ASSIGNMENT: BRANCHING EXERCISE: CARDIAC CASE 2
ASSIGNMENT: BRANCHING EXERCISE: CARDIAC CASE 2
Admission Orders Template
Primary Diagnosis: Urinary tract infection
Status/Condition (Critical, Guarded, Stable, etc.): Unstable
Code Status: DNR
Allergies: None
Admit to Unit: Female medical ward
Activity Level: The patient is confused, lethargic, and cannot perform activities of daily living independently. She needs assistance in undertaking them.
Diet: The patient is to proceed with a normal diet, as there are no contraindications.
IV Fluids: Intravenous 0.9% normal saline 4L in 24 hours.
Critical Drips (If ordered, include type and rate. Do not defer to ICU protocol.): None
Respiratory: Oxygen (If ordered, include type and rate.), pulmonary toilet needs, ventilator settings: None
Good News For Our New customers . We can write this assignment for you and pay after Delivery. Our Top -rated medical writers will comprehensively review instructions , synthesis external evidence sources(Scholarly) and customize a quality assignment for you. We will also attach a copy of plagiarism report alongside and AI report. Feel free to chat Us
Medications (include ALL, tx of the primary condition, underlying conditions, pain, comfort needs, etc., dose and route): intravenous norepinephrine 2 mcg per minute stat, subcutaneous soluble insulin 20 i.u and 20 iu in 500 ml of 0.9% normal saline stat then 20 iu subcutaneous thrice daily, blood glucose monitoring QUID, Oral nitrofurantoin 100 mg twice daily for 5 days, intravenous Tylenol 1 g thrice daily for three days, and intravenous ceftriaxone 1 g twice daily for five days (Rodriguez-Mañas, 2020; Zeng et al., 2020)
Nursing Orders (vital signs, skin care, toileting, ambulation, etc.): Blood pressure monitoring half hourly in the first hour and hourly afterward, instituting fall precautions, reorientation, and assistance with ambulation and toileting (Solberg et al., 2021).
Follow-Up Lab Tests: Urinalysis and complete blood count test
Diagnostic testing (CXR, US, 2D Echo, etc.):
Consults: Consult with the physician on the management and monitoring of septic shock.
Patient Education and Health Promotion (address age-appropriate patient education. if applicable): When alert and oriented, educate on treatment adherence, signs and symptoms of infection, fall precautions, and bone screening for osteoporosis.
Discharge Planning and Required Follow-Up Care: Discharge the patient through social support services, follow up after a week, and link her with a community social worker.
References (minimum of three timely references that prove this plan follows current standards of care):
Rodriguez-Mañas, L. (2020). Urinary tract infections in the elderly: A review of disease characteristics and current treatment options. Drugs in Context, 9, 2020-4–13. https://doi.org/10.7573/dic.2020-4-13
Solberg, L. M., Campbell, C. S., Jones, K., Vaughn, I., Suryadevara, U., Fernandez, C., & Shorr, R. (2021). Training hospital inpatient nursing to know (THINK) delirium: A nursing educational program. Geriatric Nursing, 42(1), 16–20. https://doi.org/10.1016/j.gerinurse.2020.10.018
Zeng, G., Zhu, W., Lam, W., & Bayramgil, A. (2020). Treatment of urinary tract infections in the old and fragile. World Journal of Urology, 38(11), 2709–2720. https://doi.org/10.1007/s00345-020-03159-2
For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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.
BY DAY 7 OF WEEK 4
Submit your completed Assignment by Day 7 of Week 4 in Module 2.
SUBMISSION INFORMATION
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
To submit your completed assignment, save your Assignment as MD2Assgn2_LastName_Firstinitial
Then, click on Start Assignment near the top of the page.
Next, click on Upload File and select Submit Assignment for review.
Rubric
NRNP_6566_Module2_Assignment2_Rubric
NRNP_6566_Module2_Assignment2_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. |
| 5 to >4.0 ptsExcellent Point range: 90–100
The order set includes an accurate and correct diagnosis. |
4 to >3.0 ptsGood Point range: 80–89
The order set includes a diagnosis that is an appropriate differential diagnosis. |
3 to >2.0 ptsFair Point range: 70–79
The order set includes a diagnosis that is incorrect and not supported by patient data. |
2 to >0 ptsPoor 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 ptsExcellent Point range: 90–100
The order set includes an accurate description / plan for condition, code status, and admission location. |
4 to >3.0 ptsGood Point range: 80–89
The order set includes an accurate description for 2 of the 3 variables. |
3 to >2.0 ptsFair Point range: 70–79
The order set includes an accurate description for 1 of the 3 variables. |
2 to >0 ptsPoor 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 ptsExcellent Point range: 90–100
The order set includes an accurate description / plan for allergies, activity level, and diet. |
4 to >3.0 ptsGood Point range: 80–89
The order set includes an accurate description for 2 of the 3 variables. |
3 to >2.0 ptsFair Point range: 70–79
The order set includes an accurate description for 1 of the 3 variables. |
2 to >0 ptsPoor 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 ptsExcellent 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 ptsGood 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 ptsFair 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 ptsPoor 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 ptsExcellent 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 ptsGood 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 ptsFair 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 ptsPoor 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 ptsExcellent 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 ptsGood 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 ptsFair 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 ptsPoor 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 ptsExcellent 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 ptsGood 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 ptsFair 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 ptsPoor 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 ptsExcellent Point range: 90–100
The order set includes complete laboratory and diagnostic testing to adequately monitor and assess the presenting patient. |
8 to >6.0 ptsGood 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 ptsFair 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 ptsPoor 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 ptsExcellent 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 ptsGood 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 ptsFair 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 ptsPoor 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 ptsExcellent 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 ptsGood 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 ptsFair 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 ptsPoor 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 ptsExcellent 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 ptsGood 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 ptsFair 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 ptsPoor 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 ptsExcellent 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 ptsGood 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 ptsFair 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 ptsPoor 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 ptsExcellent 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 ptsGood 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 ptsFair Point range: 70–79
Written orders are missing 3 to 4 essential elements are reflect an incorrect standard of care. |
2 to >0 ptsPoor 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
Required Readings:
- Fuller, V. J., & McCauley, P. S. (2023). Textbook for the adult-gerontology acute care nurse practitioner: Evidence-based standards of practice. Springer Publishing Company.
- Hypertension, pp. 99-101
- Shock States, pp. 589-604
- Sepsis, pp. 526-529
- Intravenous Fluid Management, pp. 586
- Types of fluids, p. 587
- Harris, C. (2023). Adult-gerontology acute care practice guidelines (2nd ed.). Springer Publishing Company.
- Hypertension, pp. 67-70
- Hemodynamic Monitoring Devices, pp. 637-641
- SIRS/Sepsis, pp. 298-304
- VanValkinburgh, D., Kerndt, C. C., & Hashmi, M. F. (2021, August 14). Inotropes and vasopressorsLinks to an external site.. StatPearls [Internet]. Retrieved October 20, 2021. https://www.ncbi.nlm.nih.gov/books/NBK482411/.
- Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., … Levy, M. (2021). Surviving sepsis campaignLinks to an external site.. Critical Care Medicine, Publish Ahead of Print. https://doi.org/10.1097/ccm.0000000000005337
- Farkas, J. (2020, February 20). Vasopressors. EMCrit ProjectLinks to an external site.. Retrieved October 20, 2021, from https://emcrit.org/ibcc/pressors/.
- Gourd, N. M., & Nikitas, N. (2019). Multiple organ dysfunction syndromeLinks to an external site.. Journal of Intensive Care Medicine, 35(12), 1564-1575. https://doi.org/10.1177/0885066619871452
- Document: Admission Orders Template (Word document)
- MedCram. (2018, August 19).Vasopressors explained clearly: Norepinephrine, Epinephrine, Vasopressin, DobutamineLinks to an external site.… [Video file]. Retrieved from https://www.youtube.com/watch?v=zf28Rjbu3VM
- MedCram. (2017, November 19). Hypertension guidelines explained clearly – 2017 HTN guidelinesLinks to an external site. [Video file]. Retrieved fromhttps://www.youtube.com/watch?v=Cg3Z3dFf5c0
- MedCram. (2017, November 9). Shock and sepsis explained clearly (remastered) symptoms, causes, and pathophysiologyLinks to an external site. [Video file]. Retrieved from https://www.youtube.com/watch?v=sTdrIlOGnfI
- MedCram. (2014, December 23). Hypertension explained clearly, 2 of 2Links to an external site. [Video file]. Retrieved from https://www.youtube.com/watch?v=NgMfZVEWQd8
- MedCram. (2012, September 12). Hypertension explained clearly – causes, diagnosis, medications, treatmentLinks to an external site. [Video file]. Retrieved from https://www.youtube.com/watch?v=OmKVteeuQj0
- Walden University (Producer). (2019b). Branching exerciseLinks to an external site.: Cardiac case 2 [Interactive media file]. Minneapolis, MN: Author.
- For week 4 your patient has a glucose of 1766. When you write the orders for sliding scale insulin, remember you are treating a 1766 glucose, not a 400 glucose. Write the appropriate order for a glucose of 1766
|
