Cardiovascular 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

Cardiovascular 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

Cardiovascular 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

Case Title: A 67-year-old With Tachycardia and Coughing

Ms. Baker is a 68-year-old female who is brought to your office today by her daughter Susan. Ms. Baker 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. Baker 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/cramping in her bilateral lower extremities when walking and has 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.

Ms. Baker 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 but denies any worsening shortness of breath. She admits that she has some weakness and fatigue but is still able to carry out her daily routine.

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Vital Signs: 99.2, 126/78, 90, RR 22

Labs: Complete Metabolic Panel and CBC done and were within normal limits

CMP Component

Value

CBC Component

Value

Glucose, Serum

86 mg/dL

White blood cell count

5.0 x 10E3/uL

BUN

17 mg/dL

RBC

4.71 x10E6/uL

Creatinine, Serum

0.63 mg/dL

Hemoglobin
10.9 g/dL

EGFR

120 mL/min

Hematocrit
36.4%

Sodium, Serum
141 mmol/L
Mean Corpuscular Volume
79 fL

Potassium, Serum

4.0 mmol/L

Mean Corpus HgB
28.9 pg

Chloride, Serum

100 mmol/L

Mean Corpus HgB Conc

32.5 g/dL

Carbon Dioxide
26 mmol/L
RBC Distribution Width
12.3%

Calcium
8.7 mg/dL
Platelet Count
178 x 10E3/uL

Protein, Total, Serum

6.0 g/dL

Albumin
4.8 g/dL

Globulin

2.4 g/dL

Bilirubin

1.0 mg/dL

AST
17 IU/L

ALT
15 IU/L

Allergies: Penicillin

Current Medications:

Atorvastatin 40mg p.o. daily

Multivitamin 1 tablet p.o. daily

Losartan 50mg p.o. daily

ProAir HFA 90mcg 2 puffs q4–6 hrs. prn

Caltrate 600mg+ D3 1 tablet p.o. daily

onia

Question 1: What findings would you expect to be reported or seen on her chest x-ray results, given the diagnosis of pneumonia?

Question 2: Define further what type of pneumonia Ms. Baker has, HAP (hospital-acquired pneumonia) or CAP (community-acquired pneumonia)? What’s the difference/criteria?

Question 3:

A) What assessment tool should be used to determine the severity of pneumonia and treatment options?

B) Based on Ms. Baker’s subjective and objective findings, apply that tool and elaborate on each clinical factor for this patient.

Question 4: Ms. Baker was diagnosed with left lower lobe pneumonia. What would your treatment be for her based on her diagnosis, case scenario, and evidence-based guidelines?

Question 5: Ms. Baker has a known history of COPD. What is the gold standard for measuring airflow limitation?

Question 6: Ms. Baker mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain/cramps. Which choice below would be the best choice for a potential diagnosis for this? Explain your reasoning.

DVT (Deep Vein Thrombosis)

Intermittent Claudication

Cellulitis

Electrolyte Imbalance

Question 7: Ms. Baker 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?

Question 8: Name three (3) differentials for Ms. Baker’s initial presentation.

Question 9: What patient education would you give Ms. Baker and her daughter? What would be your follow-up instructions

Question 10: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Baker’ Pneumonia?

Cardiovascular 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.

RESOURCES

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To 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.

Kennedy-Malone, L., & Groenke-Duffy, E. (2023). Cardiovascular disorders. In Advanced practice nursing in the care of older adults (3rd ed., pp. 186-218). F.A. Davis.

Kennedy-Malone, L., & Groenke-Duffy, E. (2023). Peripheral vascular disorders. In Advanced practice nursing in the care of older adults (3rd ed., pp. 258-267). F.A. Davis.

Document: Week 5 Case Assignment (Word Document)

NRNP_6540_Week5_Assignment_Rubric

NRNP_6540_Week5_Assignment_Rubric

Criteria Ratings Pts

This criterion is linked to a Learning OutcomeCreate documentation in the document about the patient in the case study to which you were assigned. Provide thorough answers to the questions asked in the assignment.
25 to >23.0 pts

Excellent

The response thoroughly and accurately answers the questions presented. The answers inform a differential diagnosis and a thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

23 to >20.0 pts

Good

The response answers the questions presented. The answers inform a differential diagnosis and a thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

20 to >18.0 pts

Fair

The response partially answers the questions presented. The answers inform a differential diagnosis, but is somewhat vague or contains minor inaccuracies. A cross-check of medications against the Beers Criteria has been completed but alternatives may be missing.

18 to >0 pts

Poor

The response provides an incomplete or inaccurate answers to questions presented. The answers may partially inform a differential diagnosis, but is somewhat vague or contains minor inaccuracies. A cross-check of medications against the Beers Criteria has not been completed. Or, other subjective documentation is missing.
25 pts

This criterion is linked to a Learning OutcomeIn the Assessment section, provide: • At least three (3) differentials with supporting evidence. Explain what rules each differential in or out, and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.
25 to >23.0 pts

Excellent

The response lists in order of priority at least three distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the conditions selected.

23 to >20.0 pts

Good

The response lists in order of priority at least three different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the conditions selected.

20 to >18.0 pts

Fair

The response lists three possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.

18 to >0 pts

Poor

The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.
25 pts

This criterion is linked to a Learning OutcomeIn the Plan section, list the treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits. • A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors.
25 to >23.0 pts

Excellent

he response thoroughly and accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies need, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. A thorough and accurate discussion of health promotion and disease prevention related to the case is provided.

23 to >20.0 pts

Good

The response accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies need, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. An accurate discussion of health promotion and disease prevention related to the case is provided.

20 to >18.0 pts

Fair

The response somewhat vaguely or inaccurately outlines a treatment plan for the patient. The discussion on health promotion and disease prevention related to the case is somewhat vague or contains inaccuracies.

18 to >0 pts

Poor

The response does not address all diagnoses or is missing elements of the treatment plan. The discussion on health promotion and disease prevention related to the case is vague, inaccurate, or missing.
25 pts

This criterion is linked to a Learning OutcomeProvide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care.
10 to >9.0 pts

Excellent

The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents the latest in standards of care and provides strong justification for treatment decisions.

9 to >8.0 pts

Good

The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents current standards of care and supports treatment decisions.

8 to >7.0 pts

Fair

Three evidence-based resources are provided to support treatment decisions, but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan.

7 to >0 pts

Poor

Two or fewer resources are provided to support treatment decisions. The resources may not be current or evidence-based, or do not support the treatment plan.
10 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 to >4.0 pts

Excellent

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.0 pts

Good

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 to >2.0 pts

Fair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.

2 to >0 pts

Poor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation
5 to >4.0 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.0 pts

Good

Contains a few (one or two) grammar, spelling, and punctuation errors.

3 to >2.0 pts

Fair

Contains several (three or four) grammar, spelling, and punctuation errors.

2 to >0 pts

Poor

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.
5 to >4.0 pts

Excellent

Uses correct APA format with no errors.

4 to >3.0 pts

Good

Contains a few (one or two) APA format errors.

3 to >2.0 pts

Fair

Contains several (three or four) APA format errors.

2 to >0 pts

Poor

Contains many (≥ five) APA format errors.
5 pts

Total Points: 100

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