NUR 2349 Week 03 Written Assignment Case Study

Module 03 Written Assignment – Case Study (Care Plan)

Rapid Reasoning

Clostridium difficile Colitis

Chief Complaint/History of Present Illness:

Mindy Perkins is a 48 year old woman who presents to the ED with 10-15 loose, liquid stools daily for the past 2 days. She completed a course of oral Amoxacillin seven days ago for a dental infection. In addition to loose stools, she complains of lower abdominal pain that began 2 days ago as well. She has not noted any blood in the stool. She denies vomiting or fever/chills. She is on Prednisone for Crohn’s disease as well as Pantoprazole (Protonix) for severe GERD.

Past Medical History:

• Crohn’s disease

• GERD

Your Initial VS:

	WILDA Pain Scale (5^th VS)
	Words:	Crampy

	Intensity:	7/10

	Location:	Generalized throughout RLQ-LLQ

	Duration:	Persistent since onset 2 days ago

	Aggreviate:	None

	Alleviate:	None


T:100.2 (o)

P:92

R:20

BP:122/78

O2 sats:98% RA

Ortho BP’s:Lying: 122/78 HR: 92

Standing: 120/70 HR: 114

Your Initial Nursing Assessment:

GENERAL APPEARANCE: appears weak and uncomfortable. Easily fatigued

RESP: breath sounds clear with equal aeration bilat., non-labored

CARDIAC: pink, warm & dry, S1S2, no edema, pulses 3+ in all extremities

NEURO: alert & oriented x4

GI/GU: active BS in all quads, abd. soft/tender to palpation in lower abd-no rebound tenderness or guarding

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MISC: Lips dry, oral mucosa tacky with no shiny saliva present in mouth

Nursing Interventions:

• Orthostatic BP’s (ED standing order)

• Establish PIV (ED standing order)

• Initiate enteric precautions (ED standing order)

Physician Orders:

• 0.9% NS 1000 mL IV bolus

• Hydromorphone (Dilaudid) 1 mg IVP

• Stool culture for C. difficile

• BMP, CBC

• Vancomycin 250 mg po

o 1000 mg/20 mL…determine dosage to administer

• Admit to medical unit

Lab/diagnostic Results:

Stool culture for C. difficile: Positive

BMP	Current	High/Low
Sodium	132		CBC	Current	High/Low
Potassium	3.5		WBC	12.6
Creatinine	1.45		HGB	14.5
BUN	47		PLTS	188
CO2	18		Neuts. %	86
			Lymphs %	10

1. What data from the chief complaint, VS & nursing assessment is RELEVANT that must be recognized as clinically significant to the nurse?

RELEVANT data:	Rationale:
Chief complaint:

VS/assessment:

2. What lab/diagnostic results are RELEVANT that must be recognized as clinically significant to the nurse?

	RELEVANT Diagnostic results:	Rationale:

3. What is the primary problem that your patient is most likely presenting with?

4. What is the underlying cause /pathophysiology of this concern?

5. What nursing priority will guide your plan of care?

6. What interventions will you initiate based on this priority?

Nursing Interventions	Rationale:	Expected Outcome:
1.	1.	1.
2.	2.	2.
3.	3.	3.
4.	4.	4.

7. What is the relationship between the following nursing interventions/physician orders and your patient’s primary medical problem?

Nsg. Interventions/MD orders:	Rationale:	Expected Outcome:
Orthostatic BP’s
(ED standing order)
Establish PIV
(ED standing order)
Initiate enteric precautions
(ED standing order)
0.9% NS 1000 mL IV bolus
Hydromorphone (Dilaudid) 1 mg
IVP
Stool culture for C. difficile
BMP
CBC
Vancomycin 250 mg po
Admit to medical unit

8. What body system(s) will you most thoroughly assess based on the patient’s chief complaint and primary/priority concern?

9. What is the worst possible complication to anticipate? (start with A-B-C priorities)

10. What nursing assessment(s) will you need to initiate to identify and respond to quickly if this complication develops?

11. What is the patient likely experiencing/feeling right now in this situation?

12. What can you do to engage yourself with this patient’s experience, and show that they matter to you as a person?

Module 04 Written Assignment – Improving Patient Care Worksheet

Your written assignment for this module is a worksheet that describes the following:

An example of an evidence-based practice (EBP) project
How EBP projects can improve patient care

You should be using complete sentences to answer the questions. Ensure that you are using correct grammar. In addition, support your answers using your textbook, course materials, credible internet resources, and scholarly journals. All citations must be in APA format.

Please click here to download the Improving Patient Care Worksheet.

Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.

Name:

Date:

Complete all of your lesson materials and assigned readings. Make sure that you are focusing on:

• An example of an evidence-based practice (EBP) project

• How EBP projects can improve patient care

1. Give an example of an evidence-based practice (EBP) project that you have either been a part of or have knowledge regarding. 2 Points

2. Describe how the EBP project can improve patient care. 2 Points

Module 05 Written Assignment- Care Plan

You are the nurse receiving report on your patient that was admitted as an emergency earlier in the day. A 64-year-old female underwent a right colectomy. The right side of her colon was removed due to cancer. She has a history of smoking & no other health problems. She is currently being transferred to you in PACU.

She has a midline incision with a Penrose drain, a stab wound w/ a Jackson Pratt drain to incision. She also has a NG tube, attached to intermittent suction. She is alert, oriented and can move all 4 extremities. BP is 110/68, Respiratory rate is 14, O2 stats are at 93% w/ additional oxygen given via nasal cannula.

All labs are normal. You are asked to change the dressings daily and document the drainage. What precautions will you take to prevent this patient from obtaining a nosocomial infection?

Please answer the questions and develop a care plan for a patient that will be having an elective surgery.
Please use the provided format for building your care plan. You will need to use your nursing reference materials as you build this care plan.
Go to ATI website for care plan – go to integration materials – scroll down to active learning templates – choose systems disorder
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.

Module 06 Written Assignment – Stress and Immunity

Your written assignment for this module should be a 1-2 page paper (not including title page and reference page) that describes the following:

What are the different types of immunities and give an example of each
Describe how stress impacts the immunity of a person

You should include a minimum of 3 scholarly references. Include a title page, in-text citations, and a reference page in APA format.

Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.

NUR 2349 Week 03 Written Assignment Case Study