NRS 410 Topic 1 Cardiorespiratory Complexities DQs and Assignment
NRS 410 Topic 1 Cardiorespiratory Complexities DQs and Assignment
NRS 410 Topic 1 Cardiorespiratory Complexities DQs and Assignment
Objectives:
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- Evaluate functions of the cardiac and respiratory systems based on findings.
- Develop a health promotion with a restoration teaching plan for a patient with cardiorespiratory complexities.
- Develop a method for patient education to prevent hospital readmission.
Assessments
Class Introductions
There are many resources a patient could need after diagnosis with cardiorespiratory
issues. Depending on the disease process, whether cardiac or respiratory or both,
determine what needs may arise. Some patients need to use durable medical
equipment like oxygen at home or a walker to get around. Using this equipment
sometimes requires rearranging the house to make it safe, like lifting rugs to reduce
tripping hazards or furniture so patients can move around easily. Many modifications
need to be made for an independent person now dependent on rides to appointments
and help to shower. Medication resources are essential due to how expensive the
medications even for those who have insurance. We must make sure patients have
access to life-saving medicines and the ability to get these prescriptions, so they don’t
run out (Johnson, 2018).
Cardiac rehab helps patients gain independence with activities of daily living after
diagnosis with cardiac issues. They are a non-pharmological approach to help decrease
mortality after myocardial infarction (MI). They help with safe exercise that can help with
healing and improve depression that some feel when faced with illness. They enter this
usually after having an acute MI. This type of rehab improves cardiac function, ejection
fraction, and resting heart rate. They can enhance the quality of life and eliminate risk
factors that could contribute to rehospitalization (Kirolos et al., 2019). Pulmonary rehab
is similar to cardiac rehab but specific to rehab for the lungs. It helps patients with
chronic lung issues learn to exercise in a controlled environment (Johnson, 2018).
These rehabs give patients tools to improve health with diet, exercise, and the ability to
be independent in daily living. If used to full advantage, patients can decrease risks of
further cardiopulmonary issues. Another goal of cardiac/pulmonary rehab is helping
patients return to work. Some may be off work for a period of time to recover. This will
mean some lose their job during this time. Factors that affect a patient’s return to work
post-MI are job description, age, gender, and psychological factors like depression.
Occupational rehab may be necessary to help patients return to work successfully
within two years. It should start right away, along with other rehabs (Zack et al., 2022).
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References
Johnson, A. R. (2018). Cardiorespiratory complexities. In Grand Canyon University
(Ed.), Pathophysiology clinical applications for client health (1st ed.). Retrieved
from https://lc.gcumedia.com/nrs410v/pathophysiology-clinical-applications-for-
clienthealth/v1.1/#/chapter/1
Kirolos, I., Yakoub, D., Pendola, F., Picado, O., Kirolos, A., Levine, Y. C., Jha, S.,
Kabra, R., Cave, B., & Khouzam, R. N. (2019). Cardiac physiology in post-myocardial
infarction patients: The effect of cardiac rehabilitation programs—a systematic review
and update meta-analysis. Annals of Translational Medicine, 7(17), 416–416.
https://doi.org/10.21037/atm.2019.08.64
Zack, O., Melamed, S., Silber, H., Cinamon, T., Levy, D., & Moshe, S. (2022). The
effectiveness of case-management rehabilitation intervention in facilitating return to
work and maintenance of employment after myocardial infarction: Results of a
randomized controlled trial. Clinical Rehabilitation, 026921552210768.
https://doi.org/10.1177/02692155221076826
REPLY
MV
Maricel Vieweg
Posted Date
Mar 10, 2022, 12:56 PM
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Older adults have multiple chronic conditions (MCCs) making it difficult to manage their
healthcare needs aside from their functional deficits and social barriers adding to the
complexities. An evidenced-based management approach called Transitional Care
Model (TCM) have shown an improved health and economic outcomes for adults with
MCCs, who experienced high rates of post-discharge complications, readmissions, or
morbidity and mortality. TCM is a nurse-led intervention focusing on quality care and
better patient and family/caregiver outcomes. In utilizing this model, the patient care is
delivered and coordinated by a Transitional Care Nurse (TCN) usually an APRN, in
collaboration with the patients, their families/caregivers, physicians, and other members
of the health team. After the patient is discharged, the nurse conducts home visits
and/or scheduled telephone call to the patient based on the policy to identify if there’s a
change in patient’s health status and managing/preventing health problems and
readmission. The nurse also works in partnership with the patient’s physician to adjust
medication therapy. TCM is a multidisciplinary approach focusing on the unique needs
of the patients and their families (Hirschman et al. (2015).
Better Outcomes for Older Adults (BOOST) is another intervention model (toolkit) which
improves patients’ care as they transitioned from hospital to home. It has resources to
help senior adults who are high risk for readmissions manage their condition by
considering their individual needs, what matters to them, and the care that is aligned to
their cultures and beliefs. The Care Transitions Intervention (CTI) is the third model
whose goal is to improve continuity of care across care settings and providers in a
patient-centered care. CTI is a low-intensity self-management program based on the
input from the patients and their caregivers which provides patients with tools, support,
and skills to navigate the healthcare system and manage their health conditions
effectively (Earl et al., 2020).
References
Earl, T., Katapodis, N., & Schneiderman, S. (2020). Making healthcare safer III: A
critical analysis of existing and emerging patient safety practices. Agency for Healthcare
Research and Quality.
Hirschman et al. (2015). Continuity of care: The transitional care model. OJIN: The
Online Journal of Issues in
Nursing, 20(3). https://doi.org/10.3912/OJIN.Vol20No03Man01
Assessment Description
Topic 1 DQ 1
Assessment Description
Identify a cardiac or respiratory issue and outline the key steps necessary to include for prevention and health promotion.
Pulmonary hypertension (PH) or pulmonary arterial hypertension (PAH) is another condition related to the heart. Affecting the lungs’ blood vessels, the constriction or wall thickening prevents blood flow and causes pressure build-up (American Heart Association [AHA], 2022). Pre-existing diseases such as congenital heart defects (CHD) can trigger secondary PAH. Atrial or ventricular septal defects cause a left-to-right- shunting of blood, causing too much blood flow through the lungs, increasing stress on the heart, and the high-pressure scars lung blood vessels (AHA, 2022). It is vital to repair congenital heart problems early, if possible, to try to reverse or prevent further damage to the vessels. Educating patients and families on CHD and PAH is vital to ensure they understand its impact on their lives. They must understand the importance of regular follow-ups with providers and taking medications as prescribed. PAH patients should avoid some activities, such as smoking, certain types of exercise, traveling to high-altitude locations, and avoiding estrogen forms of contraception and pregnancy (AHA, 2022). Preventing infections is essential; therefore, patients must be educated on the importance of vaccinations and routine dental exams. Some may need antibiotic therapy before dental procedures to prevent endocarditis. CHD is not preventable, and some patients are diagnosed as adults. Ensuring patients understand the disease and its impact on their lives, including what lifestyle changes they can make to improve their symptoms and prevent complications, is needed. Teaching gives patients the information needed to make the best health and well-being decisions, and additional resources such as websites, support groups, and community resources support continued learning.
Reference
American Heart Association. (2022). Pulmonary hypertension and chd. www.heart.org. https://www.heart.org/en/health-topics/congenital-heart-defects/the-impact-of-congenital-heart-defects/pulmonary-hypertension
Topic 1 DQ 2
Assessment Description
Discuss what resources are often necessary for nonacute care for cardiorespiratory issues. Explain how they support patient independence and decrease readmission.
Case Study: Mrs. J.
Start Date
Mar 7, 2022, 12:00 AM
Due Date
Mar 13, 2022, 11:59 PM
Assessment Description
It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.
Evaluate the Health History and Medical Information for Mrs. J., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Health History
Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.
Subjective Data
- Is very anxious and asks whether she is going to die.
- Denies pain but says she feels like she cannot get enough air.
- Says her heart feels like it is “running away.”
- Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
- Height 175 cm; Weight 95.5kg.
- Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
- Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
- Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
- Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
- IV furosemide (Lasix)
- Enalapril (Vasotec)
- Metoprolol (Lopressor)
- IV morphine sulphate (Morphine)
- Inhaled short-acting bronchodilator (ProAir HFA)
- Inhaled corticosteroid (Flovent HFA)
- Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:
- Describe the clinical manifestations present in Mrs. J.
- Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
- Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
- Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
- Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
- Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
- Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.
You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Topic 1 Participation
Start Date
Mar 7, 2022, 12:00 AM
Due Date
Mar 13, 2022, 11:59 PM
Assessment Description
There is no description for this assessment.
Case Study: Mrs. J. – Rubric
Criteria Description
Clinical Manifestations of Mrs. J.
Criteria Description
Evaluation of Nursing Interventions at Admissions