CASE STUDY 1

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Case Study #1 – Cardiac

 This case study is meant to be completed individually.  Please place questions and answers into a Word document and upload into the drop box when complete.  APA formatting is not necessary, but you must cite your work and avoid copy/pasting from any source…paraphrase!

Mr. Jones is a 52-year-old obese man with a medical history of gastric reflux and degenerative arthritis.  He arrives at the emergency department with his wife. They had been to dinner and a movie. During the movie Mr. Jones began experiencing excruciating chest pain that radiated to his jaw and left arm.  He appears short of breath and diaphoretic. He reaches the registration window when he suddenly collapses. The nurses place him on a stretcher. He has no pulse, and the monitor reveals ventricular tachycardia.  He was successfully converted to sinus rhythm after one minute of CPR and one defib/shock at 300 joules.

Mr. Jones regains consciousness after his rhythm converts.  He has a blood pressure of 130/92, a heart rate of 112, and a respiratory rate of 24.  O2 is immediately started at 3 liters/minute. Three 18 g IV’s are started, lab work is drawn (CPK-MB, Troponin, CBC, PT, PTT, type and screen & Chem 21) and a 12-lead EKG is preformed. He still complains of chest pain (8/10) and nausea. Sublingual NTG 1/150 gr is given.  The 12-lead EKG reveals sinus tachycardia, a PR interval of 0.24, and 3 mm ST-segment elevation in leads V2, V3, & V4. 

After being admitted to the CCU Mr. Jones complains of chest pain continuing at 8/10. Mr. Jones is given IV morphine 4mg and a nitroglycerin gtt.  This drip was started 10 mcg/min and titrated up every 3-5 minutes until the pain was relieved at 50 mcg/min.  His blood pressure drops to 84/40.  He is pale and diaphoretic.  He is prepared for a percutaneous coronary intervention (PCI) and taken to the cardiac cath lab.

Questions

  1. What classic signs and symptoms did Mr. Jones experience which would indicate myocardial infarction (MI)? What are the specific pathophysiological reasons for each of these signs and symptoms?
  2. What ECG changes indicate myocardial injury? According to the ECG, which coronary arteries were experiencing occlusion and subsequently what area of the heart was being affected? (List the type of change and the coronary artery most often associated with changes in V2, V3, and V4.
  3. What are three things the nurse can do to speed up the time between admission and intervention? 
  4. How is a heparin drip calculated and what is the nurses’ role in maintaining this medication?
  5. If the blood pressure drops while the patient is receiving nitroglycerin, should the nitro be shut off completely?
  6. Why is morphine the drug of choice for cardiac pain?
  7. With this type of MI, an intra-aortic balloon pump may be inserted.  What are the two main functions of the IABP?
  8. What are three differences between CKMB’s and Troponin blood tests?
  9. After the angioplasty and stent placement, Mr. Jones is admitted to the CCU for monitoring.  What are the nursing considerations and assessment priorities for a patient with an arterial sheathe in place?
  10. Once admitted to the CCU, what nursing diagnosis would be the top priority? (The diagnosis must include the “related to” and “as evidenced by”). 
  11. After angioplasty, the patient begins experiencing frequent PVC’s.  What does this indicate and what should be done about it?
  12. If the patient begins to experience chest pain post angioplasty, what is the first thing the nurse should do?
  13. Patient teaching should consist of education about risk factors and lifestyle modifications.  What are three things the nurse could teach Mr. Jones about prior to discharge?
  14. Mr. Jones is going to be discharged on Plavix, Lopressor, Zocor, and Aspirin.  List one teaching point for each of these medications.
  15. Discuss the American Association of Critical Care Nurses (AACN) Synergy Model and how this concept would be important in this patient’s care.

DIABETES AND DRUG TREATMENTS

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Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations.

For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.

To Prepare:

  • Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
  • Select one type of diabetes to focus on for this Discussion.
  • Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
  • Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments.

 Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples. 

PMHNP

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Research the 3 highest priority Differential Diagnoses, the proposed interventions with rationale and respond to the case.  

BHA415 Module 1 Case SLP Module 1

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10/9/23, 8:16 AM SLP – BHA415 Topics in Health Care Policy (2023OCT09FT-1)

https://tlc.trident.edu/d2l/le/content/202602/viewContent/5126056/View 1/1

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Module 1 – SLP

POLICYMAKING IN THE GOVERNMENT AND THE PRIVATE
SECTOR

Explain the difference between regulatory health policies and allocative health
policies.

What are determinants of health? How are they related to the determinants of
health policy?

SLP Assignment Expectations

1. Conduct additional research to gather sufficient information to justify/support your
analysis.

2. Limit your response to a maximum of 3 pages.

3. Support your paper with a minimum of 3 reliable sources. The course textbook
counts as one, and at least one of the others should be a peer-reviewed article.
Use How to Recognize Peer-Reviewed (Refereed)
Journals – http://www.angelo.edu/services/library/handouts/peerrev.php

4. Please use Evaluating Internet Resources for evaluating information found on the
internet to ensure that you are using reliable sources:
https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-
content

5. You may use Purdue OWL to assist in formatting your assignment:
https://owl.english.purdue.edu/owl/resource/560/01/.

Listen

Nursing

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Omaha System Case Study for Home Visiting Rubric.html

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Omaha System Case Study for Home Visiting Rubric

Criterion

(Questions should be answered specifically for the chosen case study)

 Points

1. What key criteria will the PHN need to consider for a successful first visit with this client? 

2

2. How will the PHN establish professional boundaries with this client?

2

3. How will the PHN communicate confidentiality with the client?

2

4. What may some ethical challenges be during this home visit with the client? 

2

5. How does the ANA Scope and Standards of Public Health (2013) nursing practice guide the responsibilities of the public health nurse in this case study? Cite this resource within your answer.

2

6. Identify key communication skills to assure respectful interaction with this client.

1

7. Describe the components of the nursing process in the planned home visit with this client. 

1

8. Identify priority problems for this individual/family.

1

9. Identify plan and nursing interventions for this individual/family. Expand on what was written in the case study.

1

10. Identify plan to evaluate problem outcome.

.5

11. Professionally written using APA formatting and writing mechanics.

.5

Total Points

15 points

Reply

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Respond to at least two of your colleagues on two different days by offering additional ideas to overcome the barriers to strategies suggested by your colleagues and/or by offering additional ideas to facilitate dissemination.

1.            The first step in the dissemination process is identifying stakeholders. Once stakeholders have been identified, you must build a rapport before presenting your information (Gllagher-Ford et al., 2011). You then need to plan how you are going to engage stakeholders and how you will deliver the information to them.

            Dissemination strategies require clearly defined goals, sources, and audiences (Crable et al., 2023). Strategies that best suit me are a mixture of traditional and social media. For traditional, I would like to create a PowerPoint to present to stakeholders. For social media, I could create a social media platform to raise awareness on the topic being discussed. I chose PowerPoint because they are typically easy for everyone to follow, and it can be printed so stakeholders can take notes during the presentation if they would like. I chose a social media platform because social media allows information to be delivered rapidly to a large group of people (Bhatt et al., 2021).

            Barriers that may be encountered while using PowerPoint to disseminate evidence-based practice are having a computer and a projector to show the information, and depending on where you are presenting, this may not be available. To overcome this barrier, I would go to the site before the presentation and scope out the resources that I may need to bring with me to the presentation. Despite being widely used, stakeholders may have differing opinions on using social media to spread information about their organization.  I would talk with stakeholders beforehand and learn their opinions on the use of social media. It may be that they are okay with using social media, just that there are certain things they do not want to be shared about their organization. Talking with them beforehand would allow me to use social media and respect their opinions.

Bhatt, N. R., Czarniecki, S. W., Borgmann, H., van Oort, I. M.,Esperto, F., Pradere, B., van Gurp, M., Bloemberg, J., Darraugh, J., Roupret, M., Loeb, S., N’Dow, J., Ribal, M. J., & Giannarini, G. (2021). A Systematic Review of the Use of Social Media for Dissemination of Clinical Practice Guidelines. European Urology Focus, 7(5), 1195–1204. https://doi.org/10.1016/j.euf.2020.10.008

Erika L. Crable, Colleen M. Grogan, Jonathan Purtle, Scott C. Roesch, & Gregory A. Aarons. (2023). Tailoring dissemination strategies to increase evidence-informed policymaking for opioid use disorder treatment: study protocol. Implementation Science Communications, 4(1), 1–14. https://doi.org/10.1186/s43058-023-00396-5

Gallagher-Ford, L., Fineout-Overhold, E., Melnyk, B.M. &  Stillwell, S.B. (2011). Evidence-based practice step-by-step:  Implementing an evidence-based practice changeLinks to an external site.. American Journal of Nursing, 111(3), 54-60

2. To disseminate EBP, I would be most likely to use posters and social media. Posters are versatile and can help merge the strengths of oral presentations and published works (White et al., 2021, p. 257) Depending on where information is disseminated, presenters can verbally present information while having a visual aid for passersby. One barrier to poster use would be choosing what information to present with limited space. There are certain standards for research posters, but with an EBP project, the presenter may have control over fonts and colors to make it visually appealing. Posters also give presenters the option to interact with interested parties. They can add anecdotes and personality to the poster. While listeners may not remember all the information on the poster, they are much more likely to remember a funny story or a smiling face.  My second choice of dissemination would be social media. There are several nuances to using social media and navigating and not being in control of how information is received and redistributed can be a barrier, but it is undoubtedly the most timely and cost-effective way to reach vast and diverse audiences. Posts/tweets, online newsletters, and blogs are all possibilities for distributing information. It may not be the best way to present lots of statistics and technical information, but it can be used to start discussions and help people engage with research (Lord et al., 2019). It also allows the public to be aware of new advancements. Social media can be used to divulge high points and digestible information and offer to link full studies for those interested. Social media is also immediate making it a timelier option. The method I would be least inclined to use is journal publications. Every journal has specific formats for the articles they publish. If my goal is to get published, my reporting and organization methods would need to reflect those standards. Manuscripts are permanent once published. They can be updated or debunked but, like social media, there will always be proof of it. The biggest barrier to manuscripts is the length of time it takes from the study to publication. As we see, healthcare moves fast, and best practices are constantly changing. It may take years to research, complete the study/project, and make all revisions necessary to get published. By then, the research may be obsolete. This is a universal problem but as a DNP, the focus is improving the practice of nursing. That is not possible to do with outdated information. While it is important that research reaches wide audiences, it is my philosophy to personally connect with nurses working directly with patients to improve nursing practice at the patient-facing level. It’s imperative that those nurses be included in quality improvement efforts to ensure that new protocols are feasible and create better workflows (Siedlecki, 2023). 

References 

Lord, S. E., Seavey, K. M., Oren, S. D., Budney, A. J., & Marsch, L. A. (2019). Digital presence of a research center as a research dissemination platform: Reach and resources. JMIR Mental Health, 6(4), e11686. https://doi.org/10.2196/11686 

Siedlecki, S. L. (2023). Translational science. Clinical Nurse Specialist, 37(2), 54–57. https://doi.org/10.1097/nur.0000000000000728 

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2021). Translation of evidence into nursing and healthcare (3rd ed., pp. 255–268). Springer Publishing Company. 

PATIENT EDUCATION FOR CHILDREN AND ADOLESCENTS

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In a 300- to 500-word blog post written for a patient and/or caregiver audience, explain signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.
Although you are not required to respond to colleagues, collegial discussion is welcome. 

Please choose one between those 2 :

  • Anxiety Disorder. or
  • Disruptive Mood Dysregulation Disorder  

Nursing

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Reflection # 7

Often, after a class is done for the week, we drop it and move on. The goal of reflection assignments is to encourage you to reflect on what we did in class that week, after the class to consolidate your learning. There will be specific prompts for you to answer; sometimes this is a reflective assignment, and other times it is more of an application assignment (e.g., given a case example and having to apply something from class). The hope is that this will help you to use what you have learned to ensure concepts “stick” or to think critically about your response to what was learned.

Task

Respond to the following prompt and upload your Word document. It should be 1-2 pages and will be due
11:59 p.m. Friday.


Module 6 Reflection

Please watch the brief (3 minute) news clip

Facing Down the Fears of the I-35W Bridge CollapseLinks to an external site.
 mentioned during Dr. Hertig's TF-CBT presentation (if interested [
not required], there is also this

brief articleLinks to an external site.
 on the same story). After watching the clip and reflecting on course materials for this week, please answer the following questions:

1. What are some factors that may have maintained Saiku's PTSD symptoms?

2. How do you think this trauma (and subsequent symptoms) impacted this child's beliefs about himself, other people, or the world in general?

3. Based on the clip, what are some of the TF-CBT strategies Saiku's therapist, Dr. Hong, used to support his recovery? See slide 55 of Dr.Hertig's lecture materials if you need a reminder of TF-CBT treatment components.

4. How did Dr. Hong make the client comfortable in the process of facing his fears?

Grading Criteria

I'm really not looking to take off points for the reflection assignments. I don't have specific rubrics for them, but if you do not seem to be engaging with the prompt or answering the questions, I may take off points. Each reflection assignment is worth
5 points.

RESPONSE TO THE MEANING OF LIFE 2

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 PLEASE RESPOND TO THE FOLLOWING POST IN 50 WORDS:

After reading these three theories I believe the best theory is a ¨virtue Ethics¨ This theory focuses more on being and not doing what I mean by this?  Well, I believe our decisions come from our beliefs and personality think about it a person who cares for others, is honest and compassionate is more likely to help someone than a person who only thinks about themselves and how they can benefit from an action. Aristotle’s said that the right thing to do is what a virtuous person would do and I agree with him. Let’s start by defining what a virtuous person is. A virtuous person is honest, kind, respectful, brave, and wise. I believe that if people develop this trait the world will become a better place to live this is because if we were all to act as virtuous people society would become a better place to live where instead of judging others we would help them to be a virtuoso person.

Do you think we live under the rules of this theory now?

I believe we do live under this theory not because we follow it but because if we were to follow the theory society would become a better place. As a right, some people are virtuous but others are not for example when there is a natural disaster majority of the people only think to themselves about how they are going to prepare or evacuate and sometimes people even get more than what they need because they are not thinking in the rest if we were all virtuous people we would just get what we need and would try to help our community to get prepare or evacuate.

why it would be beneficial as ‘the’ ethical theory for all of us to follow. 

Well as I said before I believe that if we follow this theory the world will become a safer and healthier place to live, I believe if we all were virtuous people we would pick moral decisions that benefit the world and society