Week 1 discussion
Healthy People Initiative
This week's graded discussion topic relates to the following
Course Outcomes (COs).
CO1 Utilize prior knowledge of theories and principles of
nursing and related disciplines to explain expected client behaviors, while
differentiating between normal findings, variations, and abnormalities. (PO 1)
CO3 Utilize effective communication when performing a health
assessment. (PO 3)
The topic this week asks you to apply what you have learned
to the following case study.
As the school nurse working in a college health clinic, you
see many opportunities to promote health. Maria is a 40-year-old Hispanic who
is in her second year of nursing school. She complains of a 14-pound weight
gain since starting school and is afraid of what this will do to both her
appearance and health if the trend continues. After conducting her history, you
learn that she is an excellent cook and she and her family love to eat foods
that reflect their Hispanic heritage. She is married with two school-age
children. She attends class a total of 15 hours per week, plus she must be
present for 12 hours of labs and clinical. She maintains the household
essentially by herself and does all the shopping, cooking, cleaning, and
chauffeuring of the children. She states that she is lucky to get 6 hours of
sleep per night, but that is okay with her. She lives 1 hour from campus and
commutes each day. Using Healthy People 2020 (Links to an external site.)Links
to an external site. and your text as a guide, answer the following questions.
What additional information would you like to gather from
Maria?
What are Maria's real and potential health risks?
Why is Maria's culture important when obtaining the health
assessment?
Pick one of Maria's health risks. What would be one
reasonable short-term goal for this risk?
What nursing interventions would you incorporate into
Maria's plan of care to assist her with meeting your chosen goal? Please
provide rationale for your selections.
Week 2 discussion
General Survey/Skin/Nutrition
This week's graded discussion topic relates to the following
Course Outcomes (COs).
CO1 Utilize prior knowledge of theories and principles of
nursing and related disciplines to explain expected client behaviors, while
differentiating between normal findings, variations, and abnormalities. (PO 1)
CO3 Utilize effective communication when performing a health
assessment. (PO 3)
Your home health agency has received an order from a local
hospital to evaluate and treat an elderly woman being discharged from its
medical surgical unit.
Millie Gardner, an 83-year-old female patient, is being
discharged home today to the care of her husband Fred (87 years old) following
a 9-day hospitalization for pneumonia, dehydration, and failure to thrive. She
has a history of hypertension (HTN), Type II Diabetes, and cerebral vascular
accident (CVA) with left-sided weakness. Patient is alert and oriented but does
have periods of forgetfulness during the overnight hours. Patient has
intermittent incontinence of bowel and bladder and requires assistance with all
activities of daily living (ADLs).
Medications:
Lopressor
Lisinopril
Plavix
Metformin
Novolin R per sliding scale *NEW*
Multivitamin
Colace
Zithromax *NEW*
Upon arrival you are greeted by Champ, the couple's rambunctious
miniature Doberman pinscher dog. Millie is in her wheelchair staring blankly
out the window, and Fred is busy in the kitchen preparing the couple's lunch.
Based on the scenario above, please use the general survey
process to describe the areas that you would be observing immediately upon
entry to the home.
What, if any, concerns related to Millie's skin and
nutritional status do you have?
What nursing interventions will you include in the plan of
care to address these concerns?
What teaching strategies will you use to educate Millie and
Fred on the new medications?
Using the SBAR, please include the information that you will
communicate to the physician's office at the completion of the visit.
Week 3 discussion
Assessment of the Neurological System
This week's graded discussion topic relates to the following
Course Outcomes (COs).
CO1 Utilize prior knowledge of theories and principles of
nursing and related disciplines to explain expected client behaviors, while
differentiating between normal findings, variations, and abnormalities. (PO 1)
CO2 Recognize the influence that developmental stages have
on physical, psychosocial, cultural, and spiritual functioning. (PO 1)
CO3 Utilize effective communication when performing a health
assessment. (PO 3)
Randy Adams is a 38-year-old male patient of Dr. Joseph
Reynolds who was admitted yesterday morning for 24-hour observation for mild
concussion following a motor vehicle accident. Randy lost consciousness during
the accident and was very confused when he arrived in the ER after EMS
transport. He is an Iraq war veteran and he seemed to think after the accident
that this all happened in Iraq. Dr. Reynolds is concerned that Randy has some
residual problems from a couple of explosive incidents that occurred while he
was in Iraq. The physician is unsure whether Randy's current symptoms are from
the car accident or from prior injuries so he has referred him for
consultations to both a neurologist and to a behavioral health specialist.
Based on the above please discuss the following.
Pathophysiology of concussive injuries and treatment
Neurological assessment tools used in your current practice
setting (if not presently working, please describe one used during prior
employment or schooling)
Current best practices associated with post-traumatic stress
disorder (PTSD)
Nursing interventions you would include in this patient's
plan of care
Week 4 discussion
Assessment of Cardiac Status
This week's graded discussion topic relates to the following
Course Outcomes (COs)
CO1 Utilize prior knowledge of theories and principles of
nursing and related disciplines to explain expected client behaviors, while
differentiating between normal findings, variations, and abnormalities. (PO 1)
CO3 Utilize effective communication when performing a health
assessment. (PO 3)
Esther Jackson is a 56-year-old black female who is 1-day
post-op following a left radical mastectomy. During morning rounds, the
off-going nurse shares with you during bedside report that the patient has been
experiencing increased discomfort in her back throughout the night and has
required frequent help with repositioning. She states that the patient was
medicated for pain approximately 2 hours ago but is voicing little relief and
states that you might want to mention that to the doctor when he rounds later
this morning. With the patient appearing to be in no visible distress, you
proceed on to the next patient's room for report.
Approximately 1 hour later, you return to Ms. Jackson's room
with her morning pills and find her slumped over the bedside stand in tears.
The patient states, "I don't know what is wrong, I don't feel right. My
back hurts and I'm just so tired. What is wrong with me?" The patient
refuses to take her medications at this time stating that she is starting to
feel sick to her stomach.
Just then the nursing assistant comes into the patient's
room to record Ms. Jackson's vital signs, you take this opportunity to quickly
research the patient's medication record to determine if she has a medication
ordered for nausea. Upon return, the nursing assistant hands you the following
vital signs: T 37, R 18, and BP 132/54, but states she couldn't get the
patient's pulse because "it is all over the place."
Please address the following questions related to the
scenario.
What do you suspect is the cause of the patient's symptoms?
Describe the course of action that you will take to confirm
this suspicion and prevent further decline.
What further assessments, lab values, and tests will likely
be ordered for this patient and how often? If testing is to be completed more
than once, please explain the rationale for doing so.
While you are caring for this patient, how will you ensure
that the needs of your other patients are being met?
Week 5 discussion
Assessment of Respiratory Status
This week's graded discussion topic relates to the following
Course Outcomes (COs).
CO1 Utilize prior knowledge of theories and principles of
nursing and related disciplines to explain expected client behaviors, while
differentiating between normal findings, variations, and abnormalities. (PO 1)
CO3 Utilize effective communication when performing a health
assessment. (PO 3)
CO4 Identify teaching/learning needs from the health history
of an individual. (PO 2)
Please review the video above as it will provide you with an
opportunity to immerse yourself in the role of a nurse addressing tobacco use
during routine patient care. Click to review a transcript (Links to an external
site.)Links to an external site. of this recording.
While viewing, reflect on what you have learned about
tobacco use and the role that nurses and other interdisciplinary team members
play in helping to assist tobacco users with quitting. While viewing, it is
also important to keep in mind that tobacco users move through stages of change
in the process of quitting. They move from pre-contemplation to contemplation,
contemplation to preparation; preparation to abstinence; abstinence to
maintenance. Every stage requires a different strategy by a nurse.
After watching the video, and reflecting on the information
presented, address each of the following questions.
What are the common symptoms associated with an exacerbation
of COPD?
What assessment techniques will you use to assess Mary?
Identify smoking strategies that would be appropriate for
each of the encounters that Mary had with the nurse throughout the video that
could have been used to assist Mary in quitting smoking.
Find a resource in your community that could assist Mary.
Start by searching the Internet for your local health department's website.
What services are available to Mary? Briefly describe the services that the
state quit line provides. Does it meet the 4 As? Is it accessible, acceptable,
affordable, or available for Mary?
What will you do to follow-up on Mary's smoking cessation
process?
Week 6 discussion
Assessment of the Abdomen and Genitourinary System
This week's graded discussion topic relates to the following
Course Outcomes (COs).
CO1 Utilize prior knowledge of theories and principles of nursing
and related disciplines to explain expected client behaviors, while
differentiating between normal findings, variations, and abnormalities. (PO 1)
CO2 Recognize the influence that developmental stages have
on physical, psychosocial, cultural, and spiritual functioning. (PO 1)
CO3 Utilize effective communication when performing a health
assessment. (PO 3)
Amira is a 27-year-old Syrian refugee who has been residing
in a local homeless shelter since her arrival here in the United States 4 weeks
ago. She was brought into the emergency room this morning via squad after being
found by a shelter employee sitting in a pool of blood on the bathroom floor
crying and holding her abdomen. Due to her limited English speaking abilities,
she is unable to provide specific details as to her complaints but the shelter
employee states that she has recently stopped eating and has not looked well
for the past couple of days.
Based on the limited information provided, please answer the
following questions.
How will you prioritize your care of Amira, what assessments
will you complete, and in what order? Please provide rationale for choosing
this order.
Are there any cultural beliefs/practices that must be taken
into consideration when planning her care?
Considering her symptoms of abdominal pain and bleeding, is
it possible that her status as a homeless refugee is a causative or
contributing factor to her illness? Please provide rationale for your response.
Week 7 discussion
Assessment of the Musculoskeletal System and Pain
This week's graded discussion topic relates to the following
Course Outcomes (COs).
CO1 Utilize prior knowledge of theories and principles of
nursing and related disciplines to explain expected client behaviors, while
differentiating between normal findings, variations, and abnormalities. (PO 1)
CO2 Recognize the influence that developmental stages have
on physical, psychosocial, cultural, and spiritual functioning. (PO 1)
CO3 Utilize effective communication when performing a health
assessment. (PO 3)
Fred is an 83-year-old male who is being admitted to the
medical-surgical unit status post fall. He is alert and oriented and reports
that while visiting a local casino with his wife Margaret earlier this evening,
he tripped over a curb and fell landing on his right side. After receiving
morphine in the emergency room prior to transfer to your unit, Fred is rating
his pain at 6/10. He has multiple bruises from his jawbone to his knee as well
as a slight rotation of his right leg.
Past medical history includes: myocardial infarction (MI) x
2, peripheral vascular disease (PVD) with bilateral iliac stents,
non-insulin-dependent diabetes mellitus (NIDDM), sleep apnea, and degenerative
joint disease.
Medications include: aspirin, Plavix, Lopressor, Lisinopril,
and Metformin.
After reviewing the above scenario please answer the
following questions.
Based on the information provided, how will you prioritize
your care, what assessments will you include and in what order? Please provide
rationale for your response.
Considering this patient's age, injury, past medical
history, and list of current medications, what, if any, concerns do you have
related to his potential need for surgery?
Should surgery to repair his right femur be required; what
type of clearance and pre-op orders would you anticipate receiving related to
his diet, meds, lab work, and so on?
Week 8 discussion
Rapid Assessment of a Client
This week's graded discussion topic relates to the following
Course Outcomes (COs).
CO1 Utilize prior knowledge of theories and principles of
nursing and related disciplines to explain expected client behaviors, while
differentiating between normal findings, variations, and abnormalities. (PO 1)
CO2 Recognize the influence that developmental stages have
on physical, psychosocial, cultural, and spiritual functioning. (PO 1)
CO3 Utilize effective communication when performing a health
assessment. (PO 3)
CO5 Explore the professional responsibilities involved in
conducting a comprehensive health assessment and provide appropriate documentation.
(PO 6)
Please choose one of the patient scenarios below. Next,
complete a rapid assessment, and provide a SBAR report to a classmate. Remember
to include all concepts of patient safety, standard precautions, and
professional standards.
You are covering for a coworker who is off the floor for
lunch, when you suddenly hear a loud crash coming from a nearby patient room.
You quickly run in and discover Mr. Johnson who was admitted yesterday with a
diagnosis of cerebral vascular accident (CVA) unconscious on the floor between
the bed and the bathroom.
You are called to the room of 2-year-old Jonah by his mother
who states the child has suddenly started breathing very loudly and does not
look right. Upon entering the room you quickly recognize that the child is in
respiratory distress as his lips are cyanotic and the use of accessory muscles
is evident.
You are in the process of admitting Ashley, a 27 year old
who is 28 weeks pregnant with her first child, to the obstetric unit for
complaints of headache, dizziness, and swelling of her lower extremities when
she suddenly begins seizing.
