LW is a 32 year old female patient who comes to your medical clinic for primary care. She has been on hormonal contraceptives for years, although she’s just been married and has stopped her pills in hopes of becoming pregnant. Her PMHx includes obesity, HTN (diagnosed 3 years ago), familial hypercholesterolemia, and PCOS. Her current medications are as follows: Metformin 2000 mg PO daily, Lisinopril 10 mg PO daily, rosuvastatin 5 mg PO daily, and a multivitamin.

GD is an 82-year-old patient is taking 2 mg of terazosin for BPH every morning. He comes in complaining of dizziness, generalized muscle weakness and persistent lower urinary tract symptoms (LUTS).

How should you advise these patients and manage their medications? What was the process you went through to assess the current medications and to recommend an updated regimen?

A minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required.

Patient rounds involve various disciplines coming together to discuss the patient’s condition and coordinate care. They are used as an educational tool and also help keep everyone on the same page when it comes to the treatment plan. The following case is found in the textbook (Pharmacotherapy: Principles and Practices. Chisholm-Burns et al, eds.  5th edition.  McGraw-Hill.  New York 2019. ISBN-978-1-260-01944-5; Chapter 34. “Patient encounter”).

After reading the assigned chapters in the textbook, resources identified in Dynamed and Evidence based practice guidelines, please present the case to your peers in the form of a discussion. This will be your initial post. Please be sure to address all parts of the case and ensure your responses are well researched [including supporting, evidence based guidelines such those of the WHO, CDC, APS, etc.].

Part 1:

HPI:  A 78-year-old man who is to undergo a left above the knee amputation due to a limb abscess

PMH: Peripheral artery disease for 18 years; cardiomyopathy, benign prostatic hypertrophy for 13 years

FH: Mother had osteoporosis; father had diabetes

SH: Lives with wife; has two grown children

Meds: Aspirin 81mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; pantoprazole 40 mg daily; tamsulosin 0.4 mg daily

Pain Assessment: Patient rates pain as 8 on a scale of 0 to 10.

• Based on the type of injury, what type of pain is this patient likely to experience?
• What type of pain management regimen would you suggest in the postoperative period? Explain your answer

Part 2:

Following surgery he was placed on morphine patient-controlled analgesia (PCA). He has been using 55 mg of morphine/24 hours with adequate pain control; however, he developed redness and itching on his neck that is believed to be due to the morphine.

Current Meds:  Morphine PCA; aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily; heparin 5000 units twice daily until discharged home. He will be discharged to a skilled nursing facility for rehabilitation therapy.

You would like to convert him to a combination preparation of hydrocodone and APAP for as-needed pain relief.

• What dosing regimen would you suggest?
• What would your monitoring plan include for this patient?
• How would you assess pain response?
• The patient is concerned about the redness and itching that he developed while on morphine. Would you document this as an allergic reaction?
• What other interventions or education may be necessary at this time?

Part 3:

The patient was discharged to a skilled nursing facility and is receiving physical therapy and occupational therapy 6 days each week.

Current Meds: Aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily, heparin 5000 units twice daily until discharged home, hydrocodone/acetaminophen 5/325 mg every 6 hours as needed for pain.

Pain Assessment: Patient reports pain of 7 out of 10; worse with movement.

Physical therapy notes indicate the patient is unable to complete therapy goals due to complaints of pain.

• Based on this information, what would you recommend to optimize pain control?
• Prescribers play a critical role in prescription drug misuse and abuse prevention. What steps can be taken to identify signs of dependence and abuse and what education can you provide to the patient regarding the negative effects of medication misuse?

Part 4:

The patient has been at the skilled nursing facility for 4 weeks and is making progress toward rehabilitation goals; however, he complains that his leg is throbbing and feels like pins and needles. As a result, he requests to rest several times during her therapy sessions. During unit rounds, his therapist inquires whether her previous pain medication should be reordered.

Pain Assessment: 4 out of 10

Current Meds: Aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily, heparin 5000 units twice daily until discharged home,

• What additional recommendations would you have at this time regarding pain management?
• Are there any other therapeutic issues that should be addressed?

NR226 Fundamentals – Patient Care

RUA: Concept Map Guidelines

Purpose

This assignment is designed to extend the learner’s use of concept mapping as a tool for clinical care planning. The nursing process continues to provide the foundation for organizing information and thought, whereas the mapping becomes the process for intentional critical thinking and clinical reasoning.

Course outcomes: This assignment enables the student to meet the following course outcomes:

CO 1: Demonstrate the nursing process while providing basic care to individuals and families reflecting different stages of the life span in the extended care, acute care, and community-based settings. (PO 1)

CO3: Demonstrate communication skills necessary for interaction with other health team members and for providing basic nursing care to individuals and families. (PO #3)

CO4: Incorporate critical thinking skills into clinical nursing practice. (PO #4)

Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.

Total points possible: 100 points

Preparing the assignment

Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.

1. Choose an individual for whom you have cared in the clinical setting.

2. Create a concept map based on the complete physical assessment you performed while providing care using the provided power point template.

a. Components of the concept map

i. Individual’s information (10 points/10%)

1. Age

2. Medical diagnosis

3. Brief review of underlying pathophysiology

*List what functional changes are happening

*List process that initiated and maintained disorder or disease

ii. Assessment Data (15 points; 15%)

1. Include all assessment data, not simply information that supports the selected nursing diagnoses

Inspect

Palpation

Percussion

Auscultate

Neurological Exam

iii. Nursing Diagnoses (15 points/ 15%)

1. Select three nursing diagnoses to addresses

a. One must be an actual problem

b. One must address a psychosocial need

c. The final must be a high priority for the individual

iv. Linkages Within and Between Diagnoses (5 points/5%)

1. Concept map demonstrates relationship within and between the nursing diagnoses.

v. Planning (15 points/15%)

1. Prioritize diagnoses to reflect needs of the individual

2. Set realistic outcome measurement

3. At least two (2) scholarly, primary sources from the last 5 years, excluding the textbook, are provided

vi. Implementation (15 points/15%)

1. Interventions are individualized for patient-provide rationale

2. Interventions support achievement of selected outcome measurements-provide rationale

vii. Evaluation of Outcomes (5 points/15%)

1. Determine if outcomes were met.

2. Provide evidence that supports that determination.

3. Describe what changes, if any, are needed to promote expected outcomes in the future.

viii. Safety-Communication-Infection Control 16 points/16%)

a. specific elements of communication used when providing care,

b. safety concerns related to the individual for whom you cared, and

c. infection control practices followed while caring for this patient.

ix. APA Citations and Writing (4 points/4%)

a. References are submitted with assignment.

b. Uses appropriate APA format and is free of errors.

c. Grammar is free of errors.

d. Spelling is free of errors.

e. Mechanics of writing are free of errors.

x. Power Point Template (0 points/0%) (deduction if not used)

a. Used provided Power Point Template for assignment completion or an alternate that is approved by faculty.

For writing assistance (APA, formatting, or grammar) visit the APA Citation and Writing page in your course resources.

Please note that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned in the review module.

NR226 Fundamentals – Patient Care

RUA: Concept Map Guidelines

NR226 Fundamentals – Patient Care

RUA: Concept Map Guidelines

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NR226_RUA_Concept_Map _Guideline_V4.docx 2

2

Grading Rubric Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment.

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