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 Is very anxious and asks whether she is going to die. Denies pain but says she feels like she cannot get enough air. Says her heart feels like it is "running away." Reports that she is exhausted and cannot eat or drink by herself. Objective Data Height 175 cm; Weight 95.5kg. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58. 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. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin. Intervention The following medications administered through drug therapy control her symptoms: IV furosemide (Lasix) Enalapril (Vasotec) Metoprolol (Lopressor) IV morphine sulphate (Morphine) Inhaled short-acting bronchodilator (ProAir HFA) Inhaled corticosteroid (Flovent HFA) Oxygen delivered at 2L/ NC Critical Thinking Essay In 750-1,000 words, critically evaluate Mrs. J.'s situation. Include the following: Describe the clinical manifestations present in Mrs. J. 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. 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. 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. 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. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale. 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.

The Scenario is based on an article by Helen Gregg published in the Becker's Hospital Review on the Recent Ebola outbreak (link to article). When Ebola patient Thomas Eric Duncan first presented in the emergency department of Texas Health Presbyterian Hospital Dallas, he told a nurse he had traveled to Africa and she recorded that information in the hospital's EHR system — but that information was not displayed in the physician's EHR view, and Mr. Duncan was released. When he returned to the hospital three days later by ambulance, he became the first person to be diagnosed with Ebola on American soil. Texas Health Dallas has since been criticized for not making the diagnosis on Mr. Duncan's initial visit and placing him under quarantine, potentially exposing people he came into contact with between hospital visits to the deadly virus. On Thursday, the hospital released a statement explaining the EHR workflow flaw that led to the missed diagnosis: "The documentation of the travel history was located in the nursing workflow portion of the EHR, and was designed to provide a high reliability nursing process to allow for the administration of influenza vaccine under a physician-delegated standing order. As designed, the travel history would not automatically appear in the physician's standard workflow." The hospital has since updated its EHR so that travel information is displayed in both workflows. "We have made this change to increase the visibility and documentation of the travel question in order to alert all providers. We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola," according to the statement. What to hand in: A 1-3 page document specifying the following: Identify the risks associated with the scenario What could the hospital have done differently?

MN507-5: Evaluate the role of health policy and organizational structure on quality improvement within health care environments.DirectionsFor this Assignment, you will write a position paper in which you will choose and support a policy change which reinforces the role of the nurse as a leader in ensuring access to quality health care in developed and underdeveloped countries. You should approach this assignment from the perspective of your specialty track. Information which may be helpful in selecting a proposed policy change can be found in your textbook Health Policy and Politics: A Nurse’s Guide The word count for your position paper will be 1000 to 1600 words. You must support your work with at least eight scholarly peer reviewed articles. Your paper must include the following topics:Current nursing issues related to globalization of healthcareThe proposed policy changeAgenda setting strategies (Process by which your proposal will gain attention of stakeholders and/or the public)A model or theory that can be used to bring about the changeDesign strategiesImplementation strategiesEvaluation strategiesConclusion Assignment RequirementsBefore finalizing your work, you should:be sure to read the Assignment description carefully (as displayed above);consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; andutilize spelling and grammar check to minimize errors.Your writing Assignment should:follow the conventions of Standard English (correct grammar, punctuation, etc.);be well ordered, logical, and unified, as well as original and insightful;display superior content, organization, style, and mechanics; anduse APA formatting and citation style.