NURS 6540 Week 9 Discussion: Treating Patients in Specialized Areas of Care

NURS 6540 Week 9 Discussion: Treating Patients in Specialized Areas of Care

Week 9 discussion

Discussion: Treating Patients in Specialized Areas of Care

When treating frail elder patients in specialized areas of
care, there are various dynamics that might impact patient care plans. From
questions about potential outcomes, benefits of treatment, and quality of life
to factors such as personal values, families, culture, and religion, decision
making can be difficult for patients and their families. As the advanced
practice nurse, you must support them through this process.

For this Discussion, you examine the following case studies
and consider how you might address the needs of the patients and their
families.

Case Study 1

Mr. Wiggins is a 78-year-old African American male with
chronic kidney disease, which requires dialysis. The etiology of his renal
disease was multifactorial—long-standing uncontrolled HTN and DM nephropathy.
He has been on hemodialysis for the past 10 years and has done relatively well.
Four weeks ago, he had a major CVA and is minimally responsive. His condition
is not expected to change, and the family is having a difficult time with his
recent health changes. Advanced directives were discussed with them, and his
wife is a durable power of attorney for his health care. The wife hates to see
her husband this way and understands this is not how he would want to go on,
but their children and many of the family members (his brothers and sisters)
think the patient will return to himself. They want everything done in terms of
life support measures—full code status. His family wanted a feeding tube
placed, and he is now receiving 24-hour tube feedings. You are the NP caring
for Mr. Wiggins. You have known and cared for him and his wife for several
years. The wife pulls you aside, shares her dilemma, and asks you to make the
decision regarding continuing medical care/support for her husband. How will
you respond?

NURS 6540 Week 9 Discussion: Treating Patients in Specialized Areas of Care

Case Study 2

Mrs. Adams is a 96-year-old Caucasian female who has
recently been diagnosed with colon cancer. She was admitted to the hospitalist
service through the ED with dehydration and rectal bleeding. The bleeding
resolved, and she received 2 units of PRBs and fluid/electrolyte replacement.
She is stable and ready to be discharged home.

Mrs. Adams is in remarkably good health, and other than
arthritis and mild HTN, she has no significant medical or surgical history. She
is able to carry out all of her essential daily living activities. She pays her
own bills, is competent, and has good functional abilities. She was driving up
until last year. Now, she has neighbor’s assist with weekly shopping and
transportation to church. Her sensory, functional, and cogitative abilities
were evaluated this admission and remain intact. She has been offered
palliative surgical intervention, but deferred all treatment. Her only son is
in agreement with his mother’s decision. Her parents and husband are deceased.
You have been asked to obtain advanced directives. What will your discharge
treatment plan be for Mrs. Adams?

Case Study 3

Mr. Pierce is an 82-year-old East Indian male, recently
widowed 6 months ago. He fractured his left hip 2 months ago attempting to
climb his backyard fence to get his cat out of a tree. His children live
internationally and have been taking turns caring for him. His eldest son
brought him in through the ED last night because Mr. Pierce started having
shortness of breath and his lips turned blue. In addition, his son noticed his
left leg was very swollen compared to the right. The ED nurse practitioner
ordered a thin cut cat scan (CT) with pulmonary embolism (PE) protocol and deep
vein thrombosis (DVT) scan. Mr. Pierce has a large DVT that is obstructing
circulation and multiple pulmonary emboli. His condition is life threatening
and he is only expected to live a few weeks. He has a living will and advanced
directives and has requested to be able to die in the comfort of his home. “I
hate hospitals.” You have been consulted at the patient and family’s request
because you are Mr. Pierce’s primary care provider. What additional services
can be offered to ensure his care/comfort at home and to give him peace of mind
regarding his estate?

To prepare:

Select one of the three case studies. Reflect on the
provided patient information.

Think about potential outcomes for the patient in the case
study you selected.

Consider how care, treatment, and/or support might be
facilitated for the patient. Reflect on how you might also address the needs of
the family.

By Day 3

Post an explanation of potential outcomes of the patient in
the case study you selected. Then, explain how care, treatment, and/or support
may be facilitated for the patient. Include how you might address the needs of
the patient’s family as well.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days in one or more of the ways listed below. Respond to colleagues who
selected a different case study than you did.

Offer alternative outcomes based on the case study and
provided patient information.

Share additional suggestions for the care, treatment, and/or
support for the patients in the case studies your colleagues’ selected.

Validate an idea with your own experience and additional
literature search.

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Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. *(5 points possible per graded thread)*	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements *per discussion thread*	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement *per discussion thread*	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.