DRNP 6566 Week 4 Assignment – Branching Exercise: Cardiac Case 2

DRNP 6566 Week 4 Assignment – Branching Exercise: Cardiac Case 2 – Step-by-Step Guide

The first step before starting to write the DRNP 6566 Week 4 Assignment – Branching Exercise: Cardiac Case 2, 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 4 Assignment – Branching Exercise: Cardiac Case 2

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 4 Assignment – Branching Exercise: Cardiac Case 2

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 4 Assignment – Branching Exercise: Cardiac Case 2

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 4 Assignment – Branching Exercise: Cardiac Case 2

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 4 Assignment – Branching Exercise: Cardiac Case 2

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 4 Assignment – Branching Exercise: Cardiac Case 2

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 4 Assignment – Branching Exercise: Cardiac Case 2 Instructions

Branching Exercise: Cardiac Case 2

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 6 Midterm Exam.

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 4

Submit your completed Assignment by Day 7 of Week 4 in Module 2.

Scenario #3 84 year old female

BACKGROUND

• An 84-year-old female is brought in by family with complaints of increased confusion and lethargy.
• Patient usually lives alone and is fully functional.
• Son reports that she has been increasingly confused and sleeping a lot at home.
• Son denies any fever.
• Patient complains of pain “all over” and responds to repeated questions with “I think I’m sick”
• She has a DNR status but wants full treatment at this time.

EXAM

• BP 105/64, HR 115, RR 24, T 96॰ F, SpO2 92% on room air
• Patient is alert and oriented to person, however, thinks the year is 1990
• PMH: HTN and Diabetes
• Home Med: Metoprolol, Insulin, Lantus 10mg at bedtime, Calcium
• NKDA

Decision Point One

12-lead EKG, CBC, CMP, Urinalysis, CXR

RESULTS OF DECISION POINT ONE

•  Correct!
•  Initial 12-Lead EKG to assess myocardial function
•  CBC to assess for leukocytosis (increased WBC) and potential anemia
•  CMP to assess electrolyte disturbances, liver and renal function. And potential for DKA
•  Urinalysis to assess for potential UTI
•  Chest X-ray to assess for infiltrates (pneumonia)

RESULTS OF INDICATED TESTS

Complete Blood Count (CBC)

WBC 3.4 k/UL
Hgb 9.3 g/dL
Hct 28%
Platelets 250 k/UL
Differential
Neutrolphil 90%
Bands 10%
Eosinophil 0%
Basophil 0%
Lymphocyte 2%
Monocyte 3%

Complete Metabolic Panel (CMP)

NA+ 132 mEq/L
K+ 3.7 mEq/L
HCO# 27 mEq/L
Cl- 101 mEq/L
Glucose 1766
BUN 55 mg/dL
Creatinine 2.0 mg/dL
Albumin 3.2g/dL
Alkaline Phosphatase 99 IU/L
ALT 38 IU/L
AST 30 IU/L
Total Bilirubin 2.1 mg/DL

Urinalysis (U/A)

Color: Yellow
Clarity: Dark/Cloudy
Sp gravity 1.042
pH 6.2
Total Protein: Negative
Glucose: Positive
Ketones: Negative
Bilirubin: Negative
RBCS: 10
WBC: 12
Leukocyte Esterase: 3+
Nitrite: Positive

 

 

Decision Point Two

Urinary Tract Infection

RESULTS OF DECISION POINT TWO

• Urinalysis shows +RBCs, +WBCs + nitrates, and + leukocyte esterase which are all indicative of a UTI
• The elderly frequently have low WBC and low body temperature in the presence of infection and may not present like a younger patient
• The chest X-ray is clear, and EKG shows a sinus tachycardia. There is no arrhythmia or evidence of a myocardial infarction

Decision Point Three

Septic Shock

Guidance to Student

Correct!

Because the patient has circulatory compromise (hypotension, altered mental status) she is in septic shock.

Septic Shock is a subset of sepsis with circulatory and/or cellular or metabolic dysfunction. Patients will have hypotension, decreased urine output, altered mental status-signs of organ damage

Associated with a higher risk of mortality

Aggressive resuscitation and early initiation of septic protocols are a must

DRNP 6566 Week 4 Assignment – Branching Exercise: Cardiac Case 2 Example

Scenario #3 84 year old female

Admission Orders

Primary Diagnosis: septic shock secondary to urosepsis

Status/Condition (Critical, Guarded, Stable, etc.): Critical

Code Status: DNR

Allergies: No known food or drug allergies

Admit to Unit: intensive care unit (ICU) based on qSOFA screening tool.

Activity Level: bedrest

Diet: Nothing by mouth (NPO)

• IV Fluids:
•  Fluid resuscitation with isotonic crystalloids bolus: Normal saline 0.9%, or Lactated ringer, 30ml per kg.
• Critical Drips:
• Vasopressor therapy, Norepinephrine, if the patient’s blood pressure is not responsive to fluid resuscitation, and reassess the mean arterial pressure (Fuller & Mccauley, 2023)

Respiratory: Provide oxygen via Nasal cannula, venturi mask, or nonrebreather to maintain SpO2 above 94%.

Mechanical ventilation If the patient’s respiratory condition is deteriorating.

Medications

• Piperacillin-Tazobactam 4.5 g IV QID
•  Insulin therapy to keep RBS between 140 and 180 (ElSayed et al., 2023)
• IV pantoprazole 40mg daily
• SC Enoxaparin 40mg daily (Evans et al., 2021)
• PO Metoprolol tartrate 25 mg BID

Nursing Orders

• Vital signs should be monitored continuously while the patient receives vasopressors, transitioning to hourly assessments once the patient is stable.
• Strict input and output monitoring is required, with a need to report any urine output below 30 mL per hour.
• A Foley catheter should be inserted for strict monitoring of urine output
• Daily weight measurements.
• Skin care protocols include turning and repositioning the patient every 2 hours to prevent skin breakdown.
• Blood glucose levels must be checked every 4 hours.
• Observe for any signs of worsening respiratory distress or hypotension and notify the provider.
• Neurological assessments should be conducted every 1 hour.
• Blood culture x2 and urine cultures should be collected before initiation of antibiotic therapy.

Follow-Up Lab Tests:

• Conduct CBC, CMP, and Lactate tests every six hours (six-hour bundle) to evaluate the resolution of infection and assess organ function.
• Perform arterial blood gas analysis to monitor for signs of acidosis or respiratory distress.
• Measure Procalcitonin and Lactate levels every six hours to evaluate the body’s septic response (Evans et al., 2021).
• Obtain urine culture and sensitivity testing to narrow antibiotic treatment decisions.
•  Repeat blood cultures after 48 hours. If there is no clinical improvement

Consults:

• Refer to a nephrologist for evaluation of acute kidney injury resulting from sepsis.
• Nutritionist consult once the patient is stable for enteral feeding if the patient has been NPO for more than 72 hours (Harris, 2023).

Patient Education and Health Promotion:

• Educating the patient and her family on the critical nature of the septic shock, the proposed treatment strategy, and the anticipated trajectory of care is essential.
• Address the indicators of infection in older adults and emphasize the significance of prompt identification for future healthcare management.
• Engage the patient and caregiver in discussions about the management of blood glucose levels and strategies for preventing infections.

Discharge Planning and Required Follow-Up Care:

• Assess the need for home health care services at discharge to ensure ongoing monitoring for infection recurrence and effective diabetes management. 
• Arrange follow-up consultations with primary care and nephrology specialists within one to two weeks following discharge. 

References

ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Cusi, K., Hilliard, M. E., Isaacs, D., Johnson, E. L., Kahan, S., Khunti, K., Leon, J., Lyons, S. K., Perry, M. L., Prahalad, P., Pratley, R. E., Seley, J. J., … American Diabetes Association. (2023). Erratum. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of care in diabetes-2023. Diabetes care 2023;46(suppl. 1):S49-S67. Diabetes Care, 46(9), 1722. https://doi.org/10.2337/dc23-er09a

Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., … Levy, M. (2021). Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021: International guidelines for management of sepsis and septic shock 2021. Critical Care Medicine, 49(11), e1063–e1143. https://doi.org/10.1097/ccm.0000000000005337

Fuller, V. J., & Mccauley, P. S. (2023). Textbook for the adult-gerontology acute care nurse practitioner: Evidence-based standards of practice. Springer Publishing Company.

Harris, C. (2023). Adult-gerontology acute care practice guidelines. Springer Publishing Company.

DRNP 6566 Week 4 Knowledge Check: Arrythmia Management/Hypertension and Shock

Complete the 10-question Knowledge Check to gauge your understanding of this module’s content.

Score for this quiz: 9 out of 10

This attempt took 45 minutes.

Question 1

1 / 1 pts

Transthoracic echocardiography (TTE) provides information on all of the following except:

Left ventricular function

Correct!

Left atrial thrombus

Right ventricular function

Inferior vena cava (IVC) dimensions

Question 2

1 / 1 pts

Hypertensive urgency has all of the following characteristics except:

Asymptomatic

BP greater than 180/120

No evidence of target organ damage

Correct!

Evidence of hypertensive disease

All of the above

Question 3

1 / 1 pts

This shock state demonstrates tachycardia, decreased cardiac output, increased SVR, decreased ventricular pressure, decreased pulse pressure and decreased SVO2.

Cardiogenic

Correct!

Hypovolemic

Distributive

Obstructive

Neurogenic

Question 4

1 / 1 pts

This shock state demonstrates tachycardia, decreased cardiac output, increased SVR, increased or normal ventricular pressure, decreased pulse pressure and decreased SVO2.

Cardiogenic

Hypovolemic

Distributive

Correct!

Obstructive

Neurogenic

Question 5

1 / 1 pts

Ultrasonic CO monitoring can be used to calculate the aortic and pulmonary outflow tracts to estimate CO. Values obtained in this form of monitoring are all of the following except:

Cardiac output

Systemic vascular resistance

Stroke volume

Correct!

Aortic valve surface area

Question 6

1 / 1 pts

This shock state demonstrates tachycardia, increased cardiac output, decreased SVR, increased pulse pressure and increased SVO2.

Cardiogenic

Hypovolemic

Correct!

Distributive

Obstructive

Neurogenic

Question 7

0 / 1 pts

Evidence of targeted end organ damage includes all of the following except:

Cranial nerve deficits

Papilledema

S3 on auscultation

You Answered

Epistaxis

Correct Answer

All of the above

Question 8

1 / 1 pts

This shock state demonstrates bradycardia, decreased cardiac output, low CVP, increased SVO2.

Cardiogenic

Hypovolemic

Distributive

Obstructive

Correct!

Neurogenic

Question 9

1 / 1 pts

This shock state demonstrates tachycardia, decreased cardiac output, increased SVR, increased ventricular pressure, decreased pulse pressure and decreased SVO2.

Correct!

Cardiogenic

Hypovolemic

Distributive

Neurogenic

Question 10

1 / 1 pts

An individual presents to the ED with a BP of 180/120 and headache. The ECG shows left ventricular hypertrophy. The patient reports intermittent left sided weakness and blurred vision. The best initial treatment for this patient is:

Correct!

ICU admission and IV labetalol

Start Amlodipine 5 mg and monitor

Discharge with PO beta blocker and urgent follow up with primary care

Start dual PO antihypertensive therapy and discharge