Virtual Clinical Assignment Perfusion

Virtual Clinical Assignment Fall 2020

Laboure College

Fall 2020

Virtual Clinical Assignment Perfusion

 

Course: NUR ____1025_____ Concept/Exemplar: ___Perfusion/Hypertension______________ Hours: __8.5__

 

Student Learning Outcomes (SLOs): See CLM concept/exemplar for SLOs.

 

Scenario: Please use your Pearson Text as reference

Date   Identify the Top 3 client findings requiring immediate follow-up
  M.P. is a 65-year-old African American woman who comes to the clinic for a follow-up visit. She was diagnosed with hypertension (HTN) 2 months ago and was given a prescription for a thiazide diuretic but stopped taking it 2 weeks ago because “it made me dizzy and I kept getting up during the night to empty my bladder.”

 

During today’s clinic visit, she expresses fear because her mother died of a stroke (cerebrovascular accident [CVA]) at M.P.’s age, and M.P. is afraid she will suffer the same fate. She states, “I’ve never smoked and I don’t drink, but I am so afraid of this high blood pressure.”

 

The nurse reviews the data from her past clinic visits.

 

 

 

 

 

 

 

 

 

 

(NG NCLEX What matters mostNoticing) Tanner’s Clinical Judgement model

Tanner’s Reflective Journal and Next Gen NCLEX

 

Chart View
Family History

Mother, died at age 65 years of CVA

Father, died at age 67 years of myocardial infarction (MI)

Sister, alive and well, age 62 years

Brother, alive, age 70 years, has coronary artery disease (CAD), HTN, type 2 diabetes mellitus (DM)Patient

 

Past History

Married for 45 years, 2 children, alive and well, 6 grandchildren

Cholecystectomy, age 42 years

Hysterectomy, age 48 years

Blood Pressure Assessments

January 2: 150/92

January 31: 156/94 (given prescription for hydrochlorothiazide [HCTZ] 25 mg PO every morning)

February 28: 140/90

 

 

 

1. According to the most recent guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC8), M.P.’s blood pressure (BP) falls under which classification?

http://thepafp.org/website/wp-content/uploads/2017/05/2014-JNC-8-Hypertension.pdf

http://pharma-smart.com/wp-content/uploads/2015/03/JNC-8-Guidelines.pdf

 

2. What could M.P. be doing that is causing her nocturia?

 

 

CASE STUDY PROGRESS

During today’s visit, M.P.’s vital signs are as follows: BP: 162/102; P: 78; R: 16; T: 98.2°F (36.8 ° C). Her most recent basic metabolic panel (BMP) and fasting lipids are within normal limits. Her height is 5 ft., 4 in (163 cm), and she weighs 110 lb. (50 kg). She tells you that she tries to go on walks but does not like to walk alone and so has done so only occasionally.

 

3. What risk factors does M.P. have that increase her risk for cardiovascular disease?

 

 

CASE STUDY PROGRESS

Because M.P.’s BP continues to be high, the provider decides to start another antihypertensive drug and recommends that she try again with the hydrochlorothiazide (HCTZ), taken in the mornings.

 

4. According to the JNC 8 national guidelines, describe the drug therapy recommended for M.P. at this time.

Complete ALT medication Template (Deliverable)

 

 

5. M.P. goes on to ask whether there is anything else she should do to help with her HTN. She asks, “Do I need to lose weight?” Look up her height and weight for her age on a body mass index (BMI) chart. Is she considered overweight? https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

 

6. What nonpharmacological lifestyle alteration measures might help M.P. control her BP? List 2 priority examples and explain why.

 

 

 

CASE STUDY PROGRESS

The provider decreases M.P.’s HCTZ dose to 12.5 mg PO daily and adds a prescription for benazepril (Lotensin) 5 mg daily. M.P. is instructed to return to the clinic in 1 week to have her blood work checked. She is instructed to monitor her BP at least twice a week and return for a medication management appointment in 1 month with her list of BP readings. Complete ALT medication Template (Deliverable)

 

 

7. Why did the provider decrease the dose of the HCTZ?

 

8. The nurse instructs M.P. on the common side effects of benazepril. Which side effects are included in the teaching? Select all that apply.

a. Cough

b. Dizziness

c. Headache

d. Constipation

e. Shortness of breath

 

9. Medication adherence is key to effective hypertensive therapy. What techniques are key to teach M.P. to assist in remembering to take her medications each day? Name at least 2. (Safety)

 

 

 

10. After the medication teaching session, which statement by M.P. indicates a need for further instruction?

a. “I need to rise up slowly when I get out of bed or out of a chair.”

b. “I will leave the salt shaker off the table and not salt my food when I cook.”

c. “I will call if I feel very dizzy, weak, or short of breath while on this medicine.”

d. “It’s okay to skip a few doses if I am feeling bad as long as it’s just for a few days.”

 

11. Complete a concept map that identifies 3 priority problems and collaborative/nursing care. (Deliverable)

 

 

 

CASE STUDY PROGRESS

M.P. returns in 1 month for her medication management appointment. She tells you she is feeling fine and does not have any side effects from her new medication. Her BP, checked twice a week at the senior center, ranges from 132 to 136 systolic, and 78 to 82 diastolic.

 

12. When someone is taking HCTZ and an angiotensin-converting enzyme (ACE) inhibitor, such as benazepril, what lab test results are monitored?

 

 

Chart View
Laboratory Test Results (Fasting)

Sodium Chloride

Potassium

Chloride

CO2

Glucose

Blood urea nitrogen (BUN)

Creatinine

Magnesium

 

138 mEq/L (138 mmol/L)

3.6 mEq/L (3.6 mmol/L)

100 mEq/L (100 mmol/L)

28 mEq/L (28 mmol/L)

112 mEq/L (6.2 mmol/L)

18 mg/dL (6.4 mmol/L)

0.7 mg/dL (61.9 mcmol/L)

1.9 mEq/L (0.95 mmol/L)

 

 

 

13. What lab test results, if any, are of concern at this time? Why?

 

 

14. The nurse take M.P.’s BP and get 138/88. She asks whether these BP readings are okay. What is the nurse’s best response? Why?

 

15. List the Top 3 important ways the nurse might help M.P. maintain her success. (NG NCLEX What specific Items will the nurse teach the client? Responding/Taking action)

 

 

 

CASE STUDY PROGRESS

M.P. tells you she was recently at a luncheon with her garden club and that most of those women take BP pills different from the ones she does. She asks why their pills are different shapes and color.

 

16. How can the nurse explain the differences to M.P.? Define the action of common drug classifications to treat HTN, Top 3 side effects (may be similar), and best nursing actions.

 

 

 

 

17. During the visit, the nurse asks M.P., “When was your last eye examination?” She answers, “I’m

not sure, probably about 2 years ago. What does that have to do with my blood pressure?”

What is the nurse’s best response?

 

 

 

CASE STUDY PROGRESS

M.P. comes in for a routine follow-up visit 3 months later. She continues to do well on her daily BP drug regimen, with average BP readings of 130/78. She participates in group walking program for senior citizens at the local mall. She admits she has not done as well with decreasing her salt intake but says she is trying. She visited an ophthalmologist last week and had no problems except for a slight cataract in one eye.

 

18 What findings show the interventions are working? (NG NCLEX Did treatment help? Reflecting/Evaluate outcomes)

Harding and Snyder (2020) CS 91

 

Learning activities

Websites

Concept map

Reflective Journal

Active Learning Medication Template (antihypertensive)

 

 

“Think like a Nurse” questions

· What do you know now that you did not know prior to this assignment?

· When caring for clients (across the lifespan) experiencing hypertension, what key information would be helpful to know ahead of time?

 

 

Submit Assignment: Upload deliverables to eLearning under the Coursework tab, labeled Non-COVID Clinical Assignment.

· Assignment/scenario

· ALT medication template

· Concept map

· Reflective journal

 

 

 

 

 

Rubric Criteria  

Pass  

Not Pass
Case

assignment

  Student demonstrates an understanding of the concept through complete and thoughtful answers to scenario questions and to the content within the deliverables.   Student does not demonstrate completion of scenario questions and deliverables.
Professionalism   Student completes and uploads virtual case assignments and deliverables in a timely manner.   Student does not complete and or uploads the virtual case assignment.
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Student

   

 

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Developed 6-2020 4

 
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