Category: Nursing

Review the case scenario. Norma James is a 69-year-old white female. She presents to the clinic today with worsening shortness of breath. She has a history of type 2 diabetes, hypertension, atrial fibrillation, and stroke. You perform the following assessment: Onset: You asked when she first noticed her shortness of breath, and Norma stated that it seems like it comes and goes and has been getting worse over the past four months. When asked if she has experienced any other new problems, Norma tells you her ankles have been swelling a lot more lately, and she has been unable to walk to the senior center. You ask her how controlled her blood sugars have been over the past several weeks. She ran out of testing supplies and has been unable to test her blood sugar at home. She has been going to the senior center to get tested, but now she is unable to walk there. Duration: You ask her how long she has been experiencing shortness of breath. She tells you she has had intermittent shortness of breath for a few years, but it has become almost constant in the past four months. The episodes start with activity, and it takes her up to an hour after she stops activity for her breathing to get better. When asked about the edema, she tells you it has gotten worse in the past two months, and she is unable to get the swelling down when she elevates her legs. She has always had some swelling, but it seems like it is worse now. Characteristics: You ask her to describe her shortness of breath, and she tells you it feels like she can’t get enough air in her lungs. When asked about her swelling in her legs, she tells you they are swollen mostly around the ankles; some days she can’t get her shoes on. She also tells you she has gained 10 lbs recently, according the nurse at the senior center. Aggravating factors: You ask her what makes her shortness of breath worse, and she tells you that anytime she walks from one room to another room in her house, she has a hard time breathing. When she gets dressed in the morning, and when she is doing any kind of activity like cooking or doing dishes, she has a harder time breathing. When asked what makes her leg swelling worse, she tells you that they are not too swollen in the morning, but by the time she finishes getting bathed and dressed, on the mornings she is able to bathe, her ankles are starting to swell. Alleviating factors: When you ask her what helps her shortness of breath, she tells that she sits down when it gets bad, and eventually it gets easier to breathe. You ask her if anything helps her ankle swelling, and she tells you she has tried soaking them in cold water, but it doesn’t seem to really help. Her neighbor told her to wear tight socks, but she doesn’t have any, so she hasn’t tried that yet. Other background information: Norma is a widow who lives alone with her six cats. She has two grown sons, with whom she has limited contact with one son, but recently her other son stayed with her after her stroke. She has a long history of type 2 diabetes. She had a foot ulcer two years ago that was successfully treated. She has chronic atrial-fibrillation, and last year she suffered a mild stroke and initially had affective aphasia, right-sided weakness, and difficulty swallowing. She spent several weeks in a rehab unit but has since returned home, and is once again independent in her own care. She has a history of seeing multiple physicians for her health care needs. Norma has a known drug allergy to penicillin. She is currently on the following medications: Glucotrol, 10 mg twice a day Captopril, 50 mg twice a day Digoxin, 125 mcg once a day Coumadin, 5 mg once a day You perform the following assessment: Heart: Her rhythm is irregular and rapid; she has normal S1S2. Lungs: She is clear in the upper lobes and has crackles in the lung bases. Peripheral Vascular: She has 2+ radial pulses bilaterally and 1+ pedal pulses. She has 3+ pitting edema in both legs from ankle to mid-calf. She also has jugular vein distention. Capillary refill is < 2 sec. Other vital signs and findings: Her blood pressure is 140/92, her heart rate is irregular and 112, her respirations are 24, and her blood glucose is 140. Diagnosis and treatment: Norma is sent for several tests, including an x-ray, EKG, and echocardiogram. She is diagnosed with Class II heart failure. Her physician prescribes the following additional medications: Lasix and a potassium supplement. Step 2 Write a 3-page (750 word) paper using APA 7.0 format style and address the information below. You are precepting a student nurse today who is taking her assessment class. She is learning about focused history and assessment skills. In your paper, discuss the following items: Write a detailed explanation describing what you would say to the student, explaining the assessment conducted and the findings. Discuss the heart assessment you performed and any additional assessments you would perform. What are other factors related to the probable diagnosis you would be concerned about with this client? Explain how you would document your findings in the medical record. Develop your plan of care. Identify two nursing diagnoses and one to two nursing interventions related to those diagnoses. The interventions need to be evidence based. Cite the references used in your plan in correct format. Identify what client education should be done for Norma, given her background and presenting illness. Describe your teaching strategy and how you will evaluate the effectiveness of the educational intervention. Appropriately cite and reference all resources used to complete this assignment in APA 7.0 format style. The course textbook and any article you are asked to read should be used as evidence, the next level of evidence you may use would be peer reviewed articles after that well known web sites for example CDC or the AHA. Objectives Develop a plan of care for the heart and vascular system Demonstrate documentation of the heart and vascular assessment findings Explain how to conduct a physical assessment of the heart and vascular system Assignment Overview In this writing assignment, you will review a case scenario and submit an assignment providing information on how you would conduct a focused physical assessment of the client based on the presenting complaints. You will document your findings from the focused history and physical assessment data elicited and develop a nursing plan of care for this client. The rubric used to grade this assignment is attached below the assignment description. Deliverables Write a 3-page (750 word) paper using APA 7.0 format style. The minimum page count does not include the required cover page or the reference list. The required course textbook and any article you are asked to read should be used as evidence. The next level of evidence you could utilize would be peer reviewed articles; after that well known web sites for example CDC or the AHA. Avoid blogs, continuing education articles, non-healthcare websites, or obscure web sites. Never cite or reference Wikipedia in formal writing. avoid use Wikipedia as a resource to complete any assignment or discussion in this program.

1400 word minimum, reliable resources, analyze an Ana federal advocacy issue and develop an optimal solution develop an analysis of the causes, identify short and long term effects analyze past and current solutions propose a strong solution as well as address any challenges evaluate information and sources including peer reviewed research articles for appropriate reliability validity and bias use apa style to integrate credible scholarly source material no plagiarism

Create a response for both discussion post with a positive view and understanding of the topic with 2 references and citations each in APA style from the attachments. Additional references can be used from outside sources. 150 words each

Description Pick 1 Journal article on Coursepoint and write up a summary. Summary Guidelines: 1 page The summary should be written with enough detail so that a reader would not have to look at the original research to understand all the main points. A well-written summary should cover three main points: why the research was done, what happened in the experiment, and what conclusions the author drew. Why was the research done? The first section of your summary should include all the important background information and context. It should also include the authors purpose for doing the research and the goal or hypothesis. You should typically be able to pull all this information from the introduction. What happened in the experiment? Next, cover what happened in the methods and results sections of the paper. This is important for letting the reader know what happened in the experiment. Do not mix the authors analysis with this section: simply state the facts first. This will keep your summary organized. Also, try not to include too many specific numbers or details. Only offer what is necessary or helpful in explaining what happened. What conclusions did the author draw? Lastly, write about the authors analysis and everything they concluded from the experiment. Go over all the main points that the author makes here, including their conclusion, limitations, and future directions. Remember that the conclusion is not the same thing as the results. Results are the outcomes of the experiment, and conclusions are what the author says the results mean. Analysis How is this research relevant or important? **Contents All required elements are fully addressed, easily identified, and integrated into assignment. Why the research was done, what happened in the experiment as why conclusions the author drew. **APA citations and References Journal article is cited on a reference page at the end of the paper. There are no errors in formatting.

Write a 34-page paper (maximum of 4 full pages, not including the reference page) analyzing the phases of disaster response as experienced during the COVID-19 pandemic. Your paper should incorporate the Population Exposure Model to assess community vulnerability and include a focused discussion on strategies for nurse self-protection from trauma and burnout.

Format:

• Double-spaced
• 12-point Times New Roman
• 1-inch margins
• APA format
• Minimum of 3 scholarly references

Content:

Introduction (1-2 paragraphs)

• Provide a brief overview of the COVID-19 pandemic as a disaster event.
• State the purpose of the paper (to compare and contrast response phases, examine long-term impacts, and explore nurse resilience).

Phases of Disaster Response (1 page)

Discuss the following disaster response phases during the COVID-19 pandemic: Impact Phase, Heroic Phase, Honeymoon Phase, Disillusionment Phase, Reconstruction Phase

Long-Term Impact (12 page)

• Discuss the lasting effects of COVID-19 on nursing practice, healthcare systems, and public health policies.
• Examine burnout, workforce shortages, telemedicine adoption, and pandemic preparedness improvements.

Population Exposure Model (12 page)

• Explain how the Population Exposure Model assesses community vulnerability during disasters.
• Apply the model to COVID-19, analyzing high-risk populations, healthcare disparities, and response effectiveness.

Nurse Self-Protection from Trauma (12 page)

• Identify strategies for mental health resilience, including peer support and stress management.
• Examine the importance of workplace policies that promote nurse well-being.

Conclusion (1-2 paragraphs)

• Reflect on the role of nurses in shaping future emergency preparedness strategies.
• Provide recommendations for strengthening disaster response in healthcare.

REQUIRED READING

Buppert, C. (2021). Nurse practitioners business practice and legal guide (8th Ed.). Jones & Bartlett Learning LLC.: Burlington MA.

• Ch. 7 Negligence and Malpractice

Please also review the following.

• National Practitioner Data Bank. (2021). Self-Query. Retrieved from

After educating yourself on this weeks topics through the required readings, respond to the following:

Case Study: Failure to Diagnose

The patient was a 48-year-old African American female who was experiencing bleeding during bowel movements. Her husband was an established patient of the insured nurse practitioner and made an appointment for his wife due to his rectal pain and bleeding.

During the first appointment with the nurse practitioner, the patient relayed complaints of bright red rectal bleeding intermittently for two months and on several occasions the toilet would be full of blood. She had a past medical history of depression, anxiety, heavy user of alcohol and hypertension and a family medical history positive for colon cancer and cardiac disease.

The nurse practitioner performed a detailed physical assessment on the patient along with a digital rectal examination. The digital exam was negative for any tumors or tears and she diagnosed the patient with bleeding due to internal hemorrhoids.

The NP advised her to have a colonoscopy to rule out other diseases, but the patient adamantly refused any referral. She was given prescriptions for suppositories and a hemorrhoid cream and was scheduled for a three week follow-up appointment.

During the three week follow-up appointment, the patient reported that the rectal pain and bleeding had stopped and she had not noticed any blood in his stools or bleeding.

Over the next eighteen months, the patient was seen eleven times by both the defendant nurse practitioner and another physician working in the practice for various other complaints, but did not relayed any concerns about continued rectal pain or bleeding to the insured. The nurse practitioner never had any further follow-up discussions with the patient about a colonoscopy.

Approximately twenty months after the patients initial office visit for rectal pain and bleeding, her husband made her an appointment to have a colonoscopy due to the patients continued rectal pain and bleeding.

During the procedure, the gastroenterologist found a 4.5 centimeter tumor in her rectum and the patient was diagnosed with differentiated metastatic colon adenocarcinoma. The patient died one year after her cancer diagnosis.

Risk Management Comments

The nurse practitioner could not fully explain why she failed to document the conversation with the patient about having a colonoscopy and her subsequent refusal. She stated that her medical office uses an electronic medical record and she relies on the systems drop boxes to assist her in her documentation. The discussion about the referral for a colonoscopy would have had to be manually entered into the medical record and she may not have had the time between patients to document that conversation.

She testified during her deposition that the patient seemed very uneasy about having her perform a rectal exam and was reluctant to discuss her findings. Her impression of the patient was that she was self-conscious about her rectal pain and bleeding and did not want to discuss it.

She further testified that she did not want to make the patient uncomfortable and that is why she did not follow-up with her about her rectal pain and bleeding in subsequent appointments.

• What Risk Management recommendations would you make? I.e., what should the Nurse Practitioner have done to avoid this lawsuit? Use your states Scope of Practice laws, textbook, as well as other resources to formulate your answer here.

NSO. (2021). NURSE PRACTITIONER MEDICAL MALPRACTICE. Case Study with Risk Management Strategies. file:///C:/Users/strub/Downloads/AORN-Oct-2021-Nurse-Legal-Case-Q4-2018.pdf

Notes:

• Be sure to use APA format
• Address all elements in order to receive full credit.
• Response must include a minimum of 250 words in the initial post which does not include quoted material and required references.
• Minimum of two scholarly sources are required: a) one in-class source that must be referenced and cited and b) one outside scholarly sourcereferenced and cited.