Completed in 2015 in Dalian, ChinaOlympia 66 is a statement of innovative design as a landmark in the city of Dalian, China. The design respects Chinese culture and urban context,...

xamples, and to help students begin to “think like a nurse”. This is facilitated through: (a) the development of critical thinking skills, (b) identification of important cues in a clinical situation, (d) identification of multiple and complex health issues or multiple health problems in the older adult, and (e) prioritizing goals. Directions: ● Provide your responses to each of the questions accompanying each clinical situation. ● Students may work individually, in pairs, or small groups of no more than 4 persons. Students who work in teams are strongly encouraged to review responses together, and decide, which response(s) will be the final ones. This activity is different than dividing up tasks, cutting and pasting responses into one document for homework submission. If there is a different perspective or opinion about which response(s) are final ones, during the team review justify the choice and present a rationale to the team. ● If you are working as a pair or on a team of 4, please indicate all of your names on the assignment, your class section, and delegate one team member to upload a single completed assignment for the group. Upload to “Turnitin” on Moodle, by Tuesday, March 15th, 4:00pm. ● Cite resources and references used in completing this assignment in APA format 7 th ed. (see syllabus), including those from library databases such as CINAHL or Up-to-Date 1. Cultural Cues a. Highlight the statements below that nurses recognize as exacerbating health disparities and inequities in this client: Ms. Yazzie is a 78-year-old long-term care resident. She worked most of her life as a bartender. Her mother belonged to the Mescalero Apache Tribe in New Mexico. Her father was Caucasian. Her mother gave her up at birth, hoping she would be adopted, but she spent her childhood in foster care. As a young adult Ms. Yazzie was raped and severely beaten, resulting in PTSD. She is aggressive with personal care and does not allow men to touch her; only female nurses, assistive personnel, and staff work with her. She has a history of hypothyroidism, hypertension, multi-infarct dementia, and osteoarthritis with chronic pain. She has a 66-pack year history of smoking, and typically drank liquor each night while bartending. She is 5′5″ tall and weighs 110 pounds (BMI 18.30 kg/m2). She is no longer ambulatory. However, she wheels herself around the facility and can often be heard crying and repeatedly asking, “do you love me?.” She engages in conversation, and stops crying, when prompted and talks about her childhood when asked. Ms. Yazzie never married and has no children. b. In addition to exacerbating health disparities and inequities in this client, what are other issues that are of concern based on the information provided? List these. I am concerned about her psychosocial and neurological status given her history with PTSD, rape, drinking, aggression towards men, and her behavior in the facility (i.e. the crying and repeated asking: “do you love me?”) c. Are there other questions you would ask of Ms. Yazzie as you begin your shift with her? What are they? How are you feeling today? What kinds of medications do you take? Could you tell me about your drinking and smoking habits? Could you please tell me about your PTSD? What tends to trigger your PTSD? d. How would you approach her aggressive behavior? I would ask her culturally appropriate questions that will elicit a response and understanding about her aggressive behavior. Questions would include: Why do you think you tend to lash out when we are providing personal care? Is there something that we do that is triggering to you, in terms of your PTSD? How can we best support you and always provide personal care? e. Are there other important assessments or diagnostic tests that should be done? Which ones would you recommend? I would recommend assessment by a social worker or psychiatrist following your own psychosocial assessment. I would also follow through with a neurological assessment given her history of dementia. In addition, I would perform a musculoskeletal assessment, determining her functional skills and ADLs given limited mobility due to osteoarthritis and being confined to a wheelchair. Further, a cardiovascular assessment would be relevant given her history with hypertension and hypothyroidism. f. Given the list you have identified as issues of concern, which are immediate priorities? Immediate priorities include: aggressive behavior and history of PTSD, and behavior in the facility. g. Given the list you have identified as issues of concern, which are longer term priorities? Longer term priorities involve understanding her behavior, and her history of drinking and smoking. h. Who are other interprofessionals with whom you would consult in providing effective care for Ms. Yazzie? Social worker, psychiatrist, physical therapist. i. There is only 1 female RN, in the long term care facility, the nurse manager, where Ms.Yazzie stays. The RN is in meetings with long term care accreditation representatives from the State of California, who have made an unannounced visit that morning. The day shift staff on Ms.Yazzie’s include a male LVN (a licensed vocational nurse) who is assisting residents with rehabilitation exercises. Another staff member is a female CNA (certified nursing assistant) who is overseeing and assisting cognitively impaired and dysphagic residents with breakfast in the common dining room. She cannot leave these residents unattended. A newly licensed graduate, a male RN is in day one of his orientation to the facility with the director of staff development. How would you handle this situation given Ms. Yazzie’s information? Who would you assign to take care of Ms. Yazzie? Why? Given the responsibilities of both the CNA and LVN, it would be most appropriate to assign Ms. Yazzie to the female CNA since she has experience with cognitively impaired residents like Ms. Yazzie with multi infarct dementia and a history of aggressive behavior when it comes to personal care which can be attributed to agitation associated with dementias. 2. Patient-centered Care Highlight the statements below that correspond to a patient-centered culture: Mrs. Adams is an 87-year-old widowed female. She is being admitted to a rural long-term care (LTC) facility following hospitalization for uncontrolled hypertension. Prior to hospitalization, she had been living alone and it was determined she had not been taking her medications for hypertension, osteoporosis, depression, and coronary artery disease. The nurse completing her admission interview concludes by asking Mrs. Adams what time she usually eats, stating the facility serves food cafeteria style between 0600 and 0800 hours for breakfast, 1100 and 1300 for lunch, and 1700 and 1900 hours for dinner. Residents are assisted to bed by 2200 hours. Her bath days would be Tuesday, Thursday, and Saturday mornings. The nurse gives Mrs. Adams an activity schedule with the daily offerings and states that if she did not like any of them, they would try to find something else she enjoyed. 3. Assessment of Late Life Changes Which cues correspond to the “C” in the FANCAPES assessment pneumonic? The home health nurse is completing the intake assessment for Mr. Agens, an 85-year-old male. When responding to question, he replies in clear, complete sentences without dyspnea. He lives on his own in a small one story, two-bedroom home. He has been a widower for 10 years. His two adult children live in a neighboring state. They call him once a month and visit twice a year. He has a 60-pack year history of smoking; he has been using portable oxygen for the past 10 years. He states he has shortness of breath with exertion at times. He receives Meals-on-Wheels each weekday. His neighbor’s wife buys his groceries when she goes shopping once a week. He can cook simple meals without difficulty. Mr. Agens ambulates using a walker; he has used it for the past 3 years. He no longer drives. He attends the local senior center Bingo night each month and attends the local church on Sundays. He wears bilateral hearing aids and has no difficulty hearing the questions he is asked. Mr. Agens also wears bifocal glasses. He states he dropped out of school in the 8th grade to go to work. His vital signs include a blood pressure of 132/82 mm Hg, pulse of 80 beats per minute, respiratory rate of 14 breathes per minute, a temperature of 97.6°F, and pulse oximetry reading of 92% on O2 at 2 L per nasal cannula. 4. Safe Medication Use The nurse is performing the first home visit for Mr. Ortiz, an 86-year-old Hispanic male, following his discharge from the hospital for community-acquired pneumonia. Assessment findings include blood pressure of 110/60 mm Hg, heart rate of 75 beats per minute, respirations 14 breaths per minute, temperature 97.3°F, and oxygen 94% on room air. His heart has regular rate and rhythm; lungs with rhonchi left lower lobe; abdomen with normoactive bowel sounds, soft and nontender; no peripheral edema; skin warm and pale. He reports feeling fatigued but unable to sleep. He has pain in his back and ribs with coughing; he denies shortness of breath. Mr. Ortiz states his appetite has not yet returned, but he is trying to eat. States his last bowel movement was yesterday; it was soft. The hospital discharge summary notes these findings : ● HgbA1c of 7.2% (normal 5.7%), Higher A1c increases risk for DM II ● Creatinine 1.8 mg/dL (adults normal: male-0.6-1.2 mg/dl; female 0.5-1.1 mg/dl), High ● BUN 32 mg/dL(normal 8-21 mg/dl), High ● Sodium 134 mEq/L (normal 136-144 mEq/L), WNL ● Potassium 4.2 mEq/L (normal 3.5-5.0 mEq/L) WNL ● Glucose of 150 mg/dL (normal 110 mg/dl), High ● Hemoglobin/Hematocrit of 10.2 mg/dL and 30.0%. (hemoglobin adults normal: male-12.6-17.4 g/dl; female 11.7-16.1 g/dl)/ (hematocrit adults normal: male-36-52%; female 34-46%) Low When asked to show his medications, Mr. Ortiz brings out the following bottles: UTILIZE BEERS LIST ● Levofloxacin 750 mg daily; should be at 500 mg daily ● Lisinopril/hydrochlorothiazide 20/25 mg daily ● High Potency Multivitamin 400 mcg daily ● Calcium carbonate 500 mg daily ● Vitamin D3 400 units daily ● Aspirin 81 mg daily ● Metformin 850 mg twice daily indicated for PCOS, diabetes & prevention, antipsychotic-induced weight gain ● Glipizide 5 mg twice a day indicated for type 2 diabetes ● Gemfibrozil 600 mg daily ● Glucosamine and chondroitin 2 tabs daily ● Melatonin 300 mcg daily ● CoQ10 200 mg daily ● Odorless Garlic 1000 mg daily indicated for hypertension, atherosclerosis; OTC, not enough scientific evidence to support drug interactions ● Probiotics 2 caps daily ● Pantoprazole 20 mg daily indicated for GERD, erosive esophagitis, PUD, Zollinger Ellison disease, acid reflux ● Paroxetine 10 mg every evening antidepressant; indicated for diabetic nephropathy ● Percogesic Extra Strength 2 tabs every 6 hours as needed contains codeine, analgesic ● Tylenol 8-hour arthritis pain 2 tabs every 8 hours as needed a. Which medication should the nurse clarify with the provider? Select all that apply. 1. Levofloxacin 750 mg daily 2. Metformin 850 mg twice daily 3. Glipizide 5 mg twice a day 4. Odorless Garlic 1000 mg daily 5. Pantoprazole 20 mg daily 6. Paroxetine 10 mg every evening b. Are any of Mr. Ortiz’ medications on Beer’s list? (Consult the 2019 expert panel publication from the American Geriatrics Society posted on Moodle). If “yes” which ones? Are there alternative recommendations from the expert panel? If “yes” what is recommended? Yes, avoid paroxetine. c. Are there any discharge lab values that concern you? Which ones? Why? HgbA1c, creatinine, glucose are high; Hematocrit, Hemoglobin are low. High creatinine and glucose could indicate kidney failure. Low hematocrit and hemoglobin could mean you are losing red blood cells typically, through bleeding. d. Which physical assessment findings are of concern to you? Why? Physical assessment findings of concern include: rhonchi in left lung, pale skin, fatigue, pain in lower back, no appetite. These findings could indicate poor recovery from CAP. e. What are potential factors contributing to Mr. Ortiz’ fatigue? No physical activity, little appetite. f. What are potential factors contributing to Mr. Ortiz’ poor sleep? Fatigue, pain in lower back. g. What are potential factors contributing to Mr. Ortiz’ poor appetite? Pain in ribs when coughing. No appetite. 5. Clinical Judgment and Nutritional Health The nurse is completing the monthly nursing assessment of Mr. Dawson. Mr. Dawson is a 92-year old male. He has been at the long-term care facility for the past 5 years. His weight this month is 300 pounds (BMI 26.6 kg/m2). His blood pressure is 145/82 mmHg, heart rate 90 beats per minute, respirations 18 breaths per minute and temperature 97.4 degrees F (orally). He responds to questions appropriately. During the physical examination at 0900 hours, the nurse notes Mr. Dawson is drooling and coughing intermittently. His upper dentures fall when he opens his mouth for evaluation. His lungs are clear on examination and his heart has regular rhythm. Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. The nurse recognizes that (1) Copious secretions, (2) Difficulty chewing, and (3) Coughing after eating, put Mr. Dawson at increased risk of (4) Dysphagia, and he should be (5) NPO, until the (6) Swallowing evaluation is completed. Options: Overnutrition Swallowing evaluation Depression Coughing after eating NPO