Final Assignment Details

Outcomes assessed in this Assignment:

NU416-6: Assemble evidence-based nursing interventions that maximize wellness for complex patients with chronic co-morbid conditions and is consistent with chronic care delivery model.

GEL-7.02: Apply ethical reasoning to ethical issues within the field of study.

Mr. Bale is an 85-year-old who is oxygen dependent following a recent diagnosis of Chronic Obstructive Pulmonary Disorder (COPD). (He has a history of smoking 2 packs per day for 50 years.) He also has two other chronic co-morbid conditions, Congestive Heart Failure (CHF) and hearing loss. Mr. Bale and his wife live independently at the home of their eldest son, daughter-in-law, and two grandchildren. Two other children also live close. Mr. Bale immigrated to the U.S. from Mexico many years ago and became an American citizen 15 years ago. Mr. Bale’s primary language is Spanish; however, he does speak and understand limited English. His family generally translates for him.

Mr. Bale is receiving Western healthcare through the local healthcare system, but also continues to use cultural remedies he learned in Mexico many years ago. Recently there has been a concern that he continues to smoke in the house despite the agreement he signed to stop smoking when oxygen therapy was initiated.

For this case study, you will write a 3-4-page descriptive essay that addresses each of the elements listed below.

1. Introduce the reader to Mr. Bale, his family, and his situation.

2. Think about the impact that Mr. Bale’s three co-morbid conditions would have on him and his family.

• What health/safety problems and risk factors can you identify?
• Explain why the identified problems and risk factors are threats to Mr. Bale’s health and safety.  
• How would the Chronic Care Model assist in Mr. Bale’s care?

3. If you were the home health nurse, how would you approach this situation?

• What evidence-based interventions would you employ to address at least three of Mr. Bale’s health issues?
• What communication strategies would you employ?
• Provide rationale for your choices.

4. There are several ethical situations in this case study regarding Mr. Bale and his family.  

• Identify one ethical dilemma.
• What is the underlying ethical principle behind the identified dilemma?
• Propose two possible solutions to this ethical dilemma.  
• Which solution do you support as the appropriate course of action and why?

Assignment Requirements

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above)
• consult the Grading Rubric to make sure you have included everything necessary;
• utilize spelling and grammar check to minimize errors; and

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;
• use APA 6th edition format.

Final Assignment Details

Outcomes assessed in this Assignment:

NU416-6: Assemble evidence-based nursing interventions that maximize wellness for complex patients with chronic co-morbid conditions and is consistent with chronic care delivery model.

GEL-7.02: Apply ethical reasoning to ethical issues within the field of study.

Mr. Bale is an 85-year-old who is oxygen dependent following a recent diagnosis of Chronic Obstructive Pulmonary Disorder (COPD). (He has a history of smoking 2 packs per day for 50 years.) He also has two other chronic co-morbid conditions, Congestive Heart Failure (CHF) and hearing loss. Mr. Bale and his wife live independently at the home of their eldest son, daughter-in-law, and two grandchildren. Two other children also live close. Mr. Bale immigrated to the U.S. from Mexico many years ago and became an American citizen 15 years ago. Mr. Bale’s primary language is Spanish; however, he does speak and understand limited English. His family generally translates for him.

Mr. Bale is receiving Western healthcare through the local healthcare system, but also continues to use cultural remedies he learned in Mexico many years ago. Recently there has been a concern that he continues to smoke in the house despite the agreement he signed to stop smoking when oxygen therapy was initiated.

For this case study, you will write a 3-4-page descriptive essay that addresses each of the elements listed below.

1. Introduce the reader to Mr. Bale, his family, and his situation.

2. Think about the impact that Mr. Bale’s three co-morbid conditions would have on him and his family.

• What health/safety problems and risk factors can you identify?
• Explain why the identified problems and risk factors are threats to Mr. Bale’s health and safety.  
• How would the Chronic Care Model assist in Mr. Bale’s care?

3. If you were the home health nurse, how would you approach this situation?

• What evidence-based interventions would you employ to address at least three of Mr. Bale’s health issues?
• What communication strategies would you employ?
• Provide rationale for your choices.

4. There are several ethical situations in this case study regarding Mr. Bale and his family.  

• Identify one ethical dilemma.
• What is the underlying ethical principle behind the identified dilemma?
• Propose two possible solutions to this ethical dilemma.  
• Which solution do you support as the appropriate course of action and why?

Assignment Requirements

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above)
• consult the Grading Rubric to make sure you have included everything necessary;
• utilize spelling and grammar check to minimize errors; and

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;
• use APA 6th edition format.

Topic: Reflection

The Discussion requirements for the Saturday posting deadline and the number of responses will be reduced this week.  Please focus first on your assignment which is due by end of day Sunday of this week. When that is complete, focus on this discussion question.  If you respond to this question and reply to at least one classmate, you will earn full credit.

Refer back to your first introduction in Unit 1 of this class and your definition of chronic illness. After reflecting back over the class, please share any insights or “ah ha moments” you have experienced. Has your definition of chronic illness changed? What is the most significant thing you will remember and take with you from this class? Has this class resulted in any changes in your clinical practice?

What are the ethical challenges that need to be considered when implementing motivational self-management health promotion strategies for those with chronic illness? Include the ethical principle and give rationale.

Assignment Details

Managing Medications

Outcomes assessed in this Assignment:

NU416-5: Implement evidence-based interventions for managing the chronic care of patients to promote health and quality of life across the lifespan.

Co-morbid chronic illness often requires that many prescribed medications often resulting in what is referred to as “polypharmacy”.  This can result in several problems. Adherence to a medication regimen is a key factor in promoting health and quality of life in those with chronic illness. Non-adherence or non-compliance can be attributed to a multitude of factors including cost, complexity of the medication regimen, and actual or perceived side effects (Ferdinand et al., 2017). Side effects and adverse drug reactions are other problems associated with polypharmacy.  Nurses in both acute care and community or public health settings play an integral role in increasing medication regimen adherence and reducing adverse medication reactions for  those with chronic illness (Shin & Haberman, 2016). For this assignment, evaluate a medication list and search for  evidence-based interventions to increase quality of life and promote health through improved medication adherence.

Consider an 80-year old patient, Mrs. X. Mrs. X has a long list of medications, both prescribed and OTC.

Altace  5 mg qd for congestive heart failure

Atalat CC 60 mg qd for hypertension

Cardizem LA 180 mg qd for coronary artery disease

Lasix 40 mg qd for edema

Hydrochlorothiazide 25 mg qd for hypertension/edema

Baby aspirin 81mg qd to prevent clots

Lipitor 10 mg qd for hypercholesterolemia

Synthroid 0.125 mcg ac qd for hypothyroidism

Tylenol 650 mg q4-6h for pain (arthritis)

Aleve 250 mg q6-8 hrs for prn  for pain (arthritis)

Amrix 15 mg qd for pain/muscle spasms

Glucosamine 500 mg bid for pain

Amitriptyline 75 mg qhs for pain/sleep

Paxil 20 mg qd for depression

Oxazepam 15 mg hs for insomnia

Tylenol PM 1 tab qhs prn for insomnia

Benadryl 25 mg prn for allergy/itching

Prilosec 40 mg ac qd for gastric reflux/heartburn

Fiber laxative in water qd for constipation

Colace 50 mg bid for constipation

Multivitamin 1 qd

What are your first thoughts as you see this list? What are your impressions of Mrs. X’s health?

Read the following article:  American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults as found in your reading list.   Compare Mrs. X’s medication list against the Beers List Criteria for Potentially Inappropriate Medication use in Older Adults.  What potential problems and concerns do you have for Mrs. X related to side effects and drug interactions? Consider the content items of the SPICES screening tool when answering.

What health promotion strategies would you use to address these concerns about side effects and drug interactions?

What evidence-based interventions would you recommend to help Mrs. X remain compliant with her medications?

This document should be no more than three pages in length. When creating this document:

·         Consider Mrs. X’s age and level of understanding.

·         Avoid medical terms Mrs. X  and her family might not understand.

Assignment Requirements

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above);
• consult the Grading Rubric (under Course Resources) to make sure you have included everything necessary;
• utilize spelling and grammar check to minimize errors;
• review APA formatting and citation information found in the Writing Center, online, or elsewhere in the course.

Your document should:

·         be up to three pages in length;

·         Use at least four scholarly nursing articles or resources to support your work;

·         follow the conventions of Standard American English (correct grammar, punctuation, etc.);

·         be well ordered, logical, and unified, as well as original and insightful;

·         display superior content, organization, style, and mechanics; and

·         use APA 6th edition format for crediting sources.

Ferdinand, K. C., Senatore, F. F., Clayton-Jeter, H., Cryer, D. R., Lewin, J. C., Nasser, S. A., & … Califf, R. M. (2017). The present and future: Improving medication adherence in cardiometabolic disease. Practical and regulatory implications. Journal Of The American College Of Cardiology, 69437-451. doi:10.1016/j.jacc.2016.11.034

Shin, J. Y., & Habermann, B. (2016). Medication adherence in people with Parkinson disease. Journal of Neuroscience Nursing, (4). 185.

Topic: Health Promotion

The diagnosis of a chronic illness represents a major transition in an individual’s life.  Life as it was is no more and will not be again. Imagine a patient with several chronic illness diagnoses and multiple prescribers. This patient has diagnosis of congestive heart failure, hypertension, and diabetes. There are many self-management care and health promoting lifestyle changes that accompany the diagnosis of these chronic illnesses that the individual will need to incorporate into his or her daily life.

What are the challenges that face this patient?

What evidence-based health promotion interventions would be helpful to motivate the individual to make the necessary changes?

What are the challenges that face the healthcare system relative to quality chronic illness care?

What can nurses do to bring about the necessary changes to our healthcare system?

Assessment of the individual with several chronic illnesses becomes very complicated. Things are not always what they seem.  The traditional signs and symptoms of disease that were learned from textbooks do not always apply in an older adult. Often there are atypical presentations of illness.  For instance an elderly person might not demonstrate a temperature with an infection. The assessment of the complex older adult requires critical thinking to put together the assessment clues.

For this discussion the class is divided into three groups, each of which will answer a different question.  When responding to classmates, make at least one response to a classmate’s post in each of the two questions you were not assigned to answer.   

Group 1: Those with last names that begin with A-H will answer this question:

There is a high correlation between the presence of multiple chronic co-morbid conditions, geriatric syndromes, iatrogenesis, frailty, and poor outcomes.

What is a geriatric syndrome? Which comes first? Might the presence of geriatric syndromes be the clues to the diagnosis of underlying chronic illness? Or might the complex presence of chronic co-morbid conditions lead to the development of geriatric syndromes? Does the condition of frailty meet the criteria of a geriatric syndrome? Why or why not? Give an example of how our well-intended interventions might cause iatrogenesis.

Group 2:  Those with last names that begin with I-P will answer this question:

Most elderly adults want to remain independent in their homes. The thing the elderly fear the most is the loss of independence.  But with aging often comes loss of mobility, loss of function, sensory loss, loss of friends, etc. and this can lead to social isolation. What are the health effects of social isolation?  How do you assess for the signs and symptoms of social isolation?

Group 3:  Those with last names that begin with Q-Z will answer this question:

One’s concept of “old” changes as one ages. What is the “stereotypical” image of “old” or “chronically ill”?  Discuss an example of negative stereotyping or attitudes towards a chronically ill elderly person or child this week. Use newspapers, TV reports or programs, greeting cards, motion pictures, or even something you witness yourself. Did you find any positive examples?  Imagine yourself as a chronically ill elderly person or child. What can nurses do to change these negative stereotypes?

Assignment Details

SPICES Case Study

Outcome assessed in this Assignment:

NU416-4: Appraise holistic assessment data on patients with co-morbid chronic illness across the lifespan, including symptom recognition and self-care strategies.

As the first step in the nursing process, assessment is very important for those with chronic illness and co-morbid conditions. Traditional physical assessments involve the collection of objective and subjective data that relate to a client’s physiological health, but many other factors influence the health of those with chronic illness.

For this Clinical Practice Experience Assignment, you will prepare a paper that illustrates the importance of screening tools to support a holistic assessment of those with chronic and co-morbid conditions. You will describe the results of your completed assessment.

Create your Assignment in accordance with the Holistic Assessment Guide and using the Holistic Assessment Template located under Course Documents.

Complete the Clinical Practice Experience Log located under Course Documents and attach to your final submission.

Assignment Details

Outcome assessed in this Assignment:

NU416-3: Investigate the factors that influence patients with co-morbid chronic illnesses across the lifespan and across transitions of care and health.

GEL-1.03: Demonstrate college-level communications through the oral delivery of original materials in Standard English.

Approximately one third of all veterans returning from service in the Middle East have received a mental health diagnosis (Ganzer, 2016). The most common diagnoses differ between male and female veterans. Female veterans are at greater risk for post-traumatic stress disorder, military sexual trauma, and suicide (Ganzer, 2016) while male veterans are at greatest risk for post-traumatic stress disorder, depression, and traumatic brain injury (National Alliance for Mental Illness, 2017). The need for mental health services to our newest veterans has never been greater.

References

Ganzer, C. A. (2016). Veteran women: Mental health-related consequences of military service. American Journal of Nursing, 116(11), 32-39. doi: 10.1097/01.NAJ.0000505583.09590.d4

National Alliance for Mental Illness. (2017). Veterans & active duty. Retrieved from https://www.nami.org/Find-Support/Veterans-and-Active-Duty

For this Assignment, you will determine the adequacy mental health services available to veterans in your community.

Assess the community and/or state sponsored services that are available to veterans with co-morbid chronic mental illness. For example, what services are available to a veteran who suffers from post-traumatic stress disorder and alcohol abuse? In a 10-12 slide informative PowerPoint presentation (title slide and reference slides are in addition to the 10-12 slide requirement), Include the following:

• What factors (outside of military service) influence the veterans need for mental health services? (Use evidence to support your rationale.)
• How is the veteran evaluated to determine eligibility for services?
• What is the cost of these services to those veterans receiving it?
• Are the available services in your community adequate for the population served?  Explain your answer.
• What recommendations do you have for improving the available services? (Are more services needed? Are different services needed? How would additional funding help?)

Your presentation should establish a clear viewpoint and purpose. A minimum of three references should be included, and placed in a reference slide at the end of your presentation.

The presentation should include speaker notes, which will assist in the audio portion below.

You will also need to add audio to your presentation. The audio should present the information, not just read from the presentation slides. Use your speaker notes to assist with the audio narration. Please keep your audio narration to a maximum of 20 minutes.

How to record on PowerPoint:

1. Prepare to record the narration. Open the presentation and Click the Slide Show tab on the menu bar. Click the Record Slide Show button and select Start Recording From Beginning from the pull-down menu. The Record Slide Show dialog box will open. Place a check in the Narrations And Laser Pointer check box and click Start Recording. The Slide Show preview window will open.
2. Record the narration. Click the right-pointing arrow in the left corner of the preview window to begin the narration. Record the presentation in a quiet environment and in a professional manner reflective of a presentation given in your workplace. Pause the narration at any time by clicking the pause button on the Recording shortcut menu, located in the upper-left corner of the screen.

Assignment Requirements

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above)
• consult the Grading Rubric to make sure you have included everything necessary;
• utilize spelling and grammar check to minimize errors; and
• include a minimum of three references

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; and
• use APA 6th edition formatting and citation style as found in the Writing Center’s Citation Guidelines.

Topic: Determinants of Health

When it comes to chronic illness, there is no standard or “normal” experience.  Each person’s illness experience is individual and is influenced by a variety of factors. Factors that can influence the chronic illness experience include underlying health, family status, environment, employment, economics, past experiences, age, gender, culture, and more.  

The causes of chronic illness are also many and varied.  For example, genetics are a contributor to chronic illness that one cannot change. Nurses can, however, address the social and environmental determinants that contribute to chronic illness.  

Review the “Healthy People.gov” websites provided:

Office of Disease Prevention and Health Promotion.(2018). Social Determinants of Health. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

Office of Disease Prevention and Health Promotion.(2018). Environmental Quality Across the Life Stages. Retrieved from https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Environmental-Quality/determinants

Identify one social and one environmental determinant of chronic illness and the health
promotion/prevention strategies that nurses could implement to decrease the risk of chronic illness.

Topic: Transition

Read the two articles on chronic illness and transition by Kralik and von Loon in your reading list and address the questions listed below.

• Is transition the same as change?  (Explain your answer.)
• Do the readings give you a different perspective on chronic illness?  (How so?)
• What kind of transitions and adjustments must a person make upon diagnosis of a chronic illness?  
• Is our current patient education process meeting the patient’s needs?