Explain the pathophysiology of the risk factors that predispose Mrs. Adams to developing pressure ulcers?

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Case Study, Chapter 10, Principles and Practices of Rehabilitation

1. Mrs. Adams, 72 years of age, is admitted to the rehab unit with the diagnosis of stroke. The stroke affected the limbic area in the brain, which has caused the patient to have emotional labiality (her mood changes rapidly because she misinterprets situations). As a result of the emotional labiality, she sometimes refuses to be repositioned or to participate in physical or occupational therapy. She sometimes also refuses to eat and drink. The patient’s right side is paralyzed and flaccid. She has no feeling on her right side. She has reddened areas on her coccyx and both heels at least 1 cm in diameter that do not go away with repositioning. She is incontinent of urine and stool. She has problems with communication called global aphasia (difficulties understanding speech and the written word and difficulties with speaking and writing). She is 5 feet tall and weighs 178 pounds. She has a tendency to develop skin tears because her skin is thin, and she has several bandages on her arms. The family states they are concerned because the staff on the previous medical-surgical unit would drag their mother up in bed when she slid down. The staff would chart when their mother refused to be repositioned and then would not reposition her for hours.

  1. Explain the pathophysiology of the risk factors that predispose Mrs. Adams to developing pressure ulcers?
  2. What nursing measures need to be instituted for Mrs. Adams based on the information presented in the case study?

2. You are assigned to care for David Ramsey, a 22-year-old male patient who sustained a back injury secondary to being thrown from a motorcycle. He did not damage the spinal cord, but the computed tomography revealed a compression fracture at L-2 (lumbar area). David complains of severe lower back pain with numbness and tingling in the lower extremities. You identify the following nursing diagnosis: Impaired Physical Mobility.

  1. What assessments are indicated based on this nursing diagnosis?
  2. List other major nursing diagnoses based on David’s clinical presentation.

Identify one health care reform initiative put forth by a  politician. Briefly discuss the initiative. Who do you feel the  initiative benefits? Who does it harm? Should it be passed? Why or why  not?

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Question 1 :

Identify one health care reform initiative put forth by a  politician. Briefly discuss the initiative. Who do you feel the  initiative benefits? Who does it harm? Should it be passed? Why or why  not?

Question 2 :

For this reflective discussion:  Reflect upon two concepts that you learned in this course.

  • What are the concepts? What insight or ideas did you gain from  learning each of these concepts? Were there aspects of the concepts that  you would challenge?
  • What is the importance of these concepts to public health? How will you use this new wisdom in your current or future career?
  • Optional: Offer feedback on how the course and/or facilitation of the course can be improved.

Reflection is a mental process that challenges you to use critical  thinking to examine the course information, analyze it carefully, make  connections with previous knowledge and experience, and draw conclusions  based on the resulting ideas. A well-cultivated critical thinker raises  vital questions and problems, formulating them clearly and precisely;  gathers and assesses relevant information, using abstract ideas to  interpret it effectively; comes to well-reasoned conclusions and  solutions, testing them against relevant criteria and standards; thinks  open-mindedly within alternative systems of thought, recognizing and  assessing, as need be, their assumptions, implications, and practical  consequences; and communicates effectively with others in figuring out  solutions to complex problems. (Paul & Elder, 2008)

In order to earn maximum credit, the comment should be more than your  opinion, and more than a quick “off the top of your head” response. Be  sure to support your statements, cite sources properly, cite within the  text of your comments, and list your reference(s). The response must be a  minimum of 250 words.

Describe in detail health promotion intervention(s) that a CHN could implement in the assigned community setting.

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Community health nurses practice in a variety of settings. The purpose of this paper is to describe the community setting and analyze the role of a nurse in the assigned setting. Health promotion nursing interventions and a professional nursing organization related to this role will also be examined.

The topic for this paper is the role of a nurse in a correctional setting. 

Course Outcomes

This assignment enables the student to meet the following Course Outcomes.

  • CO5: Analyze the nursing roles in providing comprehensive care in a variety of community health settings. (PO 1)
  • CO6: Utilize a systems-based and collaborative approach to address factors that influence the health of a community and population health problems. (PO 2)

This APA paper is expected to be no more than four pages in length (not including the title page and reference list). Below are the requirements for successful completion of this paper. Please use the recommended APA Template linked below, which incorporates the following categories as the first level headings on your paper. APA formatting helps you to organize your paper in a professional manner and provides consistent methods for citing your sources and completing your reference page. See the documents in the APA category in Resources for assistance with APA formatting. The Student Success Strategies resource has great sections on writing scholarly papers and APA formatting.

  1. The community health setting for this paper must be a correctional setting such as a jail or prison (state, federal, men’s, women’s, juvenile, psychiatric, military, etc.).
  2. Click to view and download the NR443 Community Settings APA Template (Links to an external site.) to complete your paper. The template is formatted with the appropriate running head, title page, page numbers, paragraph formatting, and most of the headings. Please edit the headers and title page with your specific information. You are also encouraged to view the Week 4 assignment tutorial found at the end of the Academic Integrity Reminder.
  3. Read the chapter of your textbook on the  assigned community health setting and take notes based on the outline below.
  4. Locate and read at least one scholarly peer-reviewed journal article that is not assigned in the course related to a nurse’s role in health promotion in this setting. Go to the Chamberlain library at http:/library.chamberlain.edu (Links to an external site.). Search peer reviewed journals to find a scholarly article on this topic. The article must be less than 10 years old (less than 5 years is best).
  5. Thoroughly address the following categories using the APA Template that is provided.
  • Introduction (one paragraph):
    • The introduction should be interesting and capture the reader’s attention.
    • Introduce the assigned community setting
    • Briefly identify CHN role(s) in this setting
    • Identify vulnerable population(s) served in this setting
    • Include a purpose statement
  • Community Setting (two to three paragraphs)
    • Describe the assigned community setting, including vulnerable population(s) served.
    • Discuss three health services provided by the a CHN in the assigned setting.
    • Use your textbook or an outside scholarly source to address these sub-points.
  • Health Promotion Nursing Intervention (two to three paragraphs) 
    • Describe in detail health promotion intervention(s) that a CHN could implement in the assigned community setting.
    • Identify people/organizations/community members this CHN role may collaborate with in health promotion interventions.
    • Utilize at least one peer-reviewed scholarly article related to a health promotion intervention.
  • Professional Nursing Organization (two paragraphs)
    • Provide a detailed description of a professional nursing organization related to the assigned community setting. Search the text, your article, or the Internet for one professional organization that supports nurses in this role. If you can’t find an organization specific to this group, search the American Nurses Association (ANA) website for information on this role. Cite the organization in the body of the text with (organization name, year), and include a complete reference on the reference page.
    • Discuss one professional issue that this organization is addressing related to the assigned community setting.
  • Summary (one paragraph)

The summary reiterates key points about:

  • The community setting and the CHN role(s)
  • Health promotion intervention
  • Professional organization
  • Includes a concluding statement.
  • Reference Page: The reference page should start on a new page (insert a page break). All references should be cited within the body of the paper as (author or organization, year), and the full reference should be included in APA format on the reference page. A URL link alone is not an adequate reference. See the Chamberlain Guidelines for Professional Writing in the APA Folder in Resources for examples of properly formatted references.

Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.

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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

  1. Is very anxious and asks whether she is going to die.
  2. Denies pain but says she feels like she cannot get enough air.
  3. Says her heart feels like it is “running away.”
  4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

  1. Height 175 cm; Weight 95.5kg.
  2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
  3. 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.
  4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
  5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

  1. IV furosemide (Lasix)
  2. Enalapril (Vasotec)
  3. Metoprolol (Lopressor)
  4. IV morphine sulphate (Morphine)
  5. Inhaled short-acting bronchodilator (ProAir HFA)
  6. Inhaled corticosteroid (Flovent HFA)
  7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

  1. Describe the clinical manifestations present in Mrs. J.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
  7. 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.