Nursing Assignment 2

please read each assignment carefully and complete!

Virtual Clinical Assignment Fall 2020

Laboure College

Fall 2020

Virtual Clinical Assignment Perfusion

Course: NUR ____1025_____ Concept/Exemplar: ___Perfusion/Hypertension______________ Hours: __8.5__

Student

Learning Outcomes (SLOs): See CLM concept/exemplar for SLOs.

Scenario: Please use your Pearson Text as reference

Date

Identify the Top 3 client findings requiring immediate follow-up

M.P. is a 65-year-old African American woman who comes to the clinic for a follow-up visit. She was diagnosed with hypertension (HTN) 2 months ago and was given a prescription for a thiazide diuretic but stopped taking it 2 weeks ago because “it made me dizzy and I kept getting up during the night to empty my bladder.”
During today’s clinic visit, she expresses fear because her mother died of a stroke (cerebrovascular accident [CVA]) at M.P.’s age, and M.P. is afraid she will suffer the same fate. She states, “I’ve never smoked and I don’t drink, but I am so afraid of this high blood pressure.”
The nurse reviews the data from her past clinic visits.

(NG NCLEX What matters most? Noticing) Tanner’s Clinical Judgement model

Tanner’s

Reflective Journal

and Next Gen NCLEX

Chart View

Family History
Mother, died at age 65 years of CVA 
Father, died at age 67 years of myocardial infarction (MI)
Sister, alive and well, age 62 years 
Brother, alive, age 70 years, has coronary artery disease (CAD), HTN, type 2 diabetes mellitus (DM)Patient 
Past History
Married for 45 years, 2 children, alive and well, 6 grandchildren
Cholecystectomy, age 42 years
Hysterectomy, age 48 years
Blood Pressure Assessments 
January 2: 150/92 
January 31: 156/94 (given prescription for hydrochlorothiazide [HCTZ] 25 mg PO every morning)
February 28: 140/90

1. According to the most recent guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC8), M.P.’s blood pressure (BP) falls under which classification?

http://thepafp.org/website/wp-content/uploads/2017/05/2014-JNC-8-Hypertension

http://pharma-smart.com/wp-content/uploads/2015/03/JNC-8-Guidelines

2. What could M.P. be doing that is causing her nocturia? 

CASE STUDY PROGRESS

During today’s visit, M.P.’s vital signs are as follows: BP: 162/102; P: 78; R: 16; T: 98.2°F (36.8 ° C). Her most recent basic metabolic panel (BMP) and fasting lipids are within normal limits. Her height is 5 ft., 4 in (163 cm), and she weighs 110 lb. (50 kg). She tells you that she tries to go on walks but does not like to walk alone and so has done so only occasionally.

3. What risk factors does M.P. have that increase her risk for cardiovascular disease?

CASE STUDY PROGRESS

Because M.P.’s BP continues to be high, the provider decides to start another antihypertensive drug and recommends that she try again with the hydrochlorothiazide (HCTZ), taken in the mornings.

4. According to the JNC 8 national guidelines, describe the drug therapy recommended for M.P. at this time.

Complete ALT medication Template (Deliverable)

5. M.P. goes on to ask whether there is anything else she should do to help with her HTN. She asks, “Do I need to lose weight?” Look up her height and weight for her age on a body mass index (BMI) chart. Is she considered overweight?

https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

6. What nonpharmacological lifestyle alteration measures might help M.P. control her BP? List 2 priority examples and explain why.

CASE STUDY PROGRESS

The provider decreases M.P.’s HCTZ dose to 12.5 mg PO daily and adds a prescription for benazepril (Lotensin) 5 mg daily. M.P. is instructed to return to the clinic in 1 week to have her blood work checked. She is instructed to monitor her BP at least twice a week and return for a medication management appointment in 1 month with her list of BP readings. Complete ALT medication Template (Deliverable)

7. Why did the provider decrease the dose of the HCTZ?

8. The nurse instructs M.P. on the common side effects of benazepril. Which side effects are included in the teaching? Select all that apply.

a. Cough

b. Dizziness

c. Headache

d. Constipation

e. Shortness of breath

9. Medication adherence is key to effective hypertensive therapy. What techniques are key to teach M.P. to assist in remembering to take her medications each day? Name at least 2. (Safety)

10. After the medication teaching session, which statement by M.P. indicates a need for further instruction?

a. “I need to rise up slowly when I get out of bed or out of a chair.”

b. “I will leave the salt shaker off the table and not salt my food when I cook.”

c. “I will call if I feel very dizzy, weak, or short of breath while on this medicine.”

d. “It’s okay to skip a few doses if I am feeling bad as long as it’s just for a few days.”

11. Complete a concept map that identifies 3 priority problems and collaborative/nursing care. (Deliverable)

CASE STUDY PROGRESS

M.P. returns in 1 month for her medication management appointment. She tells you she is feeling fine and does not have any side effects from her new medication. Her BP, checked twice a week at the senior center, ranges from 132 to 136 systolic, and 78 to 82 diastolic.

12. When someone is taking HCTZ and an angiotensin-converting enzyme (ACE) inhibitor, such as benazepril, what lab test results are monitored?

Chart View

Laboratory Test Results (Fasting) Sodium Chloride Potassium Chloride CO2 Glucose Blood urea nitrogen (BUN) Creatinine Magnesium

138 mEq/L (138 mmol/L) 3.6 mEq/L (3.6 mmol/L) 100 mEq/L (100 mmol/L) 28 mEq/L (28 mmol/L) 112 mEq/L (6.2 mmol/L) 18 mg/dL (6.4 mmol/L) 0.7 mg/dL (61.9 mcmol/L) 1.9 mEq/L (0.95 mmol/L)

13. What lab test results, if any, are of concern at this time? Why?

14. The nurse take M.P.’s BP and get 138/88. She asks whether these BP readings are okay. What is the nurse’s best response? Why?

15. List the Top 3 important ways the nurse might help M.P. maintain her success. (NG NCLEX What specific Items will the nurse teach the client? Responding/Taking action)

CASE STUDY PROGRESS

M.P. tells you she was recently at a luncheon with her garden club and that most of those women take BP pills different from the ones she does. She asks why their pills are different shapes and color.

16. How can the nurse explain the differences to M.P.? Define the action of common drug classifications to treat HTN, Top 3 side effects (may be similar), and best nursing actions.

17. During the visit, the nurse asks M.P., “When was your last eye examination?” She answers, “I’m

not sure, probably about 2 years ago. What does that have to do with my blood pressure?”

What is the nurse’s best response?

CASE STUDY PROGRESS

M.P. comes in for a routine follow-up visit 3 months later. She continues to do well on her daily BP drug regimen, with average BP readings of 130/78. She participates in group walking program for senior citizens at the local mall. She admits she has not done as well with decreasing her salt intake but says she is trying. She visited an ophthalmologist last week and had no problems except for a slight cataract in one eye.

18 What findings show the interventions are working? (NG NCLEX Did treatment help? Reflecting/Evaluate outcomes)

Harding and Snyder (2020) CS 91

Learning activities

Websites

Concept map

Reflective Journal

Active Learning Medication Template (antihypertensive)

“Think like a Nurse” questions

· What do you know now that you did not know prior to this

assignment

?

· When caring for clients (across the lifespan) experiencing hypertension, what key information would be helpful to know ahead of time?

Submit Assignment: Upload deliverables to eLearning under the Coursework tab, labeled Non-COVID Clinical Assignment. · Assignment/scenario · ALT medication template · Concept map · Reflective journal

Rubric Criteria	Pass	Not Pass
Case assignment	Student demonstrates an understanding of the concept through complete and thoughtful answers to scenario questions and to the content within the deliverables.	Student does not demonstrate completion of scenario questions and deliverables.
Professionalism	Student completes and uploads virtual case assignments and deliverables in a timely manner.	Student does not complete and or uploads the virtual case assignment.
Comments, Signatures and Dates	Student	Faculty

Developed 6-2020 4

Assignment:

Please read the following articles, then choose between one of the additional articles and complete the following assignment.

As the COVID-19 pandemic has continued the research has shown adjustments in how we behave as health care professionals. The research has improved our understanding of how the virus behaves and as such, has assisted us with better treatment and care. 

This first article written in July reviews the pathophysiology, transmission, diagnosis and treatment for coronavirus. Within this article you will see that there have been some changes since the article was written with treatment as well as vaccine status.

Please begin by following this link and reading the following article:

https://jamanetwork.com/journals/jama/fullarticle/2768391

Modeling and determining how the virus behaves has become a mechanism to assist with prevention. This next article gives a visual depiction of virus transmission and also shares how the COVID-19 virus is transmitted. This article is a summary of research and model depicting transmission originally completed in July 2020 by Dr. Jose L. Jimenez, PhD a professor from the University of Colorado- Boulder.  If you are interested in the details of his work, it can be found at: 

https://docs.google.com/spreadsheets/u/0/d/16K1OQkLD4BjgBdO8ePj6ytf-RpPMlJ6aXFg3PrIQBbQ/htmlview#gid=519189277

Since the initial publication of his model and research, his work has been extensively used to demonstrate virus transmission. This article was chosen as to show how Dr. Jimenez’s model has been used to explain transmission of this virus not just in the US but across the globe, in simple terms.

Please follow this link and read the following article:

https://english.elpais.com/society/2020-10-28/a-room-a-bar-and-a-class-how-the-coronavirus-is-spread-through-the-air.html?fbclid=IwAR05h5xVrqv4DBFHg4TW7CBGi_mMCUciJqE-hk2KsTqonJmYjxrGSkmCVko

Here at Laboure College, we look at these models and the research that is being completed locally and at the national level in order to maximize the safety of the student and staff here at the college. It is important to insure that the research you look at is peer reviewed.

1. Please choose one of the following articles, read the article.  Using the article of your choice compare the article to what you see in practice clinically and on campus, what has changed since the pandemic began, and what you feel has influences this.  This compare and contrast should be at minimum two pages, double spaced and 12-font typed. Please identify your resources.

2. Identify three activities related to the COVID screening/PPE/masks etc that you feel the Laboure Community has done well and three activities that are opportunities for improvement.  Elaborate on both with specific recommendations within the opportunities for improvement.

ARTICLE CHOICES

Mask wearing

https://jamanetwork.com/journals/jama/fullarticle/2772459

N-95 Masks

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2769441

Symptom Screening

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjG8_fqoOTsAhWolHIEHcjrDfwQFjARegQIDRAC&url=https%3A%2F%2Fwww.rand.org%2Fcontent%2Fdam%2Frand%2Fpubs%2Fperspectives%2FPEA600%2FPEA653-1%2FRAND_PEA653-1 &usg=AOvVaw3VypO0xU0lMCed8UWkBupo

Social Distancing

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003244

Under coursework in e-learning in your course there will be an assignment listed where you will be able to upload this assignment if you choose to complete this assignment. If you have completed an Alt. Clinical: Symptom Screen/PPE on campus, coursework will reflect the date that you completed the assignment on campus.

The link to upload the assignment will be available by Thursday Nov. 4, and the dates if completed on campus will be reflected in coursework by your final exam date.

Fall 2020

Laboure College

Concept: Clinical Judgement Student Reflective Journal for Virtual Clinical Assignment

Use the guide for reflection as a way to
tell the story of the situation
. The guide provides you with a way of thinking about patient care that supports the development of your clinical judgement based on Tanner’s Model (Noticing, Interpreting, Responding, and Reflection).

Instructions: Think about the clinical assignment this week and answer the questions.

Phases	Questions	Situation
Background	· Describe how the virtual clinical assignment assisted you in understanding the role of the nurse (e.g. link to previous experiences or clinical contact). · Describe your formal knowledge (e.g. physiology, psychology, and communication skills), previous experiences that helped guide your work in this situation. (Patient-Centered Care, Teamwork and Collaboration)
Noticing	· What did you notice initially? · As you worked through the virtual assignment (case study) how did what you noticed changed? (Patient-Centered Care)
Interpreting	· Describe what you thought about the situation (e.g. cause, patterns). · Describe any similar situations you have encountered before in your experience including similarities/differences compared to this situation. · What other information (e.g. assessment data) did you decide you needed? How could this information be obtained? (Patient-Centered Care, Informatics and Technology, Safety and Quality Improvement)
Conclusion	· What did your observations and data lead you to believe? Include pertinent pathophysiology and /or psychopathology.
Responding	· After considering the situation, what was the goal for your patient/family/staff? What was your nursing response and/or interventions? List priority actions.. (Patient-Centered Care, Professionalism, Safety and Quality)
Reflection	· What worked and what did you find challenging with the virtual clinical assignment and why? · Describe 3 ways your nursing care and/or skills can be expanded during this experience. · Describe any changes in your values of feelings as a result of this experience. (Safety and Quality Improvement, Professionalism)

Nielsen, A.et al. (2007). Guide for Reflecting Using the Clinical Judgement Model. Journal of Nursing Education, Vol. 46. No. 11

Revised 5-12-2020, R 6-24-2020, R 9-2020

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)Nutrition Signs/symptoms

What is Disease Process?

Patient Care

Medical Interventions/Tests

Education

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)Medications Nursing Interventions