after 2008 are required along with APA format. 

A 70 year old black American female who has the following
preexisting conditions;

Hypertension (HTN): longterm

Heart failure (CHF) : 2 months

Coronary artery disease (CAD) : longterm

Myocardial infarction (MI) : five years ago

Ejection (EF) of 55% : 2 months ago

Socioeconomic data:

Widow, Lives alone, independent ADL’s, Nonsmoker, Nondrinker

Pharmacologic data:

Aspirin (acetylsalicylic acid, ASA)

Clopidogrel bisulfate (Plavix)

Lisinopril (Prinivil, Zestril)

Carvedilol (Coreg)

Furosemide (Lasix)

Potassium chloride (KCL)

Client Profile:

70 year old woman originally from Alabama. She lives alone and is able to manage herself independently. She is active in her community and church. Diagnosed with heart failure 2 months age and is followed up at home with a visiting nurse every other week for to assist is managing her heart failure symptoms. She is being referred to the nurse practitioner for follow up of changes in her symptoms.

Assessment:

At the office the following subjective and objective data was supplied:

“I noticed my legs were getting a bit bigger and they are achy, too.”

She has gained 10 pounds over the last 5 days.

She gets short of breath when ambulating from one room to the other (approximately 20 feet) and must sit down to catch her breath.

Her oxygen saturation is 95% on room air. Bibasilar crackles are heard when auscultating her lung sounds.

She denies any chest, arm, or jaw pain or nausea.

She denies any back pain, stomach pain, confusion, dizziness, or a feeling faint.

She admits only to feeling a little more tired than usual.

Eats Southern Cooking when at home.

Vital signs :

T= 97.6 F (36.4C), BP 140/70, P 93, R 22.

Labs ordered:

complete blood count (CBC), basic metabolic panel (BMP), brain natriuretic peptide (B-type natriuretic peptide assay or BNP), troponin, creatine kinase (CPK), creatine kinase-MB (CKMB), and albumin. The APN also prescribes oral (PO) Furosemide and arranges an outpatient electrocardiogram (ECG, EKG), chest X-ray, and echocardiogram.

Questions

1. Which assessment findings during this visit are consistent with heart failure?

2. Why did the APN ask about back pain, stomach pain, confusion, dizziness or a feeling that she might faint?

3. Explain what the following terms indicate and include the normal values: cardiac output, stroke volume, afterload, preload, ejection fraction and central venous pressure. Is an ejection fraction of 55% significant. Provide rationale.

5. Discuss the body’s compensatory mechanisms during hear failure. Include an explanation of the Frank-Starling law in your discussion.

6. Heart failure can be classified as left or right ventricular failure, systolic versus diastolic, according to the New York Heart Association (NYHA) and using the ACC/AHA (American Heart Association) guidelines. Explain these four classification systems and the signs and symptoms that characterize each. Which Classification fits this patient?

7. Provide a rationale for why each of the following medications have been prescribed: Aspirin, Clopidogrel bisulfate (Plavix), Lisinopril(Prinivil/Zestril) , and Carvedilol (Coreg).

8. What information will each of the following tests provide: CBC, BMP, BNP, Troponin, CPK, CKMB, and albumin, EKG, CXR, and Echocardiogram

 

  

Subjective

Danny Rivera is an 8 years old boy presenting with a wet cough. He reports that the cough has lasted three days. He describes the cough as wet and gurly.

Objective

The cough is temporarily treated by the children’s cough medicine his mother gave him. He reports that the cough is not aggravated by activity. He reports the cough gets worse at night, which keep him up at night. He reports tenderness of his throat. He reports a history of frequent rhinorrhea and cough. Risk factor includes second-hand smoke from father, history of pneumonia in the past year, and being overwiegt for his age.

Assessment

He has no acute respiratory distress, his lungs are clear to auscultation and is afebrile, He has current rhinorrhea, examination of the nose reveals boggy turbinate. His throat appears red with visible cobblestoning in the back. His respiratory rate is inscreased, and he present mild tachycardia.

Plan

I recomende calling his grandmother to pick him up from school. He should see his primary care provider within the next few days for an evaluation and tests to rule out asthma and allergies. In the meantime, he should be allowed to rest and should be given cough medicine as needed.

 

outline the metrics you would use to measure the success of your proposed intervention. Include the source of your metrics (should be from the evidence-based practice literature) and the hypothesized outcomes you anticipate from the intervention. Include risks and both potential positive and negative outcomes.

Cite any sources in APA format.

Describe your experience in the utilization of nursing research in your clinical practice.

Submission Instructions:

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

 

Go to the ANA home page and search for their Advocacy Policy. Read through the ANA Advocacy Policy’s web pages.

Look at issues at a federal, state, or local level for which the ANA is advocating change or new policies.

Which one are you most eager to see enacted? Why does it interest you? How will passage of such legislation affect you or your patients?

https://www.nursingworld.org/