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NRS 410 : Evaluate the Health History and Medical Information for Mrs. J.

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
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.
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.
Rubric Criteria
Total120 points
Criterion 1. Unsatisfactory 2. Less Than Satisfactory 3. Satisfactory 4. Good 5. Excellent
COPD Triggers
and Options for
Smoking
Cessation
COPD Triggers
and Options for
Smoking
Cessation

0 points
COPD triggers
exacerbating return
visits and options for
smoking cessation are
omitted.

9 points
Some COPD triggers
exacerbating return visits
are partially presented.
Options for smoking
cessation are incomplete; it
is unclear if the options are
relevant to the patient.

9.48 points
General COPD triggers
exacerbating return visits
are generally presented.
Some options for smoking
cessation relevant to the
patient are summarized.
Some support or
information is needed.

10.68 points
Key COPD triggers
exacerbating return visits
are outlined. General
options for smoking
cessation relevant to the
patient are summarized.

12 points
All appropriate COPD
triggers exacerbating return
visits are clearly outlined.
Strong options for smoking
cessation are detailed and
are highly relevant to the
patient.

Mechanics of
Writing (includes
spelling,
punctuation,

0 points
Surface errors are
pervasive enough that
they impede

4.5 points
Frequent and repetitive
mechanical errors distract
the reader. Inconsistencies

4.74 points
Some mechanical errors or
typos are present, but they
are not overly distracting to

5.34 points
Prose is largely free of
mechanical errors,
although a few may be

6 points
Writer is clearly in
command of standard,
written, academic English.

grammar,
language use)
Mechanics of
Writing (includes
spelling,
punctuation,
grammar,
language use)

communication of
meaning. Inappropriate
word choice or
sentence construction
is used.

in language choice
(register), sentence
structure, or word choice
are present.

the reader. Correct
sentence structure and
audience-appropriate
language are used.

present. A variety of
sentence structures and
effective figures of speech
are used.

Documentation
of Sources
Documentation of
Sources (citations,
footnotes,
references,
bibliography, etc.,
as appropriate to
assignment and
style)

0 points
Sources are not
documented.

2.7 points
Documentation of sources
is inconsistent or incorrect,
as appropriate to
assignment and style, with
numerous formatting
errors.

2.84 points
Sources are documented,
as appropriate to
assignment and style,
although some formatting
errors may be present.

3.2 points
Sources are documented,
as appropriate to
assignment and style, and
format is mostly correct.

3.6 points
Sources are completely
and correctly documented,
as appropriate to
assignment and style, and
format is free of error.

Argument Logic
and Construction
Argument Logic
and Construction

0 points
Statement of purpose
is not justified by the
conclusion. The
conclusion does not
support the claim
made. Argument is
incoherent and uses
noncredible sources.

4.5 points
Sufficient justification of
claims is lacking. Argument
lacks consistent unity.
There are obvious flaws in
the logic. Some sources
have questionable
credibility.

4.74 points
Argument is orderly but
may have a few
inconsistencies. The
argument presents minimal
justification of claims.
Argument logically, but not
thoroughly, supports the
purpose. Sources used are
credible. Introduction and
conclusion bracket the
thesis.

5.34 points
Argument shows logical
progression. Techniques
of argumentation are
evident. There is a smooth
progression of claims from
introduction to conclusion.
Most sources are
authoritative.

6 points
Clear and convincing
argument presents a
persuasive claim in a
distinctive and compelling
manner. All sources are
authoritative.

Method for
Providing
Education to
Prevent Hospital
Readmissions

0 points
A method for providing
education to the patient
for the maintenance of
prescribed medications

13.5 points
A method for providing
education to the patient for
the maintenance of
prescribed medications that

14.22 points
A method for providing
education to the patient for
the maintenance of
prescribed medications that

16.02 points
A method for providing
education to the patient for
the maintenance of
prescribed medications

18 points
A method for providing
education to the patient for
the maintenance of
prescribed medications that

Method for
Providing
Education to
Prevent Hospital
Readmissions

that prevents future
hospital admissions is
omitted. The method is
not appropriate for the
client or health status.

prevents future hospital
admissions is partially
summarized. The method
may not be relevant to for
this situation. More
information is needed.
There are major
inaccuracies.

prevents future hospital
admissions is summarized.
The method is generally
appropriate. Some
rationale is provided for
support.

that prevents future
hospital admissions is
described. Overall, the
method is appropriate.
General rationale is
provided for support.

prevents future hospital
admissions is thoroughly
described. The method is
clearly appropriate for the
client and prevents
readmission. Strong
rationale is provided for
support.

Nursing
Interventions for
Older Patients to
Prevent
Problems
Caused by
Multiple Drug
Interactions
Nursing
Interventions for
Older Patients to
Prevent Problems
Caused by
Multiple Drug
Interactions

0 points
Fewer than three
nursing interventions
that can help prevent
problems caused by
multiple drug
interactions in older
patients are presented.

9 points
Four nursing interventions
that can help prevent
problems caused by
multiple drug interactions in
older patients are partially
presented.

9.48 points
Four nursing interventions
that can help prevent
problems caused by
multiple drug interactions in
older patients are
summarized. Overall, the
discussion meets
assignment criteria but
requires more rationale for
the interventions. There are
minor inaccuracies.

10.68 points
Four nursing interventions
that can help prevent
problems caused by
multiple drug interactions
in older patients are
discussed. Overall, the
discussion meets
assignment criteria and
general rationale for the
interventions is provided.

12 points
Four nursing interventions
that can help prevent
problems caused by
multiple drug interactions in
older patients are
discussed. The discussion
fulfills the assignment
criteria and strong rationale
for the interventions is
provided.

Paper Format
(use of
appropriate style
for the major and
assignment)
Paper Format (use
of appropriate
style for the major
and assignment)

0 points
Template is not used
appropriately, or
documentation format
is rarely followed
correctly.

1.8 points
Appropriate template is
used, but some elements
are missing or mistaken. A
lack of control with
formatting is apparent.

1.9 points
Appropriate template is
used. Formatting is correct,
although some minor errors
may be present.

2.14 points
Appropriate template is
fully used. There are
virtually no errors in
formatting style.

2.4 points
All format elements are
correct.

Evaluation of
Nursing
Interventions at

0 points
Evaluation of
appropriateness of

9 points
Evaluation of
appropriateness of nursing

9.48 points
Evaluation of
appropriateness of nursing

10.68 points
Evaluation of
appropriateness of nursing

12 points
Evaluation of
appropriateness of nursing

Admissions
Evaluation of
Nursing
Interventions at
Admissions

nursing interventions at
the time of admission
and explanation of the
rationale for each of the
medications listed are
not discussed.

interventions at the time of
admission is partially
presented. An incomplete
explanation for each of the
medications listed is
presented. The discussion
contains significant
inaccuracies.

interventions at the time of
admission is summarized.
A general explanation and
some rationale for each of
the medications listed are
presented. There are minor
inaccuracies.

interventions at the time of
admission is discussed.
An explanation and
general rationale for each
of the medications listed
are presented. Some
information is required for
accuracy or clarity.

interventions at the time of
admission is thoroughly
discussed. A well-
supported explanation for
each of the medications
listed is presented. Strong
and compelling rationale is
provided.

Health Promotion
and Restoration
Teaching Plan
Health Promotion
and Restoration
Teaching Plan

0 points
A health promotion and
restoration teaching
plan for the patient is
omitted.

13.5 points
A health promotion and
restoration teaching plan
for the patient is partially
presented. Multidisciplinary
resources for rehabilitation
and any modifications that
may be needed are omitted
or incomplete. An
explanation for how
rehabilitation resources and
modifications assist patient
transition to independence
is omitted or incomplete.

14.22 points
A health promotion and
restoration teaching plan
for the patient is
summarized.
Multidisciplinary resources
for rehabilitation and any
modifications that may be
needed are generally
presented. A summary for
how rehabilitation
resources and
modifications assist patient
transition to independence
is presented. There are
minor inaccuracies.

16.02 points
A health promotion and
restoration teaching plan
for the patient is
presented.
Multidisciplinary resources
for rehabilitation and any
modifications that may be
needed are discussed. An
explanation for how
rehabilitation resources
and modifications assist
patient transition to
independence is
presented.

18 points
A well-developed health
promotion and restoration
teaching plan for the
patient is presented.
Multidisciplinary resources
for rehabilitation and any
modifications that may be
needed are clearly
discussed. An strong
explanation for how
rehabilitation resources and
modifications assist patient
transition to independence
is presented. The overall
discussion is well-
supported.

Cardiovascular
Conditions
Leading to Heart
Failure and
Interventions
Cardiovascular
Conditions
Leading to Heart
Failure and
Interventions

0 points
Fewer than three
cardiovascular
conditions that may
lead to heart failure,
and medical or nursing
interventions to prevent
the development of
heart failure in each
condition, are

9 points
Four cardiovascular
conditions that may lead to
heart failure are partially
described. Medical or
nursing interventions to
prevent the development of
heart failure in each
condition are incomplete.
There are significant

9.48 points
Four cardiovascular
conditions that may lead to
heart failure are
summarized. Medical or
nursing interventions to
prevent the development of
heart failure in each
condition are generally
discussed. There are some

10.68 points
Four cardiovascular
conditions that may lead to
heart failure are
described. Medical and
nursing interventions to
prevent the development
of heart failure in each
condition are discussed.
There are minor

12 points
Four cardiovascular
conditions that may lead to
heart failure are clearly
described. Medical and
nursing interventions to
prevent the development of
heart failure in each
condition are discussed.
Overall, the discussion

described. inaccuracies. inaccuracies. inaccuracies, or

information is needed for
clarity.

demonstrates insight into
medical and nursing
interventions used to
prevent heart failure.

Clinical
Manifestations of
Mrs. J.
Clinical
Manifestations of
Mrs. J.

0 points
Clinical manifestations
are omitted.

9 points
Clinical manifestations are
partially presented. There
are major omissions and
inaccuracies.

9.48 points
Clinical manifestations are
summarized. An overview
of the general symptoms is
presented. Some findings
are incomplete.

10.68 points
Subjective and objective
clinical manifestations are
described. Overall, the
clinical manifestations are
accurate and reflect
observed and perceived
signs and symptoms.

12 points
Subjective and objective
clinical manifestations are
detailed. The clinical
manifestations are accurate
and clearly report the
observed and perceived
signs and symptoms.

Thesis
Development and
Purpose
Thesis
Development and
Purpose

0 points
Paper lacks any
discernible overall
purpose or organizing
claim.

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