Assignment 2: NRNP 6566 Module 2 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
Assignment 2: NRNP 6566 Module 2 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
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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To prepare:
Review the interactive media under Required Media: Branching exercise. This is provided in the Learning Resources.
Review the information provided in the case (patient presentation, vital signs, pmh, home meds, results of labs and diagnostics. With this information, critically think about what is happening with the patient.
Use your critical thinking skills and current guidelines to develop orders. Include additional labs/diagnostics, what needs repeated and followed up on. Medications that need to be ordered or changed.
The Assignment:
Using the required admission orders template found under the Learning Resources: Required Reading.
Develop a set of orders as the admitting provider.
Be sure to address each aspect of the order template
Write the orders as you would in the patient’s chart. Be specific. Do not leave room for the nurse to interpret your orders.
Do not assume anything has already been done/order. Use the information given. Example: If the case does not mention fluids were given, the patient did not receive fluids. You may have to start from scratch as if you are working in the ER. And you must provide orders if the patient needs to be admitted.
Make sure the order is complete and applicable to the patient.
Make sure you provide rationales for your labs and diagnostics and anything else you feel the need to explain. This 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 (within the last 5 years), evidenced based references are required.
BY DAY 7 OF WEEK 4
Submit your completed Assignment by Day 7 of Week 4 in Module 2.
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Rubric
NRNP_6566_Module2_Assignment2_Rubric
NRNP_6566_Module2_Assignment2_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeUsing the Admission Orders Template, write a full set of admission orders for the patient in the branching exercise. Be sure to address the following:· Identify the Correct Diagnosis.
5 to >4.0 pts
Excellent Point range: 90–100
The order set includes an accurate and correct diagnosis.
4 to >3.0 pts
Good Point range: 80–89
The order set includes a diagnosis that is an appropriate differential diagnosis.
3 to >2.0 pts
Fair Point range: 70–79
The order set includes a diagnosis that is incorrect and not supported by patient data.
2 to >0 pts
Poor Point range: 0–69
The order set includes and inaccurate / dangerous diagnosis.
5 pts
This criterion is linked to a Learning Outcome· Identify the ‘Status/Condition’, ‘Code Status’, ‘Admit to Unit’for the patient in the presenting case.
5 to >4.0 pts
Excellent Point range: 90–100
The order set includes an accurate description / plan for condition, code status, and admission location.
4 to >3.0 pts
Good Point range: 80–89
The order set includes an accurate description for 2 of the 3 variables.
3 to >2.0 pts
Fair Point range: 70–79
The order set includes an accurate description for 1 of the 3 variables.
2 to >0 pts
Poor Point range: 0–69
The order set includes inaccurate, missing, or dangerous descriptions for these variables.
5 pts
This criterion is linked to a Learning Outcome· Describe the “Allergies’, ‘Activity Level’ and “Diet” for the patient in the presenting case.
5 to >4.0 pts
Excellent Point range: 90–100
The order set includes an accurate description / plan for allergies, activity level, and diet.
4 to >3.0 pts
Good Point range: 80–89
The order set includes an accurate description for 2 of the 3 variables.
3 to >2.0 pts
Fair Point range: 70–79
The order set includes an accurate description for 1 of the 3 variables.
2 to >0 pts
Poor Point range: 0–69
The order set includes inaccurate, missing, or dangerous descriptions for these variables.
5 pts
This criterion is linked to a Learning Outcome· Identify any ‘IV Fluids’ needed for the patient in the presenting case.
10 to >8.0 pts
Excellent Point range: 90–100
The order set clearly and accurately identifies a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.
8 to >6.0 pts
Good Point range: 80–89
The order set is missing 1 element of a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.
6 to >4.0 pts
Fair Point range: 70–79
The order set is missing 2 elements of a complete order for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.
4 to >0 pts
Poor Point range: 0–69
The order set is incomplete, includes wrong / dangerous fluids or flow rate, incorrect parameters for IV fluid type, flow rate, and administration parameters for the patient in the presenting case.
10 pts
This criterion is linked to a Learning Outcome· Identify any ‘Respiratory’ needs for the patient in the presenting case. Be specific about oxygen (if ordered, include type and rate), pulmonary toilet needs, and ventilator settings.
5 to >4.0 pts
Excellent Point range: 90–100
The order set clearly and accurately identifies a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.
4 to >3.0 pts
Good Point range: 80–89
The order set is missing 1 element of a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.
3 to >2.0 pts
Fair Point range: 70–79
The order set is missing 2 elements of a complete order for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.
2 to >0 pts
Poor Point range: 0–69
The order set is incomplete, includes wrong / dangerous orders, or incomplete parameters for respiratory care, delivery method, treatments and parameters for the patient in the presenting case.
5 pts
This criterion is linked to a Learning Outcome· Describe the ‘Medications’ including any IV drips for the patient in the presenting case. Be specific about medications related to the reason for admission and any chronic medications the patient may be taking (ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc.). Be sure to include name, dose, route of administration, and frequency of each medication.
15 to >12.0 pts
Excellent Point range: 90–100
The order set clearly and accurately identifies a complete set of medication orders for the patient in the presenting case. Orders are complete, account for all conditions, and are appropriate to treat the patient.
12 to >9.0 pts
Good Point range: 80–89
The order set clearly and accurately identifies a complete set of medication orders for the patient in the presenting case. There are incomplete orders, missing medications, or missing elements in the orders.
9 to >4.0 pts
Fair Point range: 70–79
The order set is missing essential elements of a medication order, missing medications, or are inappropriate to treat the patient in the presenting case.
4 to >0 pts
Poor Point range: 0–69
The order set is incomplete, includes wrong / dangerous orders, or inappropriate medications to treat the patient in the presenting case.
15 pts
This criterion is linked to a Learning Outcome· Explain any ‘Nursing Orders’ for the patient in the presenting case. Be specific about vital signs, skin care, toileting, and ambulation.
10 to >8.0 pts
Excellent Point range: 90–100
The order set includes a full set of nursing orders that provide essential direction to provide care, monitor, assess, ensure safety, prevent complications and promote healing.
8 to >6.0 pts
Good Point range: 80–89
The order set include inaccurate or is missing 1 or 2 nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.
6 to >4.0 pts
Fair Point range: 70–79
The order set include inaccurate or is missing 3 or 4 nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.
4 to >0 pts
Poor Point range: 0–69
The order set include inaccurate, missing, or provides dangerous nursing orders essential to direct nursing care, monitor, assess, ensure safety, prevent complications, and promote healing.
10 pts
This criterion is linked to a Learning Outcome· Explain the ‘Follow-Up Lab’ tests for the patient in the presenting case. Be specific about diagnostic testing (e.g., CXR, US, 2D Echo, etc.).
10 to >8.0 pts
Excellent Point range: 90–100
The order set includes complete laboratory and diagnostic testing to adequately monitor and assess the presenting patient.
8 to >6.0 pts
Good Point range: 80–89
The order set includes most (missing 1 or 2) laboratory and diagnostic testing to adequately monitor and assess the presenting patient.
6 to >4.0 pts
Fair Point range: 70–79
The order set includes some (missing 3 or 4) complete laboratory and diagnostic testing to adequately monitor and assess the presenting patient.
4 to >0 pts
Poor Point range: 0–69
The order set is missing essential laboratory and diagnostic testing to adequately monitor and assess the presenting patient.
10 pts
This criterion is linked to a Learning Outcome· Explain the ‘Consults’ for the patient in the presenting case. Be specific about how you, as an ACNP, would manage the patient’s acute needs for at least a 24-hour period. Include indication for consult (e.g., “Cardiology consult for evaluation of new-onset atrial fibrillation,” “Nutrition consult for TPN recommendations”).
5 to >4.0 pts
Excellent Point range: 90–100
The order set includes clear, accurate, and essential consults for the patient in the presenting case including complete rationale for the consult.
4 to >3.0 pts
Good Point range: 80–89
The order set is missing one of the following: necessary consult, inaccurate information, or inaccurate rationale for consults needed to manage the presenting patient.
3 to >2.0 pts
Fair Point range: 70–79
The order set is missing 2 or more of the following: necessary consult, inaccurate information, or inaccurate rationale for consults needed to manage the presenting patient.
2 to >0 pts
Poor Point range: 0–69
The order set is missing multiple consults, rations, or accurate descriptions for consults needed to manage the presenting patient.
5 pts
This criterion is linked to a Learning Outcome· Explain the ‘Patient Education and Health Promotion’ for the patient in the presenting case. Be sure to address age-appropriate patient education, if applicable.
10 to >8.0 pts
Excellent Point range: 90–100
The order set provides clear, accurate, and complete patient education and health promotion recommendations for the patient in the presenting case.
8 to >6.0 pts
Good Point range: 80–89
The order set is missing 1 or 2 essential elements of patient education and health promotion for the patient in the presenting case.
6 to >4.0 pts
Fair Point range: 70–79
The order set is missing 3 or 4 essential elements of patient education and health promotion for the patient in the presenting case.
4 to >0 pts
Poor Point range: 0–69
The order set is missing multiple essential elements of patient education and health promotion for the patient in the presenting case.
10 pts
This criterion is linked to a Learning Outcome· Explain the ‘Discharge Planning and Required Follow-Up Care’ for the patient in the presenting case.
5 to >4.0 pts
Excellent Point range: 90–100
The order set provides clear, accurate, and complete discharge planning and necessary follow up care for the patient in the presenting case.
4 to >3.0 pts
Good Point range: 80–89
The order set is missing 1 or 2 essential elements of discharge planning and necessary follow up care for the patient in the presenting case.
3 to >2.0 pts
Fair Point range: 70–79
The order set is missing 3 or 4 essential elements of discharge planning and necessary follow up care for the patient in the presenting case.
2 to >0 pts
Poor Point range: 0–69
The order set is missing multiple essential elements of discharge planning and necessary follow up care for the patient in the presenting case
5 pts
This criterion is linked to a Learning Outcome· Identify a minimum of three ‘References.’ Be sure that they are timely and support the admission order in following current standards of care.
10 to >8.0 pts
Excellent Point range: 90–100
The order set includes a minimum of three professional level references that are timely and clearly support the admission orders following current standards of care. References are formatted in APA format.
8 to >6.0 pts
Good Point range: 80–89
The order set does not include a minimum of three professional level references that are timely and clearly support the admission orders following current standards of care. APA format is incorrect.
6 to >4.0 pts
Fair Point range: 70–79
The order set does not include a minimum of three references or includes non-professional level resources to support their admission order set. APA format is incorrect.
4 to >0 pts
Poor Point range: 0–69
The order set is missing minimum number of references or includes poor sources that do not reflect professional writing or current standard of care information. APA format is not followed.
10 pts
This criterion is linked to a Learning OutcomeWritten orders include all elements, address all the needs of the patient, are complete, logical, and meets the complete needs of the patient.
5 to >4.0 pts
Excellent Point range: 90–100
Written order set is complete, addresses all the needs of the patient, and are based on current literature.
4 to >3.0 pts
Good Point range: 80–89
Written orders are mostly complete only missing 2 essential elements in addressing the needs of the patient.
3 to >2.0 pts
Fair Point range: 70–79
Written orders are missing 3 to 4 essential elements are reflect an incorrect standard of care.
2 to >0 pts
Poor Point range: 0–69
Written orders are incomplete, do not address the needs of the patient, or reflect an outdated standard of patient care.
5 pts
Total Points: 100
Required Readings:
Fuller, V. J., & McCauley, P. S. (2023). Textbook for the adult-gerontology acute care nurse practitioner: Evidence-based standards of practice. Springer Publishing Company.
Hypertension, pp. 99-101
Shock States, pp. 589-604
Sepsis, pp. 526-529
Intravenous Fluid Management, pp. 586
Types of fluids, p. 587
Harris, C. (2023). Adult-gerontology acute care practice guidelines (2nd ed.). Springer Publishing Company.
Hypertension, pp. 67-70
Hemodynamic Monitoring Devices, pp. 637-641
SIRS/Sepsis, pp. 298-304
VanValkinburgh, D., Kerndt, C. C., & Hashmi, M. F. (2021, August 14). Inotropes and vasopressorsLinks to an external site.. StatPearls [Internet]. Retrieved October 20, 2021. https://www.ncbi.nlm.nih.gov/books/NBK482411/.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., … Levy, M. (2021). Surviving sepsis campaignLinks to an external site.. Critical Care Medicine, Publish Ahead of Print. https://doi.org/10.1097/ccm.0000000000005337
Farkas, J. (2020, February 20). Vasopressors. EMCrit ProjectLinks to an external site.. Retrieved October 20, 2021, from https://emcrit.org/ibcc/pressors/.
Gourd, N. M., & Nikitas, N. (2019). Multiple organ dysfunction syndromeLinks to an external site.. Journal of Intensive Care Medicine, 35(12), 1564-1575. https://doi.org/10.1177/0885066619871452
Document: Admission Orders Template (Word document)
MedCram. (2018, August 19).Vasopressors explained clearly: Norepinephrine, Epinephrine, Vasopressin, DobutamineLinks to an external site.… [Video file]. Retrieved from https://www.youtube.com/watch?v=zf28Rjbu3VM
MedCram. (2017, November 19). Hypertension guidelines explained clearly – 2017 HTN guidelinesLinks to an external site. [Video file]. Retrieved fromhttps://www.youtube.com/watch?v=Cg3Z3dFf5c0
MedCram. (2017, November 9). Shock and sepsis explained clearly (remastered) symptoms, causes, and pathophysiologyLinks to an external site. [Video file]. Retrieved from https://www.youtube.com/watch?v=sTdrIlOGnfI
MedCram. (2014, December 23). Hypertension explained clearly, 2 of 2Links to an external site. [Video file]. Retrieved from https://www.youtube.com/watch?v=NgMfZVEWQd8
MedCram. (2012, September 12). Hypertension explained clearly – causes, diagnosis, medications, treatmentLinks to an external site. [Video file]. Retrieved from https://www.youtube.com/watch?v=OmKVteeuQj0
Walden University (Producer). (2019b). Branching exerciseLinks to an external site.: Cardiac case 2 [Interactive media file]. Minneapolis, MN: Author.
For week 4 your patient has a glucose of 1766. When you write the orders for sliding scale insulin, remember you are treating a 1766 glucose, not a 400 glucose. Write the appropriate order for a glucose of 1766