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NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders Assignment

NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders Assignment NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentAn estimated 85.6 million American adults have some type of cardiovascular disease. Of these, 43.7 million are estimated to be over 60 years of age (American Heart Association, 2016). Cardiovascular disease is the leading cause of death among Americans over the age of 65 (Heron, 2019). Part of assessment of risk factors for coronary artery disease include blood pressure, cholesterol, and smoking. One of the challenges of the assessment of the cardiovascular system is that almost half of all older patients have cardiac disease, so distinguishing between normal and abnormal heart function may be a challenge (Kennedy-Malone et al., 2019).This week, you explore assessment, diagnosis, and treatment of cardiovascular and pulmonary conditions that commonly impact geriatric patients by analyzing a case study and completing a written Assignment. As you complete your readings, consider risk factors that contribute to the development of cardiovascular and pulmonary disease, as well as strategies for treatment and prevention.NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentORDER A PLAGIARISM-FREE PAPER HEREReferences:American Heart Association. (2016). Statistical fact sheet: 2016 update: Older Americans and cardiovascular disease [Data set]. https://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_483970.pdfHeron, M. (2019). Deaths: Leading causes for 2017. National Vital Statistics Reports, 68(6), 1–77. https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_06-508.pdfKennedy-Malone, L., Martin-Plank, L., & Duffy, E. G. (2019). Advanced practice nursing in the care of older adults (2nd ed.). F. A. Davis.NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentLearning ObjectivesStudents will:Evaluate patients presenting with cardiovascular or pulmonary disordersDevelop differential diagnoses for patients with cardiovascular or pulmonary disordersDevelop appropriate treatment plans, including diagnostics and laboratory orders, for patients with cardiovascular or pulmonary disordersAnalyze the diagnosis and treatment of cardiovascular and pulmonary disordersLearning ResourcesNRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentRequired Readings (click to expand/reduce)Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Chest disorders. In Advanced practice nursing in the care of older adults (2nd ed., pp. 152–214). F. A. Davis.Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Peripheral vascular disorders. In Advanced practice nursing in the care of older adults (2nd ed., pp. 215–224). F. A. Davis.Document: Week 5 Case Assignment (Word Document)Required Media (click to expand/reduce)Keegan, D. [dkcalgary]. (2014, July 17). How to interpret x-rays (the basics) [Video]. YouTube. https://youtu.be/zGJW766RI4UStrong Medicine. (2013, December 18). How to interpret a chest x-ray (lesson 2—a systematic method and anatomy) [Video]. YouTube. https://youtu.be/L6bnD2wOEmgRecommended Media (click to expand/reduce)Engage-IL (Producer). (2017d). Community-based interprofessional home care of the older adult [Video]. https://engageil.com/modules/community-based-interprofessional-home-care-of-the-older-adult/Note: View the Community-Based Interprofessional Home Care of the Older Adult video module available in this free course.Engage-IL (Producer). (2017r). Optimizing physical activity in older adults [Video]. https://engageil.com/modules/optimizing-physical-activity-in-older-adults/Note: View the Optimizing Physical Activity in Older Adults video module available in this free course.NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentGoldberg, C. (2018a). Cardiovascular exam. In C. Goldberg, Practical guide to clinical medicine. Regents of the University of California. https://meded.ucsd.edu/clinicalmed/heart.htmGoldberg, C. (2018d). The lung exam. In C. Goldberg, Practical guide to clinical medicine. Regents of the University of California. https://meded.ucsd.edu/clinicalmed/lung.htmAssignment: Assessing, Diagnosing, and Treating Cardiovascular and Pulmonary DisordersPhoto Credit: Getty Images/RooM RFCardiovascular conditions are among the leading causes of hospitalization and death among older adults, even though many of the risk factors that contribute to such conditions are preventable or manageable. In your role as an advanced practice nurse, you must be able to apply sound critical thinking and diagnostic reasoning skills to correctly assess and diagnosis these conditions. You also play an important role in helping patients manage disorders by planning necessary treatments, assessments, and follow-up care.NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentTo prepare:Review the Week 5 Case Assignment document in the Learning Resources.Reflect on the patient’s symptoms and aspects of disorders that may be present.Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case study.The Assignment:After reviewing the case and the accompanying case analysis questions, included in the document, answer the 10 questions directly in the Case Assignment document. When providing evidence to support your answers, be sure they evidenced-based, current (no more than 5 years old), and follow current standards of care. Follow APA 7th edition formatting. NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentBy Day 7Submit your Assignment.Submission and Grading InformationTo submit your completed Assignment for review and grading, do the following:Please save your Assignment using the naming convention “WK5Assgn+last name+first initial.(extension)” as the name.Click the Week 5 Assignment link.Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK5Assgn+last name+first initial.(extension)” and click Open.If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentClick on the Submit button to complete your submission.NRNP 6540 Week 5 Case AssignmentCase Title:A 67-year-oldWith Tachycardia and CoughingMs. Jones is a 67-year-old female who is brought to your office today by her daughter Susan. Ms. Jones lives with her daughter and is able to perform all activities of daily living (ADLs) independently. Her daughter reports that her mother’s heart rate has been quite elevated, and she has been coughing a lot over the last 2 days.Ms. Jones has a 30-pack per year history of smoking cigarettes but quit smoking 3 years ago. Other known history includes chronic obstructive pulmonary disease (COPD), hypertension, vitamin D deficiency, and hyperlipidemia. She also reports some complaints of intermittent pain/crampingin her bilateral lower extremities when walking andhas to stop walking at times for the pain to subside. She also reports some pain to the left side of her back, and some pain with aspiration.NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentMs. Jones reports she has been coughing a lot lately,and notices some thick, brown-tinged sputum. She states she has COPD and has been using her albuterol inhaler more than usual. She says it helps her “get the cold up.” Her legs feel tired butdenies any worsening shortness of breath. She admits that she has some weakness and fatigue but is still able to carry out her daily routine.Vital Signs:99.2, 126/78, 96, RR 22Labs: Complete Metabolic Panel and CBC done and were within normal limitsCMP ComponentValueCBC Component ValueGlucose, Serum86 mg/dLWhite blood cell count5.0 x 10E3/uLBUN17 mg/dLRBC4.71 x10E6/uLCreatinine, SerumNRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders Assignment0.63 mg/dLHemoglobin10.9 g/dLEGFR120 mL/minHematocrit36.4%Sodium, Serum141 mmol/LMean Corpuscular Volume79 fLPotassium, Serum4.0 mmol/LMean Corpus HgB28.9 pgChloride, Serum100mmol/LMean Corpus HgB Conc32.5 g/dLCarbon Dioxide26 mmol/LRBC Distribution Width12.3%Calcium8.7 mg/dLPlatelet Count178 x 10E3/uLProtein, Total, Serum6.0 g/dLAlbumin4.8 g/dLGlobulin2.4 g/dLBilirubin1.0 mg/dLAST17 IU/LALT15 IU/LNRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentAllergies: PenicillinCurrent Medications:Atorvastatin 40mg p.o. dailyMultivitamin 1 tablet dailyLosartan50mg p.o. dailyProAir HFA 90mcg 2 puffs q4–6 hrs. prnCaltrate 600mg+ D3 1 tablet dailyDiagnosis:PneumoniaDirections: Answer the following 10 questions directly on this template.Question 1: What findings would you expect to be reported or seen on her chest x-ray results, given the diagnosis of pneumonia?NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentAnswer: Consolidation and infiltrates are usual findings on Chest X-ray to confirm diagnosis of pneumonia.Question 2: Define further what type of pneumonia Ms. Jones has, HAP (hospital-acquired pneumonia) or CAP (community-acquired pneumonia)? What’s the difference/criteria?Answer:  Community acquired pneumonia (CAP), is an acute lower respiratory tract infection, that could be caused by a bacteria or virus. Is begins outside the hospital or long-term facility or is diagnosed within 48 hours of hospital admission, without recent residence at long-term care facility (Kennedy-Malone., Martin-Plank,& Duffy, 2019).Hospital acquired pneumonia (HAP), also called a Nosocomial pneumonia is a hospital or long-term care acquired pneumonia. It usually occurs 4 days post hospitalization and is common in patients on ventilators.Question 3:3A) What assessment tool should be used to determine the severity of pneumonia and treatment options?3B) Based on Ms. Jones’ subjective and objective findings, apply that tool and elaborate on each clinical factor for this patient.NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentAnswer:3A: Assessment tools to determine the severity and treatment options for pneumonia, will be detailed review of systems with focus on HEENT, Lungs and chest. Complete blood count (CBC), Complete basal panel (CMP), Sputum culture. Chest X-ray and CT chest. 3B: For patient with lower respiratory tract infection, while blood cell count could be elevated. Complete basal panel—May reveal alteration in kidney function, magnesium, and phosphorus. Sputum culture will reveal sensitivity. Blood cultures for offending pathogens. Question 4: Ms. Jones was diagnosed with left lower lobe pneumonia. What would your treatment be for her based on her diagnosis, case scenario, and evidence-based guidelines?Answer: For Ms Jones, gram stain sputum culture is needed before antibiotics is initiated. Empiric blood sputum antibiotics started while waiting for culture reports to prevent resistance. IV fluids started for hydration. Cough medications—expectorantsto relieve chest discomfort and sputum production. Breathing treatment with albuterol every 4-6 hours as needed for shortness of breath. Incentive spirometry started and Oxygen supplement too.NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentQuestion 5: Ms. Jones has a known history of COPD. What is the gold standard for measuring airflow limitation?Answer: The gold standard for diagnosis of COPD is the use of spirometry, as it is the most reproductive and objective way of measuring airflow limitation. FEV <80% confirms the presence of airflow limitation (Kennedy-Malone., Martin-Plank,& Duffy, 2019).Question 6: Ms. Jones mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain/cramps. Which choice below would bethe best choice for a potential diagnosis for this? Explain your reasoning.DVT (Deep Vein Thrombosis)Intermittent ClaudicationCellulitisElectrolyte Imbalance Answer: B:  Intermittent claudication is pain affecting the calf, and less often affects the thighs and buttocks. It is mostly felt during exercise and relieves during rest. It is believed to result from muscle ischemia during exercise due to arterial flow obstruction (Mizzi, Cassar, Bowen & Formosa, 2019).Question 7: Ms. Jones mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain. What test could be ordered to further evaluate this?NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentAnswer–The screening tool for diagnosing lower extremity arterial disease is the assessment of the ankle-brachial index (ABI), which is widely used in general practice. However, resting ABI can easily produce a false negative result (Tóth-Vajna. Z., Tóth-Vajna. G.,Gombos. Z.,Szilágyi. B., Járai. Z.,Berczeli. M., &Sótony. P, 2019).  Lower extremity PAD is often diagnosed late in GP practices. Current recommendations suggest the use of non-invasive ABI measurement for screening. Its sensitivity and specificity for lower extremity PAD can be estimated between 79% and 96%. It may indicate abnormalities even before the patient develops complaints of dysbasia (Toth-Vajna, et al., 2019).Comprehensive metabolic panel. (CMP), is another tool for diagnosis. CMP is used to assess kidney function and electrolytes.Question 8: Name three (3) differentials for Ms. Jones’ initial presentation.Answer:  AsthmaBronchitisChronic obstructive pulmonary disease (COPD).Question 9: What patient education would you give Ms. Jones and her daughter? What would be your follow-up instructions?Answer: Ensure she is up to date with her vaccinations, especially the influenza vaccine. Ensure she had her pneumococcal vaccination too. Influenza A&B, parainfluenza and respiratory syncytial virus (RSV)should be considered and ruled out in older patients presenting with pneumonia-like symptoms (File, 2021).Follow up appointment should be in 1 week, after initial treatment to assess therapy effectiveness. New symptoms should be reported (Kennedy-Malone., Martin-Plank,& Duffy, 2019).NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentSmoking cessation should be encouraged. Patient to limit secondhand smoking exposure. To complete antibiotics as prescribed.  Increase her fluid intake, eat well balanced diet, deep breathing exercises andhave regular rest periods. Patient to follow up with her primary care physician and consults as ordered.Question 10: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Jones’ Pneumonia? Explain why or why not.Answer: Amoxicillin/clavulanate will not be ordered, as patient is allergic to Penicillin. Hence, alternative antibiotic is needed. Most clinicians use oral therapy when ordering fluoroquinolones and Macrolides at start of treatment for pneumonia. For patients with CAP, combination therapy with a beta-lactam plus a macrolide and monotherapy with a respiratory fluoroquinolone are believed to be amazingly effective (File, 2021).Order:NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentLevaquin 500mg 1 tablet orally x 7 daysAzithromycin 500mg orally day 1, then 250mg daily x 4 days.  ReferencesFile. T.I. (2021). Treatment of community-acquired pneumonia in adults who requires hospitalization. Https://www.update.com/contents/treatment-of-community-acquired-pneumonia/Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Chest disorders. In Advanced practice nursing in the care of older adults (2nd ed., pp. 152–214). F. A. Davis.Mizzi, A., Cassar, K., Bowen, C. & Formosa, C. (2019). The progression rate of peripheral arterial disease in patients with intermittent claudication: A systemic review. Http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683562/Tóth-Vajna. Z., Tóth-Vajna. G., Gombos. Z., Szilágyi. B., Járai. Z., Berczeli. M., &Sótony. P. (2019). Screening of peripheral arterial disease in primary care. Https://www.dovepress.com/screening-of-peripheral-arterial-disease-in-primary-health-care-peer-reviewed-fulltext-article-VHRM/NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentAs with other systems, optimal function of the pulmonary system declines with age. Respiratory function is related to musculoskeletal issues, cognitive decline, heart function, and many other factors, and declines in one area may hasten declines in others. With the lungs, reduced mobility and heart function decrease the ability to participate in beneficial activities for the respiratory system and can create a downward trajectory of reduced airflow, gas exchange, and respiratory muscle. Older adults also are at greater risk of developing pneumonia from bacterial or viral infections, such as the flu or coronaviruses.NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentThis week, you continue learning about cardiovascular and pulmonary disorders and related conditions among older adults. You will also complete the midterm exam, which tests your knowledge of all topics covered in the course so far.Learning ObjectiveStudents will:Demonstrate knowledge of concepts related to the advanced care of older adults in acute and primary care settingsLearning ResourcesRequired Readings (click to expand/reduce)Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Chest disorders. In Advanced practice nursing in the care of older adults (2nd ed., pp. 152–214). F. A. Davis.Athenase, B., Mirko, P., & Timo, S. (2019). Hypertension management in older and frail older patients. Circulation Research, 124(7), 1045–1060. https://doi.org/10.1161/CIRCRESAHA.118.313236Perkins, A. (2020). Tuberculosis facts. Nursing Made Incredibly Easy!, 18(1), 44–50. https://doi.org/10.1097/01.Nme.0000613628.36961.64Roche, N., Criner, G., & Vogelmeier, C. (2019). GOLD Reports on chronic obstructive pulmonary disease (COPD): Evolutions, revolutions, and controversies. Barcelona Respiratory Network, 5(2), 104–119. https://doi.org/10.23866/BRNRev:2018-0006Required Media (click to expand/reduce)NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentRecommended Media (click to expand/reduce)Exam: Midterm ExamThis exam will cover the following topics as they pertain to assessing, diagnosing, and treating older adult patients:AssessmentHealth promotionPsychosocial disordersSkin and lymphatic disordersHead, neck, and face disordersCardiac and pulmonary disordersPrior to starting the exam, you should review all of your materials. There is a 150-minute time limit to complete this 100-question exam. You may only attempt this exam once.NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders AssignmentThis exam is a test of your knowledge in preparation for your certification exam. No outside resources, including books, notes, websites, or any other type of resource, are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.By Day 7Complete your exam.Submission InformationSubmit Your Exam Check by Day 7. NRNP 6540 Week 5: Cardiovascular and Pulmonary Disorders Assignment

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