Advanced Pathophysiology Across the Life Span Final Project
Advanced Pathophysiology Across the Life Span Final Project
NUR 540 Final Project Guidelines and Rubric
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.
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