Pathophysiology

Homework 1 (should be approx. 3.5 pages of content, not including title or reference page)

General Tips

· Page 1 is the title page. Last page is the reference list. Do not include questions.

· Use scholarly writing with correct spelling and complete sentences. Avoid nursing documentation-style writing. No direct quotes allowed.

· If abbreviations are used, they are introduced and used consistently afterwards

· Format using APA style

· Turnitin guidelines – your goal is <20% matching AND no verbatim sentences/passages. Do not worry about matches of non-content items (title page, headings, etc.)

· Support answers using current, professional/reliable sources – sources should be published within the last 5 years (2015 or later). Paraphrase and cite sources as needed. For any source cited in the text, include full reference in reference list.

· Examples of professional/scientific/published sources: textbooks, journal articles, government/scientific sites

· Journal articles – can be found in BSN library databases, see SPC single-sign on page

· Government sites – e.g., Centers for Disease Control and Prevention, National Institute of Allery and Infectious Disease, AIDS.gov, Professional Nursing Organizations (e.g., Oncology Nursing Society), World Health Organization, National Cancer Institute

· Examples of inappropriate sources – should NOT use Wiki anything, WebMD, Medscape, Health system sites (Johns Hopkins, Mayo Clinic, Cleveland Clinic)

Question 1 (approx. 1 page)– Disease process and underlying pathophysiology

· Identify the likely disease process – is pretty self-explanatory

· Explain underlying pathophysiology (evidence to support your interpretation) – underlying cellular/tissue changes that lead to abnormal findings …remember this is a pathophysiology class.

Question 2 (approx. 1 page) – Identify all appropriate NANDA labels, identify #1 priority NANDA label, provide nursing care interventions with rationales

· Identify NANDA labels that apply to the patient based on the manifestations (e.g., pain, respiratory distress, etc.)

· Among the NANDAS, identify the #1 priority NANDA and explain what the nurse should

· Assess/monitor – what should the nurse assess/monitor and provide evidence of the benefit/need

· Do – what actions should the nurse complete to promote improvement and provide evidence of the benefit/need

· Teach – what should the nurse teach the patient/family and evidence of the benefit/need

Question 3 (approx. ½ page)- Medical care and intended impact

· Explain TWO items the nurse should expect to be ordered for the patient and the intended impact of the treatment on the underlying pathophysiology. Be precise and provide specific mechanism of action at the cellular lever (e.g., medication with specific cellular actions)

Question 4 (approx. ½ page) – Choose a disorder from immune system chapters…and discuss impact on population. Give year of information and use most current information available. You will find newer statistics online than in the textbook

· Incidence = number of NEW cases

· Prevalence = number of ALL (new and old) cases

· Cost – can be anything you can find such as hospitalizations, medications, etc. Varies depending on the disease chosen

· Mortality – those who died from a disease

· Morbidity – You may see this term used instead of incidence/prevalence. You’ll have to read carefully to determine if the estimate is for incidence or prevalence. If you already addressed incidence and/or prevalence, morbidity is covered.

· Anything else?

Question 5 (approx. ½ page) – For disease in #3, find EBP recommendations and apply them to nursing

· Find article in a nursing journal or professional nursing organization. To be sure a journal is nursing (and NOT medical/physician), look for some form of the word “nurse” in the journal or organization name. For example, Critical Care Nurse, Oncology Nursing Journal, etc. The biggest mistake students make in this question is they fail to use a nursing source.

· Describe the recommendations and how they should be applied to improve nursing care…in other words; precisely, what should the nurse “do” based on the information to improve care?

Running Head: Homework 2

Homework 2

Homework 2

Care plan for MI

NUR3125

Fall 2017

This patient is presenting to the emergency with symptoms that indicate a Myocardial Infarction. The patient, who is a 48-year-old man, is stating a 3-day history of sub sternal chest pain that is radiating to his back. The symptoms started up while he was mowing his lawn. He stated the pain has eased up over time. He also reported mild trouble with breathing and some nausea but no vomiting. He exercises daily, but does report that he eats a lot of fast food. His last total cholesterol was 232 mg/dL. He also has a 15-year history of tobacco use and family history of myocardial infarction (MI), specifically his father had an MI at age 54 and his grandfather at age 58. His current blood pressure is elevated at 158/98 and heartrate of 102 bpm, his respiratory rate is currently high at 26 breaths/min and noted mild use of accessory muscles upon examination. Lungs are noted to have slight inspiratory crackles at both lung bases. Jugular venous distention is noted at less than 2cm bilaterally. His lab work reveals an elevated Troponin at 2.9 ng/ml, elevated Creatinine phosphokinase at 141 units/L, and an elevated CK-MB/CK isoenzyme at 2%. Elevated troponin indicates damage to the heart muscle, and the elevated Creatinine phosphokinase and CK-MB/CK isoenzyme along with all these other symptoms and labs indicate a heart attack. ECG is done and shows ST elevation and T wave inversion, also noted with premature ventricular contractions. The lab values and ST elevation point to a Myocardial Infarction and Transmural ischemia that will require immediate attention.

I have chosen three NANDA nursing diagnoses for this patient, with the first one being the priority. The three I choose are:

· Decreased Cardiac Output related to altered heart rate and ischemia as evidenced by ECG showing an ST elevation, elevated Troponin, and patient stating he has had chest pain for three days.

· Acute Pain related to tissue damage in the myocardium from inadequate blood supply as evidenced by elevated troponin labs and patient reporting chest pain that radiates to back for three days.

· Ineffective Health Maintenance related to deficient knowledge about self-care and treatment as evidenced by patient stating he eats fast food often and has had elevated blood pressure and cholesterol at past appointments, and patient admitting to smoking ½ pack of cigarettes daily despite family history of MI.

Care Plan Diagnosis #1 Myocardial Infarction

NANDA Diagnosis 1: Decreased Cardiac Output related to altered heart rate and ischemia as evidenced by ECG showing an ST elevation, elevated Troponin, and patient stating he has had chest pain for three days.

NOC (Nursing Outcome Classification) Label: Tissue Perfusion

Expected Client Outcomes:

1. Patient will demonstrate adequate cardiac output evidenced by blood pressure, heart rate, and heart rhythm within normal parameters by shift end tonight (7pm).

2. Patient will report resolution of chest pain by shift end tonight (7pm).

3. Patient’s respiratory rate will be within normal limits by shift end tonight (7pm).

NIC (Nursing Intervention Classification) Label: Cardiac Care

Nursing Interventions/Strategies

1. Administer oxygen to the patient as needed and as ordered by the physician.

2. Administer aspirin to the patient as ordered by the physician.

3.Prepare the patient with intravenous access and education for cardiac catheterization and possible PCI in under 90 minutes door to balloon time for a STEMI.

4.Maintain the patient on bedrest as ordered by the physician.

Scientific Rationales with Citations

1.Supplementing oxygen increases the oxygen availability to the myocardium (Ackley and Ladwig 2014).

2. Aspirin prevents platelet clumping and aggregation, thus preventing thrombus formation (Anderson et al,2011; Antman et al,2008).

3. A time of under 90 mins door to balloon has been associated with improved client outcomes (Anderson et al, 2011; Antman et al, 2008).

4. Anti-ischemic therapy would include reducing and minimizing oxygen demand by the myocardium in the early hospital phase (Anderson et al, 2011).

A common alteration of cardiovascular function is Hypertension. Hypertension is defined as a consistent elevation of systemic arterial blood pressure. It is the most common primary diagnosis in the United States, and, one in three American people has hypertension. Stage one Hypertension is diagnosed when blood pressures are in the 140-159/90-99 range, and Stage two is diagnosed when blood pressures are Systolic greater than or equal to 160 and Diastolic greater than or equal to 100.

The pathophysiology of Hypertension is a prolonged and sustained increase in peripheral resistance, an increase in volume of circulating blood, or both. Primary hypertension accounts for 92 to 95% of individuals with Hypertension, while Secondary, which is caused by an underlying disorder such as kidney disease, accounts for 5-8% of cases.

The Wisconsin Medical Journal published an article in 2012 regarding tracking patient blood pressures in an outpatient medical office setting. All staff were retrained on how to take a proper blood pressure, and patient’s results were tracked and followed so they could stay on top of diagnosing early signs of hypertension if needed. The staff was also followed, and randomly observed to ensure the blood pressures were being taken properly and accurate. As a result, Blood pressure control (<140/90) in patients age 18-85 without diabetes improved from 68.4% to 75.8% in 3 months.

This would be a huge help in the hospital setting. We as nurses, often have so many things to pay attention to, that tracking a patient’s boarder line blood pressure is sometimes missed. If we could train Nursing assistants and Nurses again to properly check and get accurate blood pressure readings, this would also be a huge benefit for patient’s. I have observed many times that a patient’s blood pressure is reported as high, when in fact the patient had just been ambulating and was out of breath when the blood pressure was measured. This is not an accurate reading. I also feel, because we have so many readmissions, having a system that tacks and trends blood pressure readings and can spot early hypertension in patient’s, would be a great benefit for the nursing practice. The journal article is attached to this assignment.

References:

Ackley, B.J, & Ladwig, G.B. (2014. Nursing diagnosis handbook: an evidence-based guide to planning care. Tenth edition. Maryland Heights, Missouri: Mosby Elsevier

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology. United States: Elsevier.

Wisconsin Medical Journal. Office based Nursing Staff Management of Hypertension in Primary Care. 2012. Retrieved from http://eds.b.ebscohost.com.db24.linccweb.org/ehost/pdfviewer/pdfviewer?vid=2&sid=b53dee4f-f5b0-45e3-9f4d-a1814e8856d1%40sessionmgr104

Week 7: Controlling Risks and Project Budgets (graded)