NUR 2214 RC Nursing Care of The Older Adult Diabetes Ketoacidosis Concept Map

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NUR 2214

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PART 1

Module 02 Course Project - Select Topic { POLYPHAMACY}

Course Competency:

  • Analyze the increased complexity of care among older adults.

Your supervisor needs to make sure that each of the in-service topics will be covered by someone, so she is asking the staff to communicate their topic preference. Below is the list of problems your supervisor wants the nursing staff to be able to teach older adult clients (and/or their family members) about.

In-service Topic Options:

  • Depression
  • Dementia
  • Polypharmacy

Your supervisor has asked you to submit a 1-page proposal, written using proper spelling, grammar, and APA, which addresses the following:

  1. Identify the client problem your in-service will address.
  2. Describe at least 5 consequences of the client problem as it relates to the health, safety, and well-being of older adults.
  3. Explain your rationale for choosing the client problem you selected.

PART 2

Module 03 Discussion - What Would You Do?

Consider the scenario below, then follow the instructions underneath it to complete the discussion. If appropriate, support your position with credible resources/examples/evidence and provide APA references.

Mr. D

Mr. D is a 90-year-old man who was admitted to the hospital with complaints of nausea, vomiting, left arm pain, and chest pain. An electrocardiogram (ECG) is performed, and he is diagnosed as having a myocardial infarction.

Mr. D has a long history of comorbidities including hypertension, diabetes, and congestive heart failure (CHF). With this in mind, the physician asks Mr. D if he wants life-sustaining measures taken (e.g., CPR, mechanical ventilation, etc.) should he experience cardiopulmonary arrest.

Mr. D tells the physician that he wants all measures taken to save his life.

Imagine that you are the nurse assigned to provide care to Mr. D, and address the following:

1.Considering Mr. D's advanced age, what are the benefits/risks associated with providing life-sustaining measures?

2.What factors should you consider based on the Mr. D's age and health history?

3.If Mr. D were your family member, how would you respond to his decision?


PART 4

Module 04 Course Project - Annotated Bibliography{ polypharmacy]

Course Competency:

Compare the care models for nursing practice specific to the older adult.

Transferable Skill:

Information Literacy: Discovering information reflectively, understanding how information is produced and valued, and using information to create new knowledge and participate ethically in communities of learning.

Your nursing supervisor likes the topic you chose for the in-service presentation and wants you to start researching! To make sure you get the project on the right track, your supervisor has asked you to do the following:

1. Using the Rasmussen Library, identify at least 2 resources pertaining to your topic..

2.Prepare an annotated bibliography for the resources you identified. Each entry will include:

a. the full APA formatted reference

b. an annotation consisting of the following elements:

2 to 4 sentences to summarize the main idea(s) of the source

1 or 2 sentences to assess and evaluate the source

1 or 2 sentences to reflect on the source


PART 5

Module 05 Assignment - Case Study Concept Map and Plan of Care

Course Competency: attached the work sheet.

Design plans for care specific to the older adult.

Consider the scenario below, then follow the instructions underneath it to complete the assignment.

Mrs. Y

Mrs. Y is an 84-year-old client who was recently discharged from the hospital for an infected diabetic ulcer on her left leg. During her hospitalization, Mrs. Y required intravenous antibiotic therapy through a peripherally inserted central catheter (PICC) line.

Due to Mrs. Y's long history of diabetes, her physician ordered that intravenous antibiotic therapy be continued at home. Subsequently, home health services were initiated, a home health nurse was assigned to Mrs. Y's case, and an initial home visit was scheduled.

The home health nurse arrives at Mrs. Y's home and introduces herself to the client and the family. The nurse explains the home nursing services that will be provided, including the PICC line and intravenous antibiotic therapy treatments.

During the initial home visit, the nurse assessed the physiological, psychological, functional, and safety needs of the client. The nurse's findings were as follows:

A. Mrs. Y lives alone; however, her daughter checks on her frequently throughout the day.

B. The client is noted to have moderate functional issues and ambulates with a cane.

C. The client has several throw rugs in the main walking quarters and minimal lighting throughout the hallways.

D. Mrs. Y states "I used to get around my house with ease, but now I get a little tired and have to sit down and rest frequently."

Consider Mrs. Y's current health status and functional decline, then address the following:

Download the Concept Map and Plan of Care worksheet below. An example is also provided for your reference.

File: Concept Map and Plan of Care worksheet

File: Concept Map and Plan of Care example

Identify three (3) priority nursing diagnoses for Mrs. Y. Consider using the resource below to assist you.

eBook: Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care - Chapter 5 Nursing Diagnoses in Alphabetical Order

Create a visual representation of the three (3) priority nursing diagnoses by incorporating them into the Concept Map (template in the worksheet). Be sure each nursing diagnosis includes the following elements:

"related to (r/t)" -- description of the client's problem

"as evidenced by" -- description of the client's symptoms

Complete the Nursing Plan of Care (table in the worksheet) describing what should be implemented for Mrs. Y.

Goals: Establish at least one (1) goal for each of the nursing diagnoses you identified (for a total of 3 goals). Goals should be: patient specific, measurable, actionable, realistic, and time limited.

Nursing Interventions: Describe at least three (3) nursing interventions for each of the goals (for a total of 9 nursing interventions). Each intervention should be in alignment with the goal it is supporting.

Complete the assignment using proper spelling, grammar, and APA.

PART 6

Module 06 Discussion - What Would You Do?

Consider the scenario below, then follow the instructions underneath it to complete the discussion. If appropriate, support your position with credible resources/examples/evidence and provide APA references.

Mr. B

Mr. B, a 70-year-old male client, presented to his primary care physician with complaints of blurred vision and headaches over the last two months. On several visits, Mr. B's blood pressure was found to be elevated, so the physician started him on hydrochlorothiazide 25 mg by mouth daily. One month later, Mr. B began to have chest pains and shortness of breath, so his primary care provider referred Mr. B to a cardiologist for further evaluation.

The cardiologist ordered an echocardiogram and stress test which revealed heart enlargement and a reduced ejection fraction (volume of blood pumped out of the heart per minute). As a result, the cardiologist started Mr. B on a beta-blocker (metoprolol 25 mg by mouth daily).

A few days after taking the new medication (in addition to the hydrochlorothiazide ordered by the primary physician), Mr. B suffered a fall at home. Upon arrival at the emergency room, Mr. B's blood pressure was 80/50. The emergency room physician suspected the cause of Mr. B's fall was hypotension secondary to the medications he was taking. The ER physician recommended that Mr. B follow up with his primary care physician and cardiologist, but hold the medication until seen by them.

As recommended, Mr. B visits his primary care physician for a follow-up. During the visit, Mr. B's blood pressure is found to be elevated (160/90), so his physician tells Mr. B to restart taking his blood pressure medication.

Imagine that you are the nurse attending to Mr. B and that he indicates that he's afraid to restart the medication because of his recent fall.

1.What considerations/actions should the nurse make regarding the client's refusal to restart his blood pressure medication?

2.What considerations/actions would have helped the healthcare team to prevent the client's fall?

PART 7

Module 08 Course Project - Presentation Outline

Course Competency: [POLPHARAMACY]

Identify local, state, and national resources which facilitate safe and effective transitions of care for older adults.

Your supervisor at Rasmussen Home Health Services is satisfied with the resources described in your annotated bibliography and is eager for you to continue your work. As a next step, your supervisor wants you to develop and share the following items with them.

Write an introduction about your in-service presentation topic.

Create an outline that identifies and describes the important content areas for your in-service presentation topic.

Write a conclusion.

Provide an APA formatted References list that contains at least 2 credible references that you intend to cite in your presentation

PART 8

Module 09 Discussion - Effects of Ageism

Due to the increasing percentage of older adult clients in the U.S., it is imperative that healthcare providers assess and confront their own attitudes and perceptions toward older adults.

In your initial post, address the following:

a. Describe ageism and its impact on societal views of older adult clients.

b. Explain how ageism can influence the healthcare provisions of older adult clients.

c. As a healthcare provider, how can one best assess and confront attitudes, perceptions, behaviors, and biases toward older adults?

PART 9

Module 10 Course Project - PowerPoint Presentation Due

Course Competencies:[POLYPHARMACY'

Incorporate professional values, attitudes, and expectations regarding ageism when caring for the older adult.

Outline the importance of advocating for older adults in management of their care.

Your supervisor provided some valuable feedback in response to your outline! They are excited to see the PowerPoint slideshow you are creating for your topic's in-service training. Having developed a number of presentations for in-services, your supervisor offered the following advice:

"When developing a slideshow, it's important to be mindful of how you layout your content. For an in-service presentation, the slides should present key points, be arranged logically, without extraneous information contributing to a cluttered look. The audience should get a lot of the content from listening to what you say, not just from reading the slides. Using the Speaker Notes feature in PowerPoint is a great way to include relevant details that you want to provide without overloading the slides."

Your supervisor wants you to work from your outline and prepare a visually appealing PowerPoint slideshow for the in-service presentation. They said it should:

1.Have a title slide.

2.Contain 6-10 content slides pertaining to the important content areas for your presentation topic.

3.Use the Speaker Notes feature in PowerPoint to reduce the amount of text that appears on the slides. (The Speaker Notes will contain the text that will guide what you say while presenting the slides.)

4.Be written using proper spelling/grammar.

5. Cite at least 2 credible references and present the sources in APA format on a References slide.

PART 10

Module 11 Assignment - Reflect on Your Development

Purpose of Assignment:

It is important for nurses to reflect on experiences and new knowledge gained in order to promote professional growth.

Course Competencies:

A. Analyze the increased complexity of care among older adults.

B. Compare care models for nursing practice specific to the older adult.

C. Design plans for care specific to the older adult.

D. Identify local, state, and national resources which facilitate safe and effective transitions of care for older adults.

E. Incorporate professional values, attitudes, and expectations regarding ageism when caring for the older adult.

F. Outline the importance of advocating for older adults in management of their care.

Transferable Skill:

Information Literacy: Discovering information reflectively, understanding how information is produced and valued, and using information to create new knowledge and participate ethically in communities of learning.

Instructions:

Reflect on your development as a nursing professional and address the following in a 1-2 page paper:

A. Describe how you achieved each of the course competencies and the transferable skill.

B. Provide at least one example of new knowledge gained related to each competency and explain how this new knowledge will impact your nursing practice.

You ca use this resources ,if you can

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span (10th ed.). Philadelphia, PA: F.A. Davis.

Doenges, M., Moorhouse, M. F., & Murr, A. C. (2019). Nursing diagnosis manual: Planning, individualizing, and documenting client care (6th ed.). Philadelphia, PA: F.A. Davis.

Silvestri, L.A. & Silvestri, A.E. (2020). Saunders comprehensive review for the NCLEX-RN Examination® (8th ed.). Elsevier.

Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2019). Davis’s drug guide for nurses (16th ed.). Philadelphia, PA: F.A. Davis.

Van Leeuwen, A. M., & Bladh, M. L. (2019). Davis’s comprehensive manual of laboratory and diagnostic tests with nursing implications (8th ed.). Philadelphia, PA: F.A. Davi

Unformatted Attachment Preview

Nursing Care of the Older Adult Module 05 Assignment - Case Study Concept Map and Plan of Care Concept Map: Prioritized Nursing Dx# 1 Prioritized Nursing Dx# 6 • Prioritized Nursing Dx# 2 • • Primary Medical Diagnosis: • Prioritized Nursing Dx# 3 Prioritized Nursing Dx# 5 • • Prioritized Nursing Dx# 4 • Nursing Care of the Older Adult Module 05 Assignment - Case Study Concept Map and Plan of Care Nursing Plan of Care Prioritized Nursing Diagnoses Goal Nursing Interventions Example: Case Study Plan of Care and Concept Map Case Scenario: Mrs. J is admitted to the emergency department with a diagnosis of congestive heart failure. She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can’t catch my breath and my legs are swollen.” After further questioning, you learn that Mrs. J is strictly following the fluid and salt restriction ordered during her last hospital admission. Mrs. J reports gaining 1 to 2 pounds every day since her discharge. Concept Map: Identify two (2) priority nursing diagnoses for Mrs. J and develop a concept map to illustrate them (see example below). Prioritized Nursing Dx# 1 Prioritized Nursing Dx# 6 • Impaired Gas Exchange r/t fluid overload as evidenced by shortness of breath • Prioritized Nursing Dx# 2 • Fluid Volume Excess r/t fluid retention as evidenced by swelling Primary Medical Diagnosis: • Congestive Heart Failure Prioritized Nursing Dx# 3 Prioritized Nursing Dx# 5 • • Prioritized Nursing Dx# 4 • Example: Case Study Plan of Care and Concept Map Nursing Plan of Care For each of the priority nursing diagnoses, establish one (1) goal. For each goal create two (2) nursing interventions. Prioritized Nursing Diagnoses 1. Ineffective Gas Exchange 2. Fluid Volume Excess Goal Pt will maintain oxygen saturations greater than 95% during my shift Pt will have decreased swelling in extremities by the end of my shift. Nursing Interventions 1. Give oxygen as ordered 2. Monitor clients oxygen saturations 1. Administer diuretic as ordered 2. Monitor Intake and Output
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Explanation & Answer

Attached.

Running Head: POLYPHARMACY

1

Polypharmacy
Student’s Name
Institutional Affiliation
Date

POLYPHARMACY

2

Part 1: In-Service Proposal
Introduction
International research studies have revealed that polypharmacy is a common practice
among older adults. Polypharmacy in medical language refers to a situation where a patient uses
multiple medications, typically three or more, in a day. An estimated 40% of older adults take
this medication at home. Patients and their families need to be educated about polypharmacy in
order to equip them with the knowledge that will lead to the safe use of medication. It helps them
to understand how to take the medication and why such medication may be stopped in the event
it has harmful outcomes on or is no longer beneficial to the patient.
Medication Non-adherence
The client problem my in-service will address is non-adherence to medication. Nonadherence in older adults is a common problem associated with complex regimens for
medications and polypharmacy. It is usually as a result of the progression of disease despite
medication, hospitalization, adverse effects, or the cost of the medication. Taking medicine as
prescribed is crucial for a patient. It helps to control chronic conditions, treat temporary
conditions, and improve their general health and well-being in the long term.
Consequences of Non-adherence
Non-adherence to medication regimen compromises the management of health
conditions, which may result in worsening of those conditions. Older adults are more prone to
comorbid and chronic conditions. If they do not take medication as prescribed, the number of
these conditions may rise, the conditions may deteriorate, the patient may make more hospital
visits, and it can also lead to alteration of the drug regimen given to the patient. This makes
health care more expensive. In the worst case scenario, it can lead to death.

POLYPHARMACY

3
Rationale for Non-adherence

Medication non-adherence is a globally recognized issue among patients on
polypharmacy, especially older adults. Yet medical adherence is the most potent way of
management of chronic conditions in this category of patients. Research shows that an estimated
50% of patients with chronic conditions do not adhere to medication regimens, which escalates
the national expenditure on health care occasioned by medication therapy that is not optimized
(remedy publications, 2019)). Non-adherence also leads to a decline in the health and well-being
of patients. The root solution to non-adherence is through patient education and counseling.
Part II: Mr. D
1. Considering Mr. D’s advanced age, what are the benefits/risks associated with providing
life-sustaining measures?
Life-sustaining treatment (LST) in health care refers to all treatment interventions whose
purpose is to prolong life without necessarily reversing the underlying medical condition of the
patient (Ko & Blinderman, 2020). Examples of life-sustaining treatments include mechanical
ventilation, cardiopulmonary resuscitation, artificial nutrition, and hydration, left ventricular
assist devices, and hemodialysis.
Mr. D is a 90-year old patient. His age predisposes him to comorbidities as captured in
his medical history. He has, however, requested the physician to do everything possible to
prolong his life using life-sustaining measures. The life-sustaining treatment has benefits and
risks. They depend on a variety of factors
The apparent benefit of life-sustaining treatment is that it increases the number of days the
patient is alive. When well managed, life-sustaining treatment improves the patient’s quality of

POLYPHARMACY

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life, health, and well-being. It also makes the dying process less painful. When cardiopulmonary
resuscitation is used, it can bring back to life an individual whose heart has stopped beating.
LST is not a good idea for older adults and patients with comorbid conditions such as
pulmonary heart failure. Once performed, such interventions need to be followed by other lifeprolonging measures such as medical care and hospitalization, especially when it is
cardiopulmonary resuscitation. Frail patients such as Mr. D run the risk of fracturing their ribs or
puncturing their lungs and or spleen. There is also a possibility of brain damage if the
resuscitation takes a longer time to happen. This can result in a change in mentation or
permanent unconsciousness. Artificial hydration and nutrition involve tube feeding, which poses
a greater risk to the terminally ill patient. Feeding tubes predispose the patient to pneumonia and
may lead to the accumulation of fluid in the lungs. It has little success probability as the inability
to eat or drink is a terminal medical condition that soon ends in death. The death is not usually a
result of starvation or dehydration but rather of the illness. Other LST measures such as electric
pacemakers may require surgery, which may be risky for a patient who is 90 years old like Mr.
D.
Reference
Ko, D., & Blinderman, C. (2020). Withholding and withdrawing life-sustaining treatment
(including artificial nutrition and hydration). Retrieved 16 October 2020, from
https://oxfordmedicine.com/view/10.1093/med/9780199656097.001.0001/med9780199656097-chapter108#:~:text=Life%2Dsustaining%20treatment%20(LST),and%20artificial%20nutrition%
20and%20hydration.

POLYPHARMACY

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2. What factors should you consider based on Mr. D’s age and health history?
Mr. D’s age predisposes him to multiple comorbid conditions, and he has several, which
include hypertension, diabetes, and congestive heart failure. During his current admission, he has
been diagnosed with myocardial infarction, whose severity is influenced by these comorbid
conditions. The fiduciary relationship between me and Mr. D compels me to act in the interest of
the patient, respecting his right to autonomy in his decision to take life-sustaining treatment.
Even so, there are a number of factors to consider in order to settle on what type of LST to give.
Comorbidity is one of the key areas that must be considered before the decision to put Mr. D on
life-sustaining treatment can be commenced. This can be done using the Charles Comorbidity
Index (CCI), developed to aid in the classification of comorbidity and to determine the risk of
death for patients with comorbid diseases. Multiple and severe comorbid conditions restrict the
application of life-sustaining treatment. Mr. D is also at a high risk of cardiac arrest because of
the comorbid conditions he suffers from. Patients being treated for cardiac arrest are restricted
from life-sustaining treatment.
3. If Mr. D were your family member, how would you respond to his decision?
As a family member, I would disagree with Mr. D’s decision to be put on life-sustaining
treatment because of his age and the several comorbid conditions he suffers from. I will,
however, recognize and respect Mr. D’s autonomy in making decisions concerning the type of
health care he wishes to be given. Even so, since as a family member, I am not a practicing
health care professional and not bound by the principles of medical ethics, I will discuss the
implications of life-sustaining treatment on my patient and try to articulate them to him. The

POLYPHARMACY

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purpose of the discussion will be to persuade him to forego the treatment because of the likely
outcomes that might make his condition worse.
Part 4: Annotated Bibliography
1. Duncan, P., & Blythe, A. (2016). Multimorbidity and polypharmacy. Essential Primary Care,
1st ed.; Blythe, A., Buchan, J., Eds, 307-313.
Chapter 34 of the book discusses the impact of multimorbidity on patients, general
practitioners, and the health system. It espouses the shifting responsibility of comorbidity
management from the health care professionals to the patients and how this should be managed.
The book links comorbidity to polypharmacy by giving statistical evidence of how comorbidity
contributes to how many medications a patient takes, especially among the older adults. It
explains appropriate and problematic polypharmacy and how the problematic one can be
managed.
The authors of the book and both based at the University of Bristol. Polly Duncan is an
academic clinical fellow, while Andrew Blyths is a General Practitioner and a senior teaching
fellow. The authors
2. Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy?
A systematic review of definitions. BMC geriatrics, 17(1), 230.
The journal article focuses on the need to refine the myriad definitions of polypharmacy
and its use in older adults so that they are aligned among the domains of research, clinical
practice, and public health. Having systematically reviewed 110 articles identified from a pool of
1156 articles, 111 numerical definitions of polypharmacy were obtained, 15 numerical
definitions that included the duration of therapy or description of a healthcare setting, and 12

POLYPHARMACY

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descriptive definitions. From the results of the reviews, the authors concluded that there is no
consensus on the definition of polypharmacy. The authors believe that mutually agreed-upon
definitions can play a significant role in enhancing the understanding of the link between using
multiple medications and health outcomes. This will aid in the development of interventions
designed to manage the inappropriate use of medications fo...


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