Assignment Branching Exercise Cardiac Case 2

Please remember to review the rubric and the comments I have made on your previous branching exercise to improve and receive maximum points.

Here is the information for your branching exercise:

  • 84 y/o Female
  • Code Status: DNR
  • PMH: HTN, DM
  • Home meds: Metoprolol/Insulin/ASA/ Calcium
  • Wt: 62kg, Ht 5’5

NKDA

Critically think about where you would send this patient from the ER and write admissions orders for that unit. Remember to be specific with your orders. Especially with your nursing orders.

Remember Oxygen is a drug. We shouldn’t be placing oxygen on patients just to place it or if they have a normal O2 sat, ie: 94%. If they have an O2 set of 92% and above O2 is not indicated. Remember if you just put oxygen on a patient routinely, if something really is going on, it could mask a problem that may warrant an investigation. Please email me with any questions, comments, or concerns. If you would like to have a zoom meeting or phone conference, please email me and we can schedule a time.

Week 4: Hypertension And Shock

Issues with the heating and cooling system of your home can be relatively benign matters that are addressed easily enough with the help of a visiting technician. But in cases of extreme weather conditions or delayed attention, these matters can seriously threaten the health of the home or its occupants.

Similarly, extreme cardiovascular conditions can pose very serious health risks. Hypertension can lead to severe health complications and increase the risk of heart disease, stroke, and sometimes death. Shock can damage the body’s organs and can also be life-threatening. Effective diagnosis and treatment of hypertension and shock can, therefore, be a critically important and even life-saving endeavor. 

This week, you will assess and develop management plans for patients with hypertension, including urgent and emergent conditions. You will review how to differentiate shock states and examine hemodynamic values for those shock states when evaluating treatment goals.

Learning Objectives

Students will:

  • Distinguish between hypertensive urgencies and emergencies
  • Develop a management plan for hypertensive emergencies
  • Apply current clinical practice guidelines to address acute and chronic management of hypertension
  • Distinguish shock states
  • Develop patient treatment plans for shock
  • Analyze pharmacologic treatments of shock
  • Evaluate normal and abnormal hemodynamic monitoring values
  • Develop appropriate treatment plans, including diagnostics and laboratory orders for patients with hypertension and shock
  • Identify concepts related to hypertension and shock

Learning Resources

Barkley, T. W., Jr., & Myers, C. M. (2020). Practice considerations for the adult-gerontology acute care nurse practitioner (3rd ed.). Barkley & Associates.

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.

To prepare:

  • Review the interactive media piece/branching exercise provided in the Learning Resources.
  • Reflect on the patient’s symptoms and aspects of disorders that may be present in the interactive media piece/branching exercise.
  • Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the interactive media piece/branching exercise.
  • You will be asked to develop a set of admission orders based on the patient in the branching exercise.

The Assignment

Using the Required Admission Orders Template, write a full set of admission orders for the patient in the branching exercise.

  • Be sure to address each aspect of the order template
  • Write the orders as you would in the patient’s chart
  • Make sure the order is complete and applicable to the patient
  • Any rationale you feel the need to supply 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, evidenced based references are required.