DRNP 6566 Week 2 Assignment – Branching Exercise: Cardiac Case 1

DRNP 6566 Week 2 Assignment – Branching Exercise: Cardiac Case 1 – Step-by-Step Guide

The first step before starting to write the DRNP 6566 Week 2 Assignment – Branching Exercise: Cardiac Case 1, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for DRNP 6566 Week 2 Assignment – Branching Exercise: Cardiac Case 1

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last few years and review each one for credibility. Ensure that you obtain the references in the required format, for example, in APA, to save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for DRNP 6566 Week 2 Assignment – Branching Exercise: Cardiac Case 1

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested in reading through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for DRNP 6566 Week 2 Assignment – Branching Exercise: Cardiac Case 1

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence collected from the research, and ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between paragraphs by using transition words and a flow of ideas.

How to Write the In-text Citations for DRNP 6566 Week 2 Assignment – Branching Exercise: Cardiac Case 1

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for DRNP 6566 Week 2 Assignment – Branching Exercise: Cardiac Case 1

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for DRNP 6566 Week 2 Assignment – Branching Exercise: Cardiac Case 1

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

DRNP 6566 Week 2 Assignment – Branching Exercise: Cardiac Case 1 Instructions

For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented. Have a look at DRNP 6566 Week 4 Assignment – Branching Exercise: Cardiac Case 2.

To prepare:

• Review the interactive media under Required Media: Branching exercise. This is provided in the Learning Resources.
• Review the information provided in the case (patient presentation, vital signs, pmh, home meds, results of labs and diagnostics. With this information, critically think about what is happening with the patient.
• Use your critical thinking skills and current guidelines to develop orders. Include additional labs/diagnostics, what needs repeated and followed up on. Medications that need to be ordered or changed.

The Assignment:

• Using the required admission orders template found under the Learning Resources: Required Reading.
• Develop a set of orders as the admitting provider.
• Be sure to address each aspect of the order template
• Write the orders as you would in the patient’s chart. Be specific. Do not leave room for the nurse to interpret your orders.
• Do not assume anything has already been done/order. Use the information given. Example: If the case does not mention fluids were given, the patient did not receive fluids. You may have to start from scratch as if you are working in the ER. And you must provide orders if the patient needs to be admitted.
• Make sure the order is complete and applicable to the patient.
• Make sure you provide rationales for your labs and diagnostics and anything else you feel the need to explain. This should be done at the end of the order set – not included with the order.
• Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is the appropriate standard of care for this patient.
• A minimum of three current (within the last 5 years), evidenced based references are required.

By Day 7 of Week 2

Submit your completed Assignment by Day 7 of Week 2 in Module 2.

Scenario #1 63 year old female

BACKGROUND

• 63-year-old female presents to the Emergency Department complaining of dizziness and shortness of breath.

VITAL SIGNS

• PMH: HTN, Diabetes, TIA
• Home Meds: Lisinopril, Metformin
• Allergies: Penicillin
• HR: 180, O2 Sat 94%, BP: 107/78, RR: 21
• The patient is a full code

Decision Point One Results

Atrial Fibrillation with Rapid Ventricular Response

Decision Point Two Results

12 lead EKG, TSH, CBC, CMP, INR

Decision Point Three

ASSUMING ALL OF HER LAB VALUES ARE WITHIN NORMAL LIMITS, WHAT IS THE PRIORITY MEDICATION TO ORDER FOR THIS PATIENT?

Decision Point Three Results

Metoprolol tartrate 2.5 mg IV bolus over 2 minutes

Guidance to Student

Correct.

Rate control in this patient is the first priority in order to enable ventricular filling and cardiac output. Anticoagulation is indicated unless there is a contraindication. Rate control and anticoagulation are the priority then Cardiology will advise on TEE/Cardioversion.

DRNP 6566 Week 2 Assignment – Branching Exercise: Cardiac Case 1 Example

Admission Orders Template

(Scenario 1, 63-year-old female)

BACKGROUND

63-year-old female presents to the Emergency Department complaining of dizziness and shortness of breath.

VITAL SIGNS

PMH: HTN, Diabetes, TIA

Home Meds: Lisinopril, Metformin

Allergies: Penicillin

HR: 180, O2 Sat 94%, BP: 107/78, RR: 21

The patient is a full code

Primary Diagnosis: Atrial Fibrillation with Rapid Ventricular Response

Status/Condition Stable

Code Status: Full code

Allergies: No known drug allergies to food or drugs

Admit to Unit: Cardiac unit

Activity Level: to remain on bed rest until heart rate is adequately regulated and stabilized.

Diet: cardiac diet

IV Fluids: restricted before electrolyte results

• Critical Drips none

Respiratory: administer oxygen via nasal cannula at 2 L/min if SpO₂ < 92%.

Medications:

• Administer Diltiazem as a 15-20 mg intravenous bolus over 2 minutes, followed by a continuous infusion of 5-15 mg per hour if the heart rate exceeds 110 beats per minute and the patient exhibits symptoms. 
• Once the heart rate is stabilized, initiate Metoprolol at a dosage of 25 mg orally twice daily, unless contraindications arise or the patient experiences hypotension or bradycardia (Burum et al., 2023). 
• For anticoagulation, prescribe Apixaban at 5 mg orally twice daily, adjust the dosage based on the renal function to mitigate stroke risk (Healey et al., 2024), and provide Acetaminophen 650 mg orally every 6 hours as needed for pain relief. Additionally, Magnesium sulfate should be administered at 2 g intravenously over 1 hour if serum magnesium levels fall below 1.8 mg/dL (Bhatti et al., 2020). 

Nursing Orders:

• continuous cardiac monitoring to identify arrhythmias, and evaluate heart rate management. 
• Assess vital signs at 15-minute intervals until the patient is stable, followed by monitoring every 1 hour. 
• Strict measurement of fluid intake and output to ensure proper fluid balance.
• Weight patient daily.
• Notify the provider of any new onset of arrhythmias or patient becomes hemodynamically unstable.

Follow-Up Lab Tests:

• Conduct a transthoracic echocardiogram to assess cardiac structure and functionality. 
• Obtain a chest X-ray to evaluate for pulmonary congestion or other underlying conditions.
• Conduct a Basic Metabolic Panel (BMP), Complete Blood Count (CBC), and Coagulation Profile upon admission, followed by assessments every six hours until the patient’s condition stabilizes. 
• Measure electrolytes, including potassium (K+), magnesium (Mg2+), and calcium (Ca2+), immediately, with subsequent tests every six hours if any abnormalities are detected. 
• Obtain troponin levels on admission and repeat the test six hours later if the initial results indicate elevation; additionally, perform thyroid function tests (TSH and Free T4) to evaluate any potential thyroid-related contributions to arrhythmia.   

Consults:

• Consultation in cardiology is required for the assessment and treatment of newly diagnosed atrial fibrillation accompanied by rapid ventricular response (RVR). 
• A pharmacy consultation is necessary to confirm the adequacy of anticoagulation therapy and validate dosing concerning renal function. 

Patient Education and Health Promotion (address age-appropriate patient education. if applicable):

• Inform the patient about atrial fibrillation, covering its symptoms, potential triggers, and the critical nature of adhering to prescribed medications. 
• The patient ‘s CHA2DS2-VASc score is 5+, which places her at high risk for thromboembolic strokes. The patient is educated on the significance of anticoagulation therapy in minimizing stroke risk, along with the necessity of regular INR monitoring when prescribed warfarin. 
• Offer recommendations for lifestyle changes, such as limiting caffeine and alcohol consumption, effectively managing stress, and identifying symptoms that necessitate immediate medical intervention. 

Discharge Planning and Required Follow-Up Care:

• The patient may be discharged when the heart rate is stable at less than 100 beats per minute while on oral medications and the patient exhibits no symptoms. 
• Schedule a follow-up appointment with cardiology within two weeks post-discharge for additional assessment and management. 
• Provide the patient with comprehensive discharge instructions, emphasizing the importance of medication adherence, awareness of potential side effects, and guidelines for seeking emergency care. Ensure that the patient receives prescriptions for all required medications prior to discharge. 

References

Bhatti, H., Mohmand, B., Ojha, N., Carvounis, C. P., & Carhart, R. L. (2020). The role of magnesium in the management of atrial fibrillation with rapid ventricular rate. Journal of Atrial Fibrillation, 13(4), 2389. https://doi.org/10.4022/jafib.2389

Burum, A., Carino, J., McBeth, M., Samuel, N., & Hintze, T. D. (2023). A systematic review of weight-based metoprolol for acute atrial fibrillation with rapid ventricular rate. Emergency Medicine International, 2023, 3138064. https://doi.org/10.1155/2023/3138064

Healey, J. S., Lopes, R. D., Granger, C. B., Alings, M., Rivard, L., McIntyre, W. F., Atar, D., Birnie, D. H., Boriani, G., Camm, A. J., Conen, D., Erath, J. W., Gold, M. R., Hohnloser, S. H., Ip, J., Kautzner, J., Kutyifa, V., Linde, C., Mabo, P., … Connolly, S. J. (2024). Apixaban for stroke prevention in subclinical atrial fibrillation. The New England Journal of Medicine, 390(2), 107–117. https://doi.org/10.1056/nejmoa2310234

MedCram-Medical Lectures Explained CLEARLY [@Medcram]. (2019, June 9). ECG Interpretation Explained Clearly and Succinctly – Arrhythmias, Blocks, Hypertrophy. Youtube. https://www.youtube.com/watch?v=Rv6l0ViRJDQ

DRNP 6566 Week 3 Knowledge Check: Arrhythmia Management

Score for this quiz: 9 out of 10

This attempt took 41 minutes.

Question 1

0 / 1 pts

Which laboratory test is it important to order when an patient comes in with an arrhythmia? 

Correct Answer

Thyroid panel

Liver function tests

You Answered

CPK level

ESR

AGACNP guidelines text p. 55

Question 2

1 / 1 pts

Which tachyarrhythmia is characterized by chaotic electrical activity in the atrium without a discernable atrial rate and variable ventricular rate? 

Correct!

Atrial Fibrillation

Atrial Flutter

Supraventricular tachycardia

Ventricular tachycardia

P. 106- Textbook for AGACNP

Question 3

1 / 1 pts

A transesophageal echo (TEE) evaluates for all of the following except?

Cardiac function

Intracardiac thrombus

Measurments of the atria and ventricle sizes

Correct!

Underlying ischemia

P.55 AGAC Guidelines 

Question 4

1 / 1 pts

Where do ventricular arrhythmias originate from? 

SA node

Above the AV node

Purkinje fibers

Correct!

Below the bundle of HIS

P. 54 AGAC Guidelines text

Question 5

1 / 1 pts

Which drug class lowers myocardial oxygen demand and is associated with lower risks of adverse events and mortality after cardiac surgery?

Statins

Antiplatelet

Ace Inhibitors

Correct!

Beta Blockers

P. 138 Textbook for AGACNP 

Question 6

1 / 1 pts

What is first-line therapy for rate control in a patient with an arrhythmia?

Adenosine

Ace Inhibitor

Correct!

Beta Blocker

Digoxin

P.56 AGAC guidelines 

Question 7

1 / 1 pts

A female has new onset paroxysmal atrial fibrillation and has a CHA2DS2-VASc score of 1. According to this score, what is the recommended anticoagulation?

Start warfarin 2.5mg

Start aspirin 81 mg

Start Apixaban 5 mg

Correct!

No therapy is recommended at this time

P. 56 AGAC guidelines

Question 8

1 / 1 pts

The pathogenesis of atrial fibrillation is caused by the dysfunction of underlying factors. Which of the following does not contribute to the pathogenesis of atrial fibrillation? 

Structural

Correct!

Chemical

Electrical

Contractile

AGACNP guidelines text p. 53

Question 9

1 / 1 pts

Which drug can help diagnose a dysrhythmia?

Metoprolol

Cardizem

Correct!

Adenosine

Lisinopril

P. 107- Textbook for AGACNP

Question 10

1 / 1 pts

In a patient with heart failure, why is it important to use caution with first-line rate control agents when treating an arrythmia?

Correct!

The can cause a potential decrease in contractility

They can cause cardiac output to be increased

The can cause decrease in stroke volume variation

They can cause tachycardia

P. 56  AGAC guidelines