Make-up Clinical Activity
Student Name: _______________________________________
Date: ______________
Case Scenarios: 2 hours
Instruction: Based on these case scenarios complete the textbook picture using your text and nursing diagnosis handbook. Additionally, look up and document common medications that are used to treat this medical diagnosis.
Case Study One
Overview: Heart failure (HF) is an abnormal clinical condition that involves inadequate pumping and/or filling of the heart. This results in the inability of the heart to provide sufficient blood to meet the oxygen needs of the tissues. HF is characterized by ventricular dysfunction, reduced exercise tolerance, diminished quality of life, and shortened life expectancy. Several factors predispose patients to the development of heart failure. Any factor that interferes with the normal mechanisms of cardiac output can lead to heart failure. Heart failure is classified according to pathology (systolic or diastolic), the part of the heart affected (right- or left-sided failure), the person’s tolerance to physical activity (New York Heart Association Functional Classification), and the absence or presence of ventricular dysfunction along with the severity of symptoms (ACCF/AHA Stages of Heart Failure). Interprofessional care of patients with heart failure includes nonpharmacologic, pharmacologic, and nutritional therapies. Complications arising from heart failure include pleural effusion, dysrhythmias, left ventricular thrombus, hepatomegaly, and renal failure.
Scenario:
Mr. Jones is a 65-year-old make with past medical history of type 2 diabetes mellitus (t2DM), hypertension, hyperlipidemia, and coronary artery disease (CAD). He has had two myocardia infarction (Mis) over the past several years. He smoked 2 packs of cigarettes for 30 years, quitting after his first MI 4 years ago. He has been overweight all his life and has no regular exercise except for household activities. Mr. Jones complaint of additional weight gain of 10 lbs in the past one week, shortness of breathing, and bilateral leg swelling.
Medical/Surgical Textbook Picture
MEDICAL DIAGNOSIS WITH DESCRIPTIVE
STATEMENTS/ CLINICAL SIGNS/ SYMPTOMS
MEDICAL/ SURGICAL MANAGEMENT NURSING MANAGEMENT INCLUDING
PROBABLE NURSING DIAGNOSES & PLANNED NURSING ACTIONS
Name of Medical Diagnosis
Clinical Signs/ Symptoms
Complications
Medical Management
Surgical Management Nursing Diagnosis/Problem #1
Nursing Actions
Nursing Diagnosis/Problem #2
Nursing Actions
Nursing Diagnosis/Problem #3
Nursing Actions:
Case Study Two
A normal cardiac impulse begins in the sinoatrial (SA) node in the upper right atrium. It spreads over the atrial myocardium via interatrial and internodal pathways. At this point, the impulse pauses momentarily at the AV node to allow the atria to contract. It then spreads quickly through the Bundle of His, right and left bundle branches, and Purkinje fibers, resulting in ventricular contraction. This coordination between the atria and ventricular contractions allows the atria to empty additional blood into the ventricles before ventricular systole, increasing cardiac output by 10% to 25%. This additional volume is referred to as the “atrial kick.”
Dysrhythmias of the atria can lead to a loss of this atrial kick and thus a decrease in cardiac output. One such dysrhythmia is atrial fibrillation. Atrial fibrillation is characterized by a total disorganization of electrical atrial activity due to multiple ectopic foci resulting in loss of effective atrial contraction. Several risk factors can lead to atrial fibrillation and significant complications that can result from this dysrhythmia. The goals of treatment for atrial fibrillation include a decrease in ventricular response (to <100 beats/min), prevention of stroke, and conversion to sinus rhythm, if possible. Treatment options include pharmacologic and electrical therapies.
Scenario:
Mrs. Smith is a 55-year-old female patient who presented with complaints of heart racing.” She states this has been happening periodically over the last several weeks. Mrs. Smith reports “just feeling lousy” during these episodes. When asked to further describe how she feels, she states “a little lightheaded and sick to my stomach at times.” Mrs. Smith past medical history is negative for heart disease. Although she was recently diagnosed with hypertension, she refused treatment because she thought she could control it with diet and exercise. She has had arthroscopic knee surgery related to osteoarthritis. Initial assessment of Mrs. Smith includes the following: height 5’6″, weight 180 lbs, BP 160/95, heart rate (HR) 84 and regular, respiration rate (RR) 18, Temp 37.2°C (99.0°F). Awake, alert, and oriented ×3. Color pink. Skin warm and dry. Lungs clear to auscultation. Abdomen soft with positive bowel sounds. Her admitting diagnosis was atrial fibrillation.
Medical/Surgical Textbook Picture
MEDICAL DIAGNOSIS WITH DESCRIPTIVE
STATEMENTS/ CLINICAL SIGNS/ SYMPTOMS
MEDICAL/ SURGICAL MANAGEMENT NURSING MANAGEMENT INCLUDING
PROBABLE NURSING DIAGNOSES & PLANNED NURSING ACTIONS
Name of Medical Diagnosis
Clinical Signs/ Symptoms
Complications
Medical Management
Surgical Management Nursing Diagnosis/Problem #1
Nursing Actions
Nursing Diagnosis/Problem #2
Nursing Actions
Nursing Diagnosis/Problem #3
Nursing Actions:
Recognizing Complications: 2 hours
Instruction: Answer the following questions for each medical diagnosis.
Case 1: Diabetic keto acidosis (DKA)
• What are the possible complications for this disease process?
• What is the nurse’s role to prevent the complications for the diagnosis?
• How will the nurse know the client is having these complications?
• What immediate actions should the nurse take if these complications are present?
• What treatment exists for these complications?
Case 2: Blood administration reaction
• What are the possible complications for this disease process?
• What is the nurse’s role to prevent the complications for the diagnosis?
• How will the nurse know the client is having these complications?
• What immediate actions should the nurse take if these complications are present?
• What treatment exists for these complications?
Case 3: Diverticulitis
• What are the possible complications for this disease process?
• What is the nurse’s role to prevent the complications for the diagnosis?
• How will the nurse know the client is having these complications?
• What immediate actions should the nurse take if these complications are present?
• What treatment exists for these complications?
Case 4: Unstable angina pectoris
• What are the possible complications for this disease process?
• What is the nurse’s role to prevent the complications for the diagnosis?
• How will the nurse know the client is having these complications?
• What immediate actions should the nurse take if these complications are present?
Critical Thinking: 2 hours
Safety Scenario: You are preparing to administer a dose of medication to a patient. Based on your experience- you are aware that the dose that the doctor prescribed will not be sufficient to help with their symptoms. What is your best action?
Professionalism: You are in the medication room. John is talking to you about the schedule and how unfair it is that he has to work tonight even though it is his brother’s birthday. He states that next year he is going to call in if he cannot get someone to cover his shift because he deserves to go to his brother’s birthday. What is the best response? Is this professional? How can this situation be avoided?
Teaching: Your patient needs to receive discharge instructions but cannot stay awake or pay attention long enough for you to be able to provide the education. What is your next action?
Caring: Your patient has chronic pain and none of the medications you are giving is covering there pain. What other interventions or actions can you take to meet this client’s needs?
Collaboration: Your patient with a stroke is having expressive aphasia, has left-sided weakness, and has foot drop. What collaborative care team members and or equipment may be helpful for this client?
Communication: You are trying to reach the physician because a client is nauseous and they are requesting Ondansetron. You have called their answering service twice with no response. What is your next best action?
Clinical Reasoning: You have the following patient assignment- who should you see first? What order would you see the rest of your patients?
Patient 1: Patient who has COPD, HTN, HF, CAD, Kidney Disease, and is awaiting placement of a dialysis catheter. They have fecal and urinary incontinence and have not been changed in 4-6 hours.
Patient 2: Patient with asthma. They are on a nonrebreather and are using accessory muscles to breathe. They were having wheezing but the nurse reports that their wheezing has diminished.
Patient 3: Patient with new diagnosis of diabetes type 2. Their last blood glucose was 250 and they are due for insulin. They also stated they need to go to the rest room ASAP.
Patient 4: Patient with recent hemorrhagic stroke who is complaining of a headache and 5 out of 10 pain.
Make-up Clinical Activity
Student Name: _______________________________________
Date: ______________
Case Scenarios: 2 hours
Instruction: Based on these case scenarios complete the textbook picture using your text and nursing diagnosis handbook. Additionally, look up and document common medications that are used to treat this medical diagnosis.
Case Study One
Overview: Heart failure (HF) is an abnormal clinical condition that involves inadequate pumping and/or filling of the heart. This results in the inability of the heart to provide sufficient blood to meet the oxygen needs of the tissues. HF is characterized by ventricular dysfunction, reduced exercise tolerance, diminished quality of life, and shortened life expectancy. Several factors predispose patients to the development of heart failure. Any factor that interferes with the normal mechanisms of cardiac output can lead to heart failure. Heart failure is classified according to pathology (systolic or diastolic), the part of the heart affected (right- or left-sided failure), the person’s tolerance to physical activity (New York Heart Association Functional Classification), and the absence or presence of ventricular dysfunction along with the severity of symptoms (ACCF/AHA Stages of Heart Failure). Interprofessional care of patients with heart failure includes nonpharmacologic, pharmacologic, and nutritional therapies. Complications arising from heart failure include pleural effusion, dysrhythmias, left ventricular thrombus, hepatomegaly, and renal failure.
Scenario:
Mr. Jones is a 65-year-old make with past medical history of type 2 diabetes mellitus (t2DM), hypertension, hyperlipidemia, and coronary artery disease (CAD). He has had two myocardia infarction (Mis) over the past several years. He smoked 2 packs of cigarettes for 30 years, quitting after his first MI 4 years ago. He has been overweight all his life and has no regular exercise except for household activities. Mr. Jones complaint of additional weight gain of 10 lbs in the past one week, shortness of breathing, and bilateral leg swelling.
Medical/Surgical Textbook Picture
| MEDICAL DIAGNOSIS WITH DESCRIPTIVE
STATEMENTS/ CLINICAL SIGNS/ SYMPTOMS
|
MEDICAL/ SURGICAL MANAGEMENT | NURSING MANAGEMENT INCLUDING
PROBABLE NURSING DIAGNOSES & PLANNED NURSING ACTIONS
|
| Name of Medical Diagnosis
Clinical Signs/ Symptoms
· Shortness of breath with activity or when lying down · Fatigue and weakness · Swelling in the legs, ankles and feet · Rapid or irregular heartbeat · Reduced ability to exercise · Persistent cough or wheezing with white or pink blood-tinged mucus · Swelling of the belly area (abdomen) · Very rapid weight gain from fluid buildup · Nausea and lack of appetite · Difficulty concentrating or decreased alertness · Chest pain if heart failure is caused by a heart attack
Complications
|
Medical Management
Surgical Management
|
Nursing Diagnosis/Problem #1
Nursing Actions
Nursing Diagnosis/Problem #2
Nursing Actions
Nursing Diagnosis/Problem #3
Nursing Actions:
|
Case Study Two
A normal cardiac impulse begins in the sinoatrial (SA) node in the upper right atrium. It spreads over the atrial myocardium via interatrial and internodal pathways. At this point, the impulse pauses momentarily at the AV node to allow the atria to contract. It then spreads quickly through the Bundle of His, right and left bundle branches, and Purkinje fibers, resulting in ventricular contraction. This coordination between the atria and ventricular contractions allows the atria to empty additional blood into the ventricles before ventricular systole, increasing cardiac output by 10% to 25%. This additional volume is referred to as the “atrial kick.”
Dysrhythmias of the atria can lead to a loss of this atrial kick and thus a decrease in cardiac output. One such dysrhythmia is atrial fibrillation. Atrial fibrillation is characterized by a total disorganization of electrical atrial activity due to multiple ectopic foci resulting in loss of effective atrial contraction. Several risk factors can lead to atrial fibrillation and significant complications that can result from this dysrhythmia. The goals of treatment for atrial fibrillation include a decrease in ventricular response (to <100 beats/min), prevention of stroke, and conversion to sinus rhythm, if possible. Treatment options include pharmacologic and electrical therapies.
Scenario:
Mrs. Smith is a 55-year-old female patient who presented with complaints of heart racing.” She states this has been happening periodically over the last several weeks. Mrs. Smith reports “just feeling lousy” during these episodes. When asked to further describe how she feels, she states “a little lightheaded and sick to my stomach at times.” Mrs. Smith past medical history is negative for heart disease. Although she was recently diagnosed with hypertension, she refused treatment because she thought she could control it with diet and exercise. She has had arthroscopic knee surgery related to osteoarthritis. Initial assessment of Mrs. Smith includes the following: height 5’6″, weight 180 lbs, BP 160/95, heart rate (HR) 84 and regular, respiration rate (RR) 18, Temp 37.2°C (99.0°F). Awake, alert, and oriented ×3. Color pink. Skin warm and dry. Lungs clear to auscultation. Abdomen soft with positive bowel sounds. Her admitting diagnosis was atrial fibrillation.
Medical/Surgical Textbook Picture
| MEDICAL DIAGNOSIS WITH DESCRIPTIVE
STATEMENTS/ CLINICAL SIGNS/ SYMPTOMS
|
MEDICAL/ SURGICAL MANAGEMENT | NURSING MANAGEMENT INCLUDING
PROBABLE NURSING DIAGNOSES & PLANNED NURSING ACTIONS
|
Name of Medical Diagnosis
Clinical Signs/ Symptoms · Sensations of a fast, fluttering or pounding heartbeat (palpitations) · Chest pain · Dizziness · Fatigue · Lightheadedness · Reduced ability to exercise · Shortness of breath · Weakness
Complications
|
Medical Management
Surgical Management
|
Nursing Diagnosis/Problem #1
Deficient knowledge regarding the association between cardiac disease and atrial fibrillation.
Nursing Actions
Nursing Diagnosis/Problem #2
Nursing Actions
Nursing Diagnosis/Problem #3
Nursing Actions:
|
Recognizing Complications: 2 hours
Instruction: Answer the following questions for each medical diagnosis.
Case 1: Diabetic keto acidosis (DKA)
- What are the possible complications for this disease process?
- Damage to the kidney or other organs from fluid loss
- Low levels of potassium (hypokalemia)
- Fluid inside lungs (pulmonary edema)
- Swelling inside the brain (cerebral edema)
- What is the nurse’s role to prevent the complications for the diagnosis?
- Ensuring medication compliance
- Helping the patient to adopt positive lifestyle
- Patient monitoring for blood sugars and stress
- Error detection
- Implementing evidence-based care processes
- Communicating clinical changes to the patient
- Ensuring that the patient receives high quality care
- How will the nurse know the client is having these complications?
- Monitoring clinical changes
- Performing diagnostic tests
- What immediate actions should the nurse take if these complications are present?
- Ongoing assessments
- Education on disease management
- Education on medication adherence
- What treatment exists for these complications?
- Use electrolytes replacement
- Fluid replacement
- Insulin therapy
Case 2: Blood administration reaction
- What are the possible complications for this disease process?
- Allergic reactions
- Acute hemolytic reaction
- Transfusion-associated circulatory overload
- What is the nurse’s role to prevent the complications for the diagnosis?
- Monitoring clinical complications
- Managing blood administration reactions
- Patient education on drug adherence and disease management
- How will the nurse know the client is having these complications?
- Monitoring clinical changes
- Asking the patient to describe symptoms
- What immediate actions should the nurse take if these complications are present?
- Stop the transfusion.
- Keep the I.V. line open with normal saline solution.
- Notify the physician and blood bank.
- Intervene for signs and symptoms as appropriate.
- Monitor the patients’ vital signs.
- What treatment exists for these complications?
- The use of intravenous fluids
- Dialysis
Case 3: Diverticulitis
- What are the possible complications for this disease process?
- Bleeding/hemorrhage
- Urinary problems
- Abscess
- Fistula
- Intestinal obstructions
- Peritonitis
- What is the nurse’s role to prevent the complications for the diagnosis?
- Advising the patient to drink more fluids to keep hydrated
- Advising the doctor to perform a segmental colectomy to prevent hemorrhage/bleeding
- Bowel rest
- Educating the patient on drug adherence
- Teach the patient to avoid fiber-rich foods
- How will the nurse know the client is having these complications?
- Monitoring of clinical changes
- Conducting both subjective and objective assessment
- What immediate actions should the nurse take if these complications are present?
- Collect drainage effectively to avoid stress
- Evaluate the patient to determine if surgery is necessary
- What treatment exists for these complications?
- Medications
- Surgery
- Diet-avoid fiber rich foods
Case 4: Unstable angina pectoris
- What are the possible complications for this disease process?
- Abnormal heart rhythms (arrhythmias)
- Heart attack
- Myocardial infarction
- Heart failure
- Cardiac arrest
- What is the nurse’s role to prevent the complications for the diagnosis?
- Instructing the patient to sit or rest in the right position (semi-Fowler’s position) anytime he or she experiences angina
- Ensuring medication compliance
- Helping the patient to adopt positive lifestyle
- Patient monitoring for blood sugars and stress
- Implementing evidence-based care processes
- How will the nurse know the client is having these complications?
- Observing clinical changes
- Conducting physical exams
- What immediate actions should the nurse take if these complications are present?
- Conduct first aid to improve breathing
- Administer aspirin and nitroglycerin
- Provide oxygen
- Position the patient to have bed rest
- Check vital signs
- Obtain electrocardiogram (ECG)
- What treatment exists for these complications?
- Administer heparin
- Administer nitroglycerin
- Administer statin drugs to control heart rhythms
- Provide supplemental oxygen to improve saturation
Critical Thinking: 2 hours
Safety Scenario: You are preparing to administer a dose of medication to a patient. Based on your experience- you are aware that the dose that the doctor prescribed will not be sufficient to help with their symptoms. What is your best action?
- The best action in this scenario is to stop preparing the dose and request the doctor to review the prescription. Explain to the doctor, using clinical practice guidelines or evidence, why it is important to review the prescription
Professionalism: You are in the medication room. John is talking to you about the schedule and how unfair it is that he has to work tonight even though it is his brother’s birthday. He states that next year he is going to call in if he cannot get someone to cover his shift because he deserves to go to his brother’s birthday. What is the best response? Is this professional? How can this situation be avoided?
- John’s planned action and viewpoint are unprofessional. The best response is to advise John that what he is about to do is unprofessional because it is against the nursing code of conduct. The best way to avoid such a situation is to involve staff in schedule development to ensure that nurses are comfortable to work in the shifts assigned.
Teaching: Your patient needs to receive discharge instructions but cannot stay awake or pay attention long enough for you to be able to provide the education. What is your next action?
- The most appropriate action is to teach family members or caregivers the same things that the patient was to be taught. Family members or caregivers should be advised on how to take care of the patient at home post-discharge.
Caring: Your patient has chronic pain and none of the medications you are giving is covering there pain. What other interventions or actions can you take to meet this client’s needs?
- Change medications and monitor clinical changes.
Collaboration: Your patient with a stroke is having expressive aphasia, has left-sided weakness, and has foot drop. What collaborative care team members and or equipment may be helpful for this client?
- Cardiologist
- Neurologist
- Speech therapist
- Physiotherapist
Communication: You are trying to reach the physician because a client is nauseous and they are requesting Ondansetron. You have called their answering service twice with no response. What is your next best action?
- Inform the patient that you are unable to reach the doctor and advise him or her to be patient as you wait for any response
- Meanwhile, it is important to seek advice from other nurses regarding the best action to take
Clinical Reasoning: You have the following patient assignment- who should you see first? What order would you see the rest of your patients?
Patient 1: Patient who has COPD, HTN, HF, CAD, Kidney Disease, and is awaiting placement of a dialysis catheter. They have fecal and urinary incontinence and have not been changed in 4-6 hours.
Patient 2: Patient with asthma. They are on a nonrebreather and are using accessory muscles to breathe. They were having wheezing but the nurse reports that their wheezing has diminished.
Patient 3: Patient with new diagnosis of diabetes type 2. Their last blood glucose was 250 and they are due for insulin. They also stated they need to go to the rest room ASAP.
Patient 4: Patient with recent hemorrhagic stroke who is complaining of a headache and 5 out of 10 pain.
Order;
Patient 1, Patient 2, Patient 4, Patient 3.