Ms. S Case Study Assignment
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages
Ms. S Case Study Assignment
Ms. S is a 58-year-old African-American woman who is admitted to the coronary care unit (CCU) from the emergency department (ED) with reports of chest pressure and indigestion associated with nausea. She started feeling ill about 10 hours before she called her daughter, who brought her to the ED for admission. She told the nurse that she tried drinking water and took some bismuth subsalicylate that was in her bathroom medicine cabinet. She also tried lying down to rest, but none of these actions helped. She states, “It just gets worse and worse.” Ms. S has been under a health care provider’s (HCP’s) care for the past 12 years for management of hypertension and swelling in her ankles. She was a smoker for 43 years but quit 1 year ago.
In the ED, admission laboratory tests, including levels of cardiac markers, were performed, and a 12-lead electrocardiogram (ECG) was taken.
Ms. S’s CCU vital sign values on admission are as follows:
Blood pressure Heart rate O2 saturation Respiratory rate Temperature
174/92 mm Hg 120 to 130 beats/min, irregular 94% on room air 30 to 34 breaths/min 99.8°F (37.7°C) (oral)
Which risk factors from Ms. S’s history would suggest a possible cardiac problem to the nurse? Select all that apply. 1. Hypertension for 12 years
- Smoked for 43 years; quit smoking 1 year ago 3. Surgery for gallbladder removal 1 year ago 4. Ms. S’sfatherdiedatage42yearsfromaheartattack 5. Client’s weight is 278 lb (126 kg) 6. Diet includes fast foods three to five times a week
Which action is best for the nurse to delegate to a new unlicensed assistive personnel (UAP) orienting to the CCU when caring for Ms. S? 1. Placing the client on a cardiac telemetry monitor 2. Drawing blood to test cardiac marker levels and
sending it to the laboratory 3. Obtaining a 12-lead ECG 4. Monitoring and recording the client’s intake and
Which action prescribed by the HCP for Ms. S takes first priority at this time? 1. Measure vital signs every 2 hours. 2. Obtain 12-lead ECG every 6 hours.
Place the client on a cardiac monitor. 4. Check levels of cardiac markers every 6 hours.
Ms. S’s cardiac telemetry monitor shows a rhythm of sinus tachycardia with frequent premature ventricular contractions (PVCs). Which drug should the nurse be prepared to administer first?
- Amiodarone IV push 2. Nitroglycerin sublingually 3. Morphine sulfate IV push 4. Atenolol IV push
All of these laboratory values were obtained for Ms. S in the emergency department. Which value would be of most concern to the nurse and have immediate implications for the care of the client?
Potassium level of 3.5 mEq/L (3.5 mmol/L) Troponin T level of more than 0.20 ng/mL (0.2 μg/L) Glucose level of 123 mg/dL (6.83 mmol/L) Slight elevation of white blood cell count
Ms. S tells the nurse that she has worsening chest dis- comfort. The cardiac monitor shows ST-segment elevation, and the nurse notifies the HCP. Which prescribed action takes priority at this time?
- Administer morphine sulfate 2 mg IV push. 2. Schedule an ECG. 3. Draw blood for coagulation studies. 4. Administer ranitidine 75 mg PO every 12 hours.
Because Ms. S continues to experience chest pain and has elevated levels of cardiac markers, the following interventions have been prescribed. Which interventions should the nurse delegate to an experienced UAP? Select all that apply.
- Measuring vital signs every 2 hours 2. Accurately recording intake and output 3. Administering tectophases IV push 4. Drawing blood for coagulation studies 5. Assessing the cardiac monitor every 4 hours 6. Assisting the client to the bedside commode
The client is scheduled for an emergent cardiac catheterization with possible percutaneous coronary intervention (PCI). Ms. S asks the nurse what is involved with this procedure. What is the nurse’s best response? 1. “It is a procedure that is usually done on clients who
have heart attacks to diagnose blockages in the
arteries that feed the heart.” 2. “The cardiologist will use a catheter to inject dye
and locate narrowed arteries, then may inflate a balloon to open the artery and place a stent to keep it open.”
- “Cardiac catheterization is usually performed on an outpatient basis to determine whether or not you have had a heart attack.”
- “After the cardiac catheterization, you will come back to the coronary care unit, where you will be on bed rest for 6 to 8 hours, and we will check your vital signs often.”
Ms. Shas returned from a cardiac catheterization and a percutaneous coronary intervention procedure. Which follow-up care orders should the nurse assign to an experienced LPN/LVN? Select all that apply.
- Reminding the client to remain on bedrest with the insertion site extremity straight
- Preparing a teaching plan that includes activity restrictions and risk factor modification
- Measuring the client’s vital signs every 15 minutes for the first hour
- Assessing the catheter insertion site for bleeding or hematoma formation
- Monitoring peripheral pulses, skin temperature, and skin color with each measurement of vital signs 6. Administering two tablets of acetaminophen for
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Which information is most important to prevent recurrence of reclusion of the coronary artery, chest discomfort, or myocardial infarction (MI)? 1. Remain on bed rest for the next 24 hours.
- Client will be prescribed dual antiplatelet therapy (DAT).
- Client should do no heavy lifting for 48 hours. 4. HCP will prescribe a beta-blocker.
Ms. S’s daughter asks the nurse why her mother did not receive a “clot-buster” drug. What is the nurse’s best response? 1. “Thrombolytic agents, also called clot busters, are
most effective when administered within the first
6 hours of a coronary event.” 2. “Thrombolytic drugs are much more effective when
used for clients who have had a recent stroke.” 3. “Thrombolytic drugs work better for clients who
have a heart attack at a much younger age.” 4. “Contraindications for these drugs include recent surgeries, and your mother had gallbladder surgery
a year ago.”
Ms.’s condition is stable, and she has been transferred to the cardiac step-down unit. What should the step- down nurse instruct the UAP to report immediately? 1. Temperature of 99°F (37.2°C) with morning vital
sign monitoring 2. Chest pain episode occurring during morning care 3. Systolic blood pressure increases of 8 mm Hg after
morning care 4. Heartrateincreaseof10beats/min after ambulation
The nurse delegates to the UAP the task of taking Ms. S’s vital signs every 4 hours and recording the vital sign values in the electronic chart. Later the nurse checks the client’s chart and discovers that vital sign measurements have not been recorded. What is the nurse’s best action?
- Take they it aligns because the UAP is not competent to complete this task.
- Notify the nurse manager immediately. 3. Reprimand the UAP at the nurses’ station. 4. Speak to the UAP privately to determine why the
values were not recorded.
The HCP prescribes captopril 12.5 mg orally twice daily and hydrochlorothiazide (HCTZ) 25 mg orally daily. Which information would the nurse be sure to include when teaching Ms. S about these drugs?
- “Take your hydrochlorothiazide in the morning.” 2. “If you miss a dose of captopril, take two tablets next
time.” 3. “Avoid foods that are rich in potassium, such as
bananas and oranges.” 4. “You should expect an increase in blood pressure
with these drugs.
The HCP orders DAT for Ms. S. What is the nurse’s priority concern for this client? 1. Reminding the client to do no heavy lifting while
hospitalized 2. Assessing the progression of walking in the halls 3. Teaching the client to apply oxygen for any short-
ness of breath 4. Monitoring the client for any form of bleeding
The HCP prescribes atenolol 50 mg each morning for Ms. S. Which instruction would the nurse provide for the LPN/LVN assigned to give this drug? 1. Hold the drug if the client’s blood pressure is higher
than 100/80 mm Hg. 2. Give the drug if the client’s respiratory rate is greater
than 30 breaths/min. 3. Hold the drug if the client’s heart rate is less than
55 beats/min. 4. Give the drug if the client’s blood pressure is less
than 90/50 mm Hg.
Which activities could the nurse delegate to UAP assisting Ms. S during phase 1 of cardiac rehabilitation? Select all that apply. 1. Assist with Ms. S’s morning bath.
- Refer Ms. S to a monitored cardiac rehab program. 3. Ambulate with Ms. S to the bathroom. 4. Administer Ms. S’s morning doses of captopril
and HCTZ. 5. Assist with progressive ambulation in the hall. 6. Assess Ms. S for additional chest pain or pressure.
Before discharging Ms. S, the HCP orders an electro- cardiogram. This test reveals normal sinus rhythm with a heart rate of 88 beats/min. What is the nurse’s best action at this time?
- Delay the client’s discharge until she is seen by the HCP.
- Administer the client’s next dose of atenolol 3 hours early before she goes home.
- Contact the HCP and ask about drawing an addi- tional set of cardiac markers.
- Document this finding as the only action
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. 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Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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