Advanced Pathophysiology Across the Life Span Final Project

Advanced Pathophysiology Across the Life Span Final Project

NUR 540 Final Project Guidelines and Rubric

Overview

The final project for this course is the submission of a case study analysis. Throughout this course, we will review the case of a specific patient, Ms. Larsen. This will provide you with an opportunity to compare normal physiology with that of someone affected by disease. You will review the information presented in the case study below to evaluate and discuss current testing and treatment decisions for the patient. In your final submission, you will present a case study analysis in which you evaluate the patient, select appropriate patient-care technologies, and make recommendations for a plan of care. The project is divided into two milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules Three and Five. The final project will be submitted in Module Seven. In this assignment, you will demonstrate your mastery of the following course outcomes: x NUR-540-01: Analyze normal physiology across the life span for informing health promotion and disease prevention in individuals with acute illnesses and chronic diseases x NUR-540-02: Interpret specific etiological relationships for effectively describing the clinical manifestations of an altered health status in promoting patient outcomes x NUR-540-03: Compare pathological phenomena and normal physiological processes of adult health states for informing health promotion, disease detection, and treatment efforts x NUR-540-04: Defend the use of patient-care technologies in diagnostic testing and treatment decisions for various altered health states through relevant pathophysiological research x NUR-540-05: Incorporate appropriate and culturally sensitive demographic information for identifying pathophysiologic change in developing an appropriate plan of care Case Study Part I This section of the case study should be used to complete Milestone One: Introduction and Assessment. Millie Larsen is an 84-year-old African American female who is both a widower and grandmother. She is moderately obese (BMI of 32), and she has continued to smoke one pack of cigarettes a day for the past 40 years. She awakens one morning with weakness on her left side. She is having difficulty with word choice, and her speech seems to be slurred. When she attempts to walk to the bathroom, she stumbles a few times and falls once. Her daughter Dina, who lives next door and is visiting for breakfast, suspects that she has suffered a stroke and calls 911. Emergency personnel arrive within minutes of her call and transport Ms. Larsen to the emergency room (ER) of the nearest hospital.

The EMT team calls ahead to the ER, informing the department of a potential cerebral vascular accident (CVA) victim. Upon arrival, Ms. Larsen continues to deteriorate by becoming more disoriented and increasingly agitated with the staff and her daughter. She continues to have slurred speech and difficulty finding words. The physician orders a non-contrast head CT. It has now been 90 minutes since the onset of the symptoms. The triage nurse has managed to obtain the following medical information from Dina about Ms. Larsen: Past Medical History x Hypertension x Hypercholesterolemia x Smokes one pack per day x 40 years (40 pack years) x Osteoporosis x Type II diabetes mellitus Home Medications x Indomethacin (Indocin) 25 mg three times a day x Aspirin 81 mg daily x Lisinopril (Prinivil) 20 mg daily x Simvastatin (Zocor) 40 mg daily x Metformin (Glucophage) 500 mg twice a day Other pertinent information that was revealed during the interview with Dina is that Ms. Larsen lives in her own home in a small rural community. Ms. Larsen is a recent widower who lost her husband of 55 years to cancer about three months ago. Ms. Larsen lives alone in their small home with a pet cat named Snuggles. Dina is Ms. Larsen’s only support system and is concerned that her mother is not always diligent at following the healthcare provider’s recommendations in controlling her longstanding Stage II hypertension and diabetes. In addition, Dina has attempted to encourage her to stop smoking on several occasions. Current Vital Signs: BP: 168/88, Pulse: L arm, 110 irregular, RR 20; Temp 37.9°C oral; Random blood glucose: 89; Pain level: 2 out 5 using the numerical rating scale. Heinrich II Fall Risk Score = 8. Approximately 60 minutes since Ms. Larsen arrives at the ER, she has settled back in the holding area awaiting a bed in the step-down area of the hospital. The nurse calls Dina back to visit with her mother. Dina finds her mother lying in bed with the head of the bed elevated, a nasal cannula in place, and an IV infusing into her right arm, and she is connected to telemetry. The nurse informs Dina that the results of the head CT point to “no bleed” and was interpreted by the neurologist on the stroke team, who will be in shortly to discuss the plan of care for Ms. Larsen. In a few minutes, the stroke team meets with Dina, and the neurologist discusses the plan to begin ischemic stroke protocol. In addition, Ms. Larsen will be admitted to the hospital as soon as a bed becomes available. Dina is confused and concerned. She has many questions as the team begins the next phase of treatment for Ms. Larsen. Imagine you are a graduate nurse working in the emergency room and helping to prepare Ms. Larsen’s admission to the hospital. You will evaluate some of the key elements of Ms. Larsen’s history and background that may have led to her current medical condition.

This section of the case study should be used to complete Milestone Two: Clinical Decision Making, Technology, and Treatment. It has been two hours since the onset of Ms. Larsen’s symptoms when you receive a report from the ER on a CVA victim who will be arriving shortly to your eight-bed step-down unit for further management and monitoring. Ms. Larsen and her daughter arrived to your unit, and you now assume care of Ms. Larsen. Vital signs upon arrival: BP: 148/88 L arm, Pulse: 118 irregular, RR: 18, Temp: 38.0°C oral. Ms. Larsen is placed on the telemetry monitor in the step-down unit, and the monitor shows this reading: Atrial Fibrillation (Burns, 2011) You further receive the following diagnostic results: Relevant lab values (assume all other lab values are normal): Na+ = 132 mEq/L, K+ = 6.4 mEq/L, Glucose = 158 (fasting), BUN = 32 mg/dL, Cr = 2.8, Hgb = 11.5 g/dL, HCT = 32.8%, Total Cholesterol = 248 mg/dL, LDL = 160 mg/dL, HDL= 25 mg/dL, Triglycerides = 186 mg/dL. Other relevant diagnostic tests: Chest x-ray: lungs clear, tortuous aorta, cardiomegaly. Non-contrast head CAT: No abnormalities, no mass, no bleed, no shift present.

EKG read by cardiology as: Atrial fibrillation (AF) with rapid ventricular response at a rate ~135 beats per minute (bpm). Coarse fibrillatory waves in V1.
Additional diagnostic tests must be performed using the appropriate patient-care technologies. You now take on the role of the graduate nurse to make
appropriate clinical decisions. You will also make assessments on patient-care technologies and diagnostic testing, and describe treatment options for this case.
Case Study Part III
This section of the case study will not be addressed in the milestones but will be addressed in your final project.
One week since Ms. Larsen has suffered a CVA, Dina is visiting at 7:00 a.m. when she finds Ms. Larsen having a near fall while ambulating to the bathroom. Dina
quickly assists her mother back to the bed and reports the concern to the nurse, who informs Dina that her mother will be discharged home tomorrow. The
nurse would like to go over discharge teaching with her and her mother. Ms. Larsen has responded well to the ischemic stroke protocol but still has residual
effects from the right-sided CVA, including the following:
x Periods of forgetfulness
x Anomia
x Spatial/visual problems (misjudging distance, for example)
x Continued left-sided weakness to her upper extremities
You are now tasked with completing a plan of care for Ms. Larsen and in charge of discharging her from the hospital.
References
Burns, E. (2011). Atrial fibrillation. Licensed under Creative Commons Attribution-NonCommercial ShareAlike 4.0 International License. Retrieved from https://lifeinthefastlane.com/ecg-library/atrial-fibrillation/ Burns, E. (2012). AF with rapid ventricular response. Licensed under Creative Commons Attribution-NonCommercial ShareAlike 4.0 International License. Retrieved from https://lifeinthefastlane.com/ecg-library/atrial-fibrillation/ National League for Nursing. (2017). Advanced Care Excellence for Seniors (ACES): Unfolding case study: Millie Larsen by C. Reese. Modified from http://www.nln.org/professional-development-programs/teaching-resources/ace-s/unfolding-cases/millie-larsen
Prompt
Create a case study analysis in which you review the case study and develop an analysis based on the patient in the case study. Specifically, you must address the critical elements listed below. Most of the critical elements align with a particular course outcome (shown in brackets). I. Introduction A. Discuss the role of ethnicity, culture, and socioeconomic status as each relates to the development of chronic disease for this case, including how these factors may increase the risk of an individual developing chronic disease. [NUR-540-05] B. Based on your patient’s case, demonstrate how cellular changes can affect the cardiovascular system and other systems of the human body. [NUR-540-02] C. Explain how early interventions may affect the processes of reversible and irreversible cellular injury to the vascular region. [NUR-540-03] II. Assessment A. Prioritize key elements of the patient’s health history that are important for designing a plan of care. Provide rationales that support the prioritization of the elements. [NUR-540-01] B. Based on your understanding of physiology, determine the elements of the physical exam that would be used to collect assessment data for a focused exam related to the patient’s loss of blood supply to her vascular region. [NUR-540-01] C. Explain the expected physical assessment findings of the patient’s focused exam and how it might compare to someone with normal physiology. [NUR-540-01] III. Clinical Decision Making A. Explain the rationale for the patient’s physical symptoms and what you would expect to assess in clients with a similar past medical history who experience a cerebrovascular accident. [NUR-540-02] B. Describe the etiology and risk factors associated with this case that are relevant to your treatment decisions in promoting patient outcomes. Provide rationale for your decisions. [NUR-540-02].
IV. Technology and Treatment A. Based on your clinical decision making, assess patient-care technologies that are appropriate for diagnostic testing and assessments for this case. Provide justification for your recommendations. [NUR-540-04] B. Explain the pathophysiological basis and clinical manifestations associated with this case, and how they may be explained by changes in the diagnostic tests. Support your claims with specific evidence. [NUR-540-03] C. Based on your rationale for the patient’s physical symptoms, assess the extent to which clinical manifestations of your selected case affect multiple body systems. Support your answer with specific evidence. [NUR-540-03] D. Describe the usual treatment(s) and expected effects of such treatment(s) for cases of this nature. Include the initial treatment(s) for health promotion, and the role of technology once the patient is stabilized to prepare for discharge. [NUR-540-04] V. Plan of Care A. Using your treatment description as a guide, explain the potential complications and patient safety concerns of this case, including when and why they may occur. [NUR-540-04] B. Assess the patient’s risk of developing any further chronic conditions or concerns that should be addressed, based on the patient’s background, health history, and your testing and treatment decisions. [NUR-540-05] C. Summarize your recommendations and plan of care for the patient, including expected treatment options, discharge location (home, rehabilitation setting, or long-term care), and follow-up care. Be sure to include a brief discussion of how you would address the family’s concerns related to discharge. [NUR-540-05] Milestones Milestone One: Introduction and Assessment In Module Three, you will submit the Introduction and Assessment sections of your case study analysis. Use Case Study Part I to complete this assignment. This milestone will be graded with the Milestone One Rubric. Milestone Two: Clinical Decision Making, Technology, and Treatment In Module Five, you will submit the Clinical Decision Making and Technology and Treatment sections of your case study analysis. Use Case Study Part II to complete this assignment. This milestone will be graded with the Milestone Two Rubric. Final Project Submission: Case Study Analysis In Module Seven, you will submit your final project. It should be a complete, polished artifact containing all of the critical elements of the final project. It should reflect the incorporation of feedback gained throughout the course. The submission will be graded with the Final Project Rubric.

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