NRNP 6566F Week 9 Branching Exercise: Common Diseases and Disorders Essay

NRNP 6566F Week 9 Branching Exercise: Common Diseases and Disorders Essay

NRNP 6566F Week 9 Branching Exercise: Common Diseases and Disorders Essay

Admission Orders

Primary Diagnosis: (Shortness of breath and productive cough) Hospital Acquired Pneumonia

Status/Condition: Fair condition

Code Status: Full Code

Allergies: Allergic to morphine. No other known drug or food allergies

Admit to Unit: Female Medical Ward

Activity Level: Up with minimal assistance- Bed rest

Diet: Per oral. Tolerating fluids and solid foods

IV Fluids: Normal Saline 0.9% 2L in 24 hours

• Critical Drips (None)

Respiratory: Oxygen 1L/minute (60L per hour) via nasal cannula per hour when saturation falls below 92%, four hourly suctioning (Al-Otaibi, 2019)

Medications:

Lisinopril 10mg PO OD

Levothyroxine 75mcg per oral

Rivaroxaban 10mg OD

Ciprofloxacin 500mg Q12 NOCTE

Nursing Orders

Monitor Vitals every 4 hours

Propp patient in bed at 45 degrees to promote breathing (Fahlberg & Laramee, 2020)

Assistance with ambulation and other activities of daily living as tolerated

Daily grooming

Daily knee assessment with weight bearing as tolerated

Provide warm drinks as needed

Follow-Up Lab Tests:

Arterial blood gas test

Complete blood count

Diagnostic testing: Sputum culture test, bronchoscopy, pulse oximetry, and blood culture (See & Lau, 2023)

Consults:

Consult cardiologist for cardiovascular evaluation for further assessment due to hypertension

Occupational therapist for follow-up on knee replacement therapy

Patient Education and Health Promotion :

Health education areas: patient condition

Treatment plans available

Coping skills- changes such as surgery

Fluid intake

Exercises

Diet conversant with underlying conditions

Medications used and their specifications

Discharge Planning and Required Follow-Up Care:

Discharge once patient symptoms are well-managed and the patient is stable, oxygen saturation above 94 on room air, and respiratory rate is below 20).

Follow-up clinic after two weeks for general assessment.

Notify the case manager and social workers about the patient’s discharge planning (Prusaczyk et al., 2019).

Follow-up with the physiotherapist

References

Al-Otaibi, H. M. (2019). Current practice of prescription and administration of oxygen therapy: an observational study at a single teaching hospital. Journal of Taibah University Medical Sciences, 14(4), 357-362. https://doi.org/10.1016/j.jtumed.2019.05.004

Fahlberg, B. B., & Laramee, A. S. (2023). 6 Reducing Episodic Dyspnea in Heart Failure. What Do I Do Now? Palliative Care, 49. https://doi.org/10.1093/med/9780190098896.001.0001

Prusaczyk, B., Kripalani, S., & Dhand, A. (2019). Networks of hospital discharge planning teams and readmissions. Journal of Interprofessional Care, 33(1), 85-92. https://doi.org/10.1080/13561820.2018.1515193

See, K. C., & Lau, Y. H. (2023). Acute management of pneumonia in adult patients. Singapore Medical Journal, 64(3), 209. https://doi.org/10.4103/singaporemedj.SMJ-2022-050

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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.

Scenario #5 68 year old female (NRNP 6566F Week 9 Branching Exercise: Common Diseases and Disorders)

A 68-year-old female is brought to the hospital from the acute rehabilitation facility with complaints of shortness of breath and productive cough for 1 week. She was started on ciprofloxin 3 days ago, but her symptoms have continued to worsen. Her past medical history includes hypertension, hypothyroidism. She underwent a right knee replacement 2 weeks ago. Current medications include lisinopril 10mg, levothyroxine 75mcg, rivaroxaban 10mg daily and ciprofloxacin 500mg Q12. Her current symptoms include fever, chills, productive cough with purulent green sputum, and worsening shortness of breath. She is allergic to morphine. The patient is a full code.

Current vital signs T 102.6 HR 92. RR 22 BP 128/82. O2 saturation is 96% on 4L of O2

Chest x-ray shows consolidation in the right lower lobe

CBC and CMP are all within normal limits

The patient is requiring oxygen to maintain her O2 saturation at the low normal range. The safest option for the patient is to admit her to make sure her oxygen requirements do not need increasing with further intervention. A PICC can be placed for antibiotic therapy.

NRNP_6566_Module5_Assignment_Rubric

Criteria Ratings Pts

This criterion is linked to a Learning OutcomeUsing the Admission Orders Template, write a full set of admission orders for the patient in the branching exercise. Be sure to address the following:· Identify the Correct Diagnosis.

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5 to >4.0 pts
Excellent Point range: 90–100

The order set includes an accurate and correct diagnosis.

4 to >3.0 pts
Good Point range: 80–89

The order set includes a diagnosis that is an appropriate differential diagnosis.

3 to >2.0 pts
Fair Point range: 70–79

The order set includes a diagnosis that is incorrect and not supported by patient data.

2 to >0 pts
Poor Point range: 0–69

The order set includes and inaccurate / dangerous diagnosis.

5 pts

This criterion is linked to a Learning Outcome· Identify the ‘Status/Condition’, ‘Code Status’, ‘Admit to Unit’for the patient in the presenting case.

5 to >4.0 pts
Excellent Point range: 90–100

The order set includes an accurate description / plan for condition, code status, and admission location.

4 to >3.0 pts

Good Point range: 80–89

The order set includes an accurate description for 2 of the 3 variables.

3 to >2.0 pts
Fair Point range: 70–79

The order set includes an accurate description for 1 of the 3 variables.

2 to >0 pts
Poor Point range: 0–69

The order set includes inaccurate, missing, or dangerous descriptions for these variables.

5 pts

This criterion is linked to a Learning Outcome· Describe the “Allergies’, ‘Activity Level’ and “Diet” for the patient in the presenting case.

5 to >4.0 pts
Excellent Point range: 90–100

The order set includes an accurate description / plan for allergies, activity level, and diet.

4 to >3.0 pts
Good Point range: 80–89

The order set includes an accurate description for 2 of the 3 variables.

3 to >2.0 pts

Fair Point range: 70–79

The order set includes an accurate description for 1 of the 3 variables.

2 to >0 pts
Poor Point range: 0–69

The order set includes inaccurate, missing, or dangerous descriptions for these variables.

5 pts

This criterion is linked to a Learning Outcome· Identify any ‘IV Fluids’ needed for the patient in the presenting case.

10 to >8.0 pts
Excellent Point range: 90–100

The order set clearly and accurately identifies a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.

8 to >6.0 pts
Good Point range: 80–89

The order set is missing 1 element of a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.

6 to >4.0 pts
Fair Point range: 70–79

The order set is missing 2 elements of a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.

4 to >0 pts
Poor Point range: 0–69

The order set is incomplete, includes wrong / dangerous fluids or flow rate, incorrect parameters for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.

10 pts

This criterion is linked to a Learning Outcome· Identify any ‘Respiratory’ needs for the patient in the presenting case. Be specific about oxygen (if ordered, include type and rate), pulmonary toilet needs, and ventilator settings.

5 to >4.0 pts
Excellent Point range: 90–100

The order set clearly and accurately identifies a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.

4 to >3.0 pts
Good Point range: 80–89

The order set is missing 1 element of a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.

3 to >2.0 pts
Fair Point range: 70–79

The order set is missing 2 elements of a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.

2 to >0 pts
Poor Point range: 0–69

The order set is incomplete, includes wrong / dangerous orders, or incomplete parameters for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.

5 pts

This criterion is linked to a Learning Outcome· Describe the ‘Medications’ including any IV drips for the patient in the presenting case. Be specific about medications related to the reason for admission and any chronic medications the patient may be taking (ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc.). Be sure to include name, dose, route of administration, and frequency of each medication.

15 to >12.0 pts
Excellent Point range: 90–100

The order set clearly and accurately identifies a complete set of medication orders for the patient in the presenting case. Orders are complete, account for all conditions, and are appropriate to treat the patient.

12 to >9.0 pts
Good Point range: 80–89

The order set clearly and accurately identifies a complete set of medication orders for the patient in the presenting case. There are incomplete orders, missing medications, or missing elements in the orders.

9 to >4.0 pts
Fair Point range: 70–79

The order set is missing essential elements of a medication order, missing medications, or are inappropriate to treat the patient in the presenting case.

4 to >0 pts

Poor Point range: 0–69

The order set is incomplete, includes wrong / dangerous orders, or inappropriate medications to treat the patient in the presenting case.

15 pts

This criterion is linked to a Learning Outcome· Explain any ‘Nursing Orders’ for the patient in the presenting case. Be specific about vital signs, skin care, toileting, and ambulation.

10 to >8.0 pts

Excellent Point range: 90–100

The order set includes a full set of nursing orders that provide essential direction to provide care, monitor, assess, ensure safety, prevent complications and promote healing.

8 to >6.0 pts
Good Point range: 80–89

The order set include inaccurate or is missing 1 or 2 nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.

6 to >4.0 pts

Fair Point range: 70–79

The order set include inaccurate or is missing 3 or 4 nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.

4 to >0 pts

Poor Point range: 0–69

The order set include inaccurate, missing, or provides dangerous nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.

10 pts

This criterion is linked to a Learning Outcome· Explain the ‘Follow-Up Lab’ tests for the patient in the presenting case. Be specific about diagnostic testing (e.g., CXR, US, 2D Echo, etc.).

10 to >8.0 pts

Excellent Point range: 90–100

The order set includes complete laboratory and diagnostic testing to adequately monitor and assess the presenting patient.

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8 to >6.0 pts

Good Point range: 80–89

The order set includes most (missing 1 or 2) laboratory and diagnostic testing to adequately monitor and assess the presenting patient.

6 to >4.0 pts
Fair Point range: 70–79

The order set includes some (missing 3 or 4) complete laboratory and diagnostic testing to adequately monitor and assess the presenting patient.

4 to >0 pts
Poor Point range: 0–69

The order set is missing essential laboratory and diagnostic testing to adequately monitor and assess the presenting patient.

10 pts

This criterion is linked to a Learning Outcome· Explain the ‘Consults’ for the patient in the presenting case. Be specific about how you, as an ACNP, would manage the patient’s acute needs for at least a 24-hour period. Include indication for consult (e.g., “Cardiology consult for evaluation of new-onset atrial fibrillation,” “Nutrition consult for TPN recommendations”).

5 to >4.0 pts
Excellent Point range: 90–100

The order set includes clear, accurate, and essential consults for the patient in the presenting case including complete rationale for the consult.

4 to >3.0 pts
Good Point range: 80–89

The order set is missing one of the following: necessary consult, inaccurate information, or inaccurate rationale for consults needed to manage the presenting patient.

3 to >2.0 pts
Fair Point range: 70–79

The order set is missing 2 or more of the following: necessary consult, inaccurate information, or inaccurate rationale for consults needed to manage the presenting patient.

2 to >0 pts
Poor Point range: 0–69

The order set is missing multiple consults, rations, or accurate descriptions for consults needed to manage the presenting patient.

5 pts

This criterion is linked to a Learning Outcome· Explain the ‘Patient Education and Health Promotion’ for the patient in the presenting case. Be sure to address age-appropriate patient education, if applicable.

10 to >8.0 pts
Excellent Point range: 90–100

The order set provides clear, accurate, and complete patient education and health promotion recommendations for the patient in the presenting case.

8 to >6.0 pts
Good Point range: 80–89

The order set is missing 1 or 2 essential elements of patient education and health promotion for the patient in the presenting case.

6 to >4.0 pts
Fair Point range: 70–79

The order set is missing 3 or 4 essential elements of patient education and health promotion for the patient in the presenting case.

4 to >0 pts
Poor Point range: 0–69

The order set is missing multiple essential elements of patient education and health promotion for the patient in the presenting case.

10 pts

This criterion is linked to a Learning Outcome· Explain the ‘Discharge Planning and Required Follow-Up Care’ for the patient in the presenting case.

5 to >4.0 pts
Excellent Point range: 90–100

The order set provides clear, accurate, and complete discharge planning and necessary follow up care for the patient in the presenting case.

4 to >3.0 pts
Good Point range: 80–89

The order set is missing 1 or 2 essential elements of discharge planning and necessary follow up care for the patient in the presenting case.

3 to >2.0 pts
Fair Point range: 70–79

The order set is missing 3 or 4 essential elements of discharge planning and necessary follow up care for the patient in the presenting case.

2 to >0 pts
Poor Point range: 0–69

The order set is missing multiple essential elements of discharge planning and necessary follow up care for the patient in the presenting case.

5 pts

This criterion is linked to a Learning Outcome· Identify a minimum of three ‘References.’ Be sure that they are timely and support the admission order in following current standards of care.

10 to >8.0 pts
Excellent Point range: 90–100

The order set includes a minimum of three professional level references that are timely and clearly support the admission orders following current standards of care. References are formatted in APA format.

8 to >6.0 pts
Good Point range: 80–89

The order set does not include a minimum of three professional level references that are timely and clearly support the admission orders following current standards of care. APA format is incorrect.

6 to >4.0 pts
Fair Point range: 70–79

The order set does not include a minimum of three references or includes non-professional level resources to support their admission order set. APA format is incorrect.

4 to >0 pts

Poor Point range: 0–69

The order set is missing minimum number of references or includes poor sources that do not reflect professional writing or current standard of care information. APA format is not followed.

10 pts

This criterion is linked to a Learning OutcomeWritten orders include all elements, address all the needs of the patient, are complete, logical, and meets the complete needs of the patient.

5 to >4.0 pts
Excellent Point range: 90–100

Written order set is complete, addresses all the needs of the patient, and are based on current literature.

4 to >3.0 pts

Good Point range: 80–89

Written orders are mostly complete only missing 2 essential elements in addressing the needs of the patient.

3 to >2.0 pts
Fair Point range: 70–79

Written orders are missing 3 to 4 essential elements are reflect an incorrect standard of care.

2 to >0 pts
Poor Point range: 0–69

Written orders are incomplete, do not address the needs of the patient, or reflect an outdated standard of patient care.

5 pts

Total Points: 100