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NURS 6512 Week 7 Assessment of the Heart, Lungs, and Peripheral Vascular System

NURS 6512 Week 7 Assessment of the Heart, Lungs, and Peripheral Vascular System

Cardiovascular disease (CVD) is the largest cause of death worldwide. Accounting for 610,000 deaths annually (CDC, 2017), CVD frequently goes unnoticed until it is too late. Early detection and prevention measures can save the lives of many patients who have CVD. Conducting an assessment of the heart, lungs, and peripheral vascular system is one of the first steps that can be taken to detect CVD and many more conditions that may occur in the thorax or chest area.

This week, you will evaluate abnormal findings in the area of the chest and lungs. In addition, you will appraise health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system.

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NURS 6512 Week 7 Assessment of the Heart, Lungs, and Peripheral Vascular System Learning Objectives

Students will:

• Evaluate abnormal cardiac and respiratory findings
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system

Learning Resources for NURS 6512 Week 7 Assessment of the Heart, Lungs, and Peripheral Vascular System

Required Readings (click to expand/reduce)

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 14, “Chest and Lungs”This chapter explains the physical exam process for the chest and lungs. The authors also include descriptions of common abnormalities in the chest and lungs
• Chapter 15, “Heart”The authors of this chapter explain the structure and function of the heart. The text also describes the steps used to conduct an exam of the heart.
• Chapter 16, “Blood Vessels”This chapter describes how to properly conduct a physical examination of the blood vessels. The chapter also supplies descriptions of common heart disorders.

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

• Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487) (previously read in Week 6; specifically focus on pp. 480–481)

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 8, “Chest Pain”
This chapter focuses on diagnosing the cause of chest pain and highlights the importance of first determining whether the patient is in a life-threatening condition. It includes questions that can help pinpoint the type and severity of pain and then describes how to perform a physical examination. Finally, the authors outline potential laboratory and diagnostic studies.

Chapter 11, “Cough”
A cough is a very common symptom in patients and usually indicates a minor health problem. This chapter focuses on how to determine the cause of the cough by asking questions and performing a physical exam.

Chapter 14, “Dyspnea”
The focus of this chapter is dyspnea, or shortness of breath. The chapter includes strategies for determining the cause of the problem through evaluation of the patient’s history, through physical examination, and through additional laboratory and diagnostic tests.

Chapter 26, “Palpitations”
This chapter describes the different causes of heart palpitations and details how the specific cause in a patient can be determined.

Chapter 33, “Syncope”
This chapter focuses on syncope, or loss of consciousness. The authors describe the difficulty of ascertaining the cause, because the patient is usually seen after the loss of consciousness has happened. The chapter includes information on potential causes and the symptoms of each.

Note: Download the Student Checklists and Key Points to use during your practice cardiac and respiratory examination.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Chest and lungs: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Chest and lungs: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Heart: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Heart: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Katz, J. N., Lyons, N., Wolff, L. S., Silverman, J., Emrani, P., Holt, H. L., … Losina, E. (2011). Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: A qualitative study. BMC Musculoskeletal Disorders, 12(1), 78–85.

This study examines the medical decision making among Hispanics and non-Hispanic whites. The authors also analyze the preferred information sources used for making decisions in these populations.

Smuck, M., Kao, M., Brar, N., Martinez-Ith, A., Choi, J., & Tomkins-Lane, C. C. (2014). Does physical activity influence the relationship between low back pain and obesity? The Spine Journal, 14(2), 209–216. 

Shiri, R., Solovieva , S., Husgafvel-Pursiainen, K., Telama, R., Yang, X., Viikari, J., Raitakari, O. T., & Viikari-Juntura, E. (2013). The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study. Seminars in Arthritis & Rheumatism, 42(6), 640–650. 

McCabe, C., & Wiggins, J. (2010a). Differential diagnosis of respiratory disease part 1. Practice Nurse, 40(1), 35–41.

This article describes the warning signs of impending deterioration of the respiratory system. The authors also explain the features of common respiratory conditions.

McCabe, C., & Wiggins, J. (2010b). Differential diagnosis of respiratory diseases part 2. Practice Nurse, 40(2), 33–41.

The authors of this article specify how to identify the major causes of acute breathlessness. Additionally, they explain how to interpret a variety of findings from respiratory investigations.

Shadow Health Support and Orientation Resources

Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY

Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us

Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)

Document: Student Acknowledgement Form (Word document)

Note: You will sign and date this form each time you complete your DCE Assignment in Shadow Health to acknowledge your commitment to Walden University’s Code of Conduct.

Document: DCE (Shadow Health) Documentation Template for Focused Exam: Chest Pain (Word document)

Use this template to complete your Assignment 1 for this week.

Optional Resource

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

• Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 1, “Chest Wall, Pulmonary, and Cardiovascular Systems,” pp. 302–433)Note:Section 2 of this chapter will be addressed in Week 10.This section of Chapter 8 describes the anatomy of the chest wall, pulmonary, and cardiovascular systems. Section 1 also explains how to properly conduct examinations of these areas.

Required Media (click to expand/reduce)

Advanced Health Assessment and Diagnostic Reasoning

Thoughtful, reasoned questioning leads from initial complaint to diagnosis in these three scenarios.
Note: Close the viewing window after the intro segment and after each diagnosis segment to view the menu. (12m)

Photo Credit:Provided courtesy of the Laureate International Network of Universities.

SkillStat Learning, Inc. (2019). The 6 second ECG. Retrieved from http://www.skillstat.com/tools/ecg-simulator#/-home

This interactive website allows you to explore common cardiac rhythms. It also offers the Six Second ECG game so you can practice identifying rhythms.

Online media for Seidel’s Guide to Physical Examination

In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 13 and 14 that relate to the assessment of the chest, heart, and lungs. Refer to Week 4 for access instructions on https://evolve.elsevier.com/

Assignment 1: Digital Clinical Experience: Assessing the Heart, Lungs, and Peripheral Vascular System

Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale NURS 6512 Week 7 Assessment of the Heart, Lungs, and Peripheral Vascular System. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack?

In order to adequately assess the chest region of a patient, nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities.

In this DCE Assignment, you will conduct a focused exam related to chest pain using the simulation too, Shadow Health. Consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted.

To Prepare for NURS 6512 Week 7 Assessment of the Heart, Lungs, and Peripheral Vascular System

• Review this week’s Learning Resources and the Advanced Health Assessment and Diagnostic Reasoning media program and consider the insights they provide related to heart, lungs, and peripheral vascular system.
• Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation with the Shadow Health platform. Review the examples also provided.
• Review the DCE (Shadow Health) Documentation Template for Focused Exam: Chest Pain found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
• Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
• Review the Week 7 DCE Focused Exam: Chest Pain Rubric provided in the Assignment submission area for details on completing the Assignment in Shadow Health.
• Consider what history would be necessary to collect from the patient.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

DCE Focused Exam: Chest Pain Assignment: NURS6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System

Complete the following in Shadow Health:

• Cardiovascular Concept Lab (Recommended but not required)
• Abdominal Concept Lab (Recommended but not required)
• Episodic/Focused Note for Focused Exam: Chest Pain

Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 7 Day 7 deadline.

NURS 6512 Week 7 Assessment of the Heart, Lungs, and Peripheral Vascular System Submission and Grading Information

By Day 7 of Week 7

• Complete your Focused Exam: Chest Pain DCE Assignment in Shadow Health via the Shadow Health link in Blackboard.
• Once you complete your Assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding Assignment in Blackboard for your faculty review.
• (Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: https://link.shadowhealth.com/download-lab-pass
• Once you submit your Documentation Notes to Shadow Health, make sure to copy and paste the same Documentation Notes into your Assignment submission link below.
• Download, sign, date, and submit your Student Acknowledgement Form found in the Learning Resources for this week.

Brian Foster Focused Exam: Chest Pains Care Plan : 11 of 12 (91.7%)

 Nursing Diagnosis

3 out of 4

International classification for nursing practice (ICNP) nursing diagnoses (v2019_06_27) [Data set]. (2019). International Council of Nurses (ICN). https://www.icn.ch/what-we-do/projects/ehealth-icnptm/icnp-download

Diagnosis

Student Response

Model Answer

Explanation

Points Earned

lack of knowledge of post-cardiac procedure care

lack of knowledge of post-cardiac procedure care

Mr. Foster has reported his previous acute pain was at 0/10; his current healthcare needs are for education on relevant topics.

1 out of 1

Signs & Symptoms

Student Response

Model Answer

Explanation

Points Earned

not currently on cardiac diet

not currently on cardiac diet

Brian’s stent was just placed, indicating a need for recovery instructions. In addition, his lifestyle is sedentary and his diet isn’t cardiac-friendly, so he has room to learn about the link between heart health and diet & exercise. NURS6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System

1 out of 1

new placement of cardiac stent

new placement of cardiac stent

Brian’s stent was just placed, indicating a need for recovery instructions. In addition, his lifestyle is sedentary and his diet isn’t cardiac-friendly, so he has room to learn about the link between heart health and diet & exercise.

1 out of 1

previous pain character (tight and uncomfortable)

sedentary lifestyle prior to hospitalization

Brian’s stent was just placed, indicating a need for recovery instructions. In addition, his lifestyle is sedentary and his diet isn’t cardiac-friendly, so he has room to learn about the link between heart health and diet & exercise.

0 out of 1

Self Assessment

Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor.

Prompt

Student Response

Model Answer

Explanation

How can a patient’s knowledge of their health risks affect their health?

A patient’s understanding of their health risks makes them aware of the warning signs to look for, and enables them to practice appropriate health habits. The knowledge also helps them to know when to seek medical help. NURS6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System

A patient’s understanding of their health risks can lead them to be wary of warning signs, practice appropriate health habits, and know when to reach out to medical professionals for help.

Your role as a healthcare provider is not limited to physical and medical interventions; knowing why and how to educate your patients is a crucial part of impacting their health.

 Planning

5.5 out of 5.5

Short-Term Goal

Student Response

Model Answer

Explanation

Points Earned

Patient will verbalize understanding of post-stent care and appropriate diet and exercise for heart healthy lifestyle prior to discharge.

Patient will verbalize understanding of post-stent care and appropriate diet and exercise for heart healthy lifestyle prior to discharge.

Having a patient verbalize their instructions lets you check for things they might have missed. In addition, if a patient doesn’t consent to their instructions, further persuasion should be made.

0.5 out of 0.5

Interventions

Student Response

Model Answer

Explanation

Points Earned

Instruct patient that if chest pain develops, he should alert staff immediately

Instruct patient that if chest pain develops, he should alert staff immediately

These interventions teach Brian appropriate stent site monitoring and heart-healthy diet & exercise tips. Timing is appropriate in interventions; chest pain, especially after a procedure that should mitigate it, should be reported to a provider immediately. Similarly, while Brian can begin his diet anytime, beginning a new exercise regimen right after his surgery increases his risk of injury.

1 out of 1

Instruct patient to begin exercise regimen after a week: low-impact walking, 15-20 minutes, 3 times a week, and increase intensity and frequency as tolerated

Instruct patient to begin exercise regimen after a week: low-impact walking, 15-20 minutes, 3 times a week, and increase intensity and frequency as tolerated

These interventions teach Brian appropriate stent site monitoring and heart-healthy diet & exercise tips. Timing is appropriate in interventions; chest pain, especially after a procedure that should mitigate it, should be reported to a provider immediately. Similarly, while Brian can begin his diet anytime, beginning a new exercise regimen right after his surgery increases his risk of injury.

1 out of 1

Instruct patient to begin cardiac diet immediately, including reduction of salt and red meat intake

Instruct patient to begin cardiac diet immediately, including reduction of salt and red meat intake

These interventions teach Brian appropriate stent site monitoring and heart-healthy diet & exercise tips. Timing is appropriate in interventions; chest pain, especially after a procedure that should mitigate it, should be reported to a provider immediately. Similarly, while Brian can begin his diet anytime, beginning a new exercise regimen right after his surgery increases his risk of injury.

1 out of 1

Instruct patient to monitor puncture site for signs of complication: bleeding, redness, swelling, warmth, and/or drainage

Instruct patient to monitor puncture site for signs of complication: bleeding, redness, swelling, warmth, and/or drainage

These interventions teach Brian appropriate stent site monitoring and heart-healthy diet & exercise tips. Timing is appropriate in interventions; chest pain, especially after a procedure that should mitigate it, should be reported to a provider immediately. Similarly, while Brian can begin his diet anytime, beginning a new exercise regimen right after his surgery increases his risk of injury.

1 out of 1

Intervention Rationale

Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor.

Prompt

Student Response

Model Answer

Explanation

In 1 or 2 sentences, explain how your selected interventions work to accomplish your goal.

These interventions will help Brian stay keen of any problem with the stent site healing, so that he knows when to contact his care provider. He also receives teaching on diet and exercise routines for his cardiovascular health, ensuring that he only makes these changes at the appropriate time during his post-surgery recovery.

These interventions help Brian stay alert for problems in his puncture site healing, so that he knows when to contact his provider. Brian also receives teaching on concrete ways to diet and exercise for his cardiovascular health, while ensuring he makes his changes at an appropriate time during his surgery recovery.

It is important to give a patient the tools they need to stay healthy in the short-term (monitoring their surgical site) and in the long-term (building habits that stave off cardiovascular disease).

Data Collections

Student Response

Model Answer

Explanation

Points Earned

Ask patient to agree to and verbalize his instructions for diet and exercise

Ask patient to agree to and verbalize his instructions for diet and exercise

After all patient instructions have been made, make sure your patient agrees to them and is able to verbalize them back, letting you spot any details they’ve missed.

0.5 out of 0.5

Ask patient to agree to and verbalize his stent-related care instructions

Ask patient to agree to and verbalize his stent-related care instructions

After all patient instructions have been made, make sure your patient agrees to them and is able to verbalize them back, letting you spot any details they’ve missed.

0.5 out of 0.5

 Discussion Of Care

Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor.

Prompt

Student Response

Model Answer

Explanation

A patient should understand their nursing diagnosis and the rationale behind it to increase their sense of involvement and to identify areas for future improvement.

Mr Brian, you now have a newly placed stent which will require some at-home recovery care from you, which you are yet to be briefed on. In addition, you have not been taught on heart-healthy practices you should adhere to in order to prevent future cardiac diseases.

Brian, your recently placed cardiac stent will require some at-home recovery care from you, which you haven’t yet been filled in on. In addition, you haven’t been taught about some heart-healthy practices that will prevent future cardiac diseases.

Explain the rationale behind your nursing diagnosis.

You should communicate the care plan to the patient, allowing them to have involvement and agency in their own healthcare.

Brian, my goal for you is, that by the end of your stay, you will agree to and be able to verbalize back the instructions I will provide on post-stent care and long-term heart health. I am going to educate you on these subjects, with some help from your provider, who will then review your medication regimen with you.

Brian, my goal for you is, by the end of your stay, to have you agree to and verbalize back the instructions you’ll receive on post-stent care and long-term heart health. I’m going to educate you on these subjects. At the end of your hospitalization, I’ll have you repeat back your instructions to make sure you’ve got them down.

Explain your goal for Mr. Foster and the interventions and data collections through which you will achieve it.

Educating Mr. Foster on how to monitor his puncture site will help ensure that any potential complications, such as infection, are caught quickly, and can then be addressed before they worsen.

Monitor the stent site for signs of infection, that is, redness, swelling, warmth, or drainage. Timing is everything. Should you experience any chest pain, immediately report it to your primary provider. Begin your heart-healthy diet immediately, and make sure to limit your salt and caffeine intake. Do not start exercise right away, as this may increase your risk of further injury. Wait until one week, before starting with simple exercises such as walking around the compound.

I’d like you to keep an eye on your puncture site to make sure it’s healing properly. Watch out for bleeding or any signs of infection, such as redness, swelling, warmth, or drainage.

Educate Mr. Foster on how to care for and monitor his puncture site.

It’s important to educate Mr. Foster on what to do if he develops further chest pain so that he doesn’t wait or hesitate in a potentially life-threatening situation.

If you develop any chest pain, please report it immediately to your primary care provider.

If you feel any more chest pain, I’d like you to immediately alert staff so we can help. Don’t hesitate to let someone know.

Educate Mr. Foster about what to do if chest pain develops.

Educating Mr. Foster on his new cardiac diet helps increase his likelihood of understanding and complying with the diet. In addition, having a conversation about changes in lifestyle gives you an opportunity to address any questions or concerns he may have.

Your cardiac diet, which you must start following today, comprises vegetables, whole grains, and oily fish. Eliminate or limit all processed foods that are high in sugar and salt from your diet.

I’d strongly advise you to begin a cardiac diet as soon as possible. In general, you’ll want to reduce your intake of red meat and salt as much as you can.

Educate Mr. Foster on how to follow a cardiac diet, as well as how soon he should begin.

Educating Mr. Foster on his new exercise regimen helps increase his likelihood of understanding and complying with the recommended exercise. In addition, having a conversation about changes in lifestyle gives you an opportunity to address any questions or concerns he may have.

After one week, begin routine exercise of walking around the house and the compound. Once you are comfortable with this, incorporate mild aerobic exercises to get your heart pumping well. Later, try out strength training, not more than 2 days per week. Include stretching and flexibility. Practice only low or moderate intensity exercise.

After a week, I recommend that you begin a regular exercise regimen. Try taking low-impact walks three times a week for about fifteen to twenty minutes each. If you feel like you’re tolerating that well, you can increase the intensity and frequency of your walks.

Educate Mr. Foster on how to follow a heart-healthy exercise program.

Asking the patient to verbalize what they’ve learned is an important part of education. If they forget or misunderstand anything, this is a good opportunity to correct them.

Kindly state back the instructions for diet and exercise?

Mr. Foster, would you please repeat what we’ve discussed about your new diet and exercise recommendations? That way, we can make sure you’re not missing anything.

Ask Mr. Foster to state back his instructions for diet and exercise.

Asking the patient to verbalize what they’ve learned is an important part of education. If they forget or misunderstand anything, this is a good opportunity to correct them.

State back the instructions for caring for your puncture site.

Mr. Foster, would you please repeat what we’ve discussed about your puncture site care instructions? That way, we can make sure you’re not missing anything.

Ask Mr. Foster to state back his puncture site-related care instructions.

 Intervention & Evaluation

2.5 out of 2.5

Student Response

Model Answer

Explanation

Points Earned

Fully

Fully

Mr. Foster’s repetition of his instructions shows a full and detailed knowledge of them; furthermore, he consents to making these new choices. Your goal has been fully achieved.

2.5 out of 2.5

 Intervention & Evaluation Rationale

Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor.

Prompt

Student Response

Model Answer

Explanation

Your goal was that the patient, by the end o

NURS6521 Week 3 Quiz Latest 2017 Homework

NURS6521 Week 3 Quiz Latest 2017 Homework

Question 1

A 45-year-old man who is a construction worker has been diagnosed with hyperlipidemia and has been prescribed lovastatin. The nurse will advise the patient to

Question 2

A 55-year-old man’s hypertension has not responded adequately to his current medication regimen consisting of an ACE inhibitor, a beta-blocker, and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which of the following nursing actions?

Question 3

A nurse has been following a male patient who is taking hydralazine, clonidine, and a diuretic for hypertension. After 2 weeks of medication therapy, the patient begins to complain of numbness and tingling in his hands and feet. The nurse suspects that these signs or symptoms are

Question 4

A nurse is caring for a male patient who has a diagnosis of coronary artery disease (CAD). His drug therapy includes lovastatin. Because the patient has a history of severe renal disease, the nurse will assess for which of the following?

Question 5

A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by

Question 6

An expected outcome for a patient who has just taken sublingual nitroglycerin should be

Question 7

A clinic nurse has been assigned a 49-year-old female patient who has a history of diabetes. A recent diagnosis of hypertension has been made, and the patient has been prescribed a thiazide diuretic and labetalol. The patient will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the nurse will be to

ORDER THROUGH BOUTESSAY

Question 8

A 39-year-old African-American male is 25 pounds overweight and has been diagnosed with hypertension after three consecutive above-normal blood pressure readings. The most likely initial drug therapy for this patient will be

Question 9

A nurse is caring for a patient with chronic angina. The patient is receiving ranolazine (Ranexa) 500 mg PO bid. Which of the following signs or symptoms would the nurse attribute to being a common adverse effect of this medication?

Question 10

Several months of treatment with a statin accompanied by lifestyle modifications have failed to appreciably improve a patient’s cholesterol levels. Consequently, the patient has been prescribed cholestyramine. The nurse should recognize that this drugs achieves its therapeutic effect by

Question 11

A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessments?

Question 12

A nurse is caring for a patient who is admitted into the cardiac care unit with acute, decompensated heart failure. Nesiritide (Natrecor) has been ordered. When preparing for administration of the drug, the nurse will

Question 13

A normal maintenance dose for digoxin is 0.125 to 0.5 mg/day. In which of the following patients would the nurse most likely administer a lower-than-normal maintenance dose of digoxin?

Question 14

A nurse who provides care in a busy clinic is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemic’s in many patients. Treatment of high cholesterol using statins would be contraindicated in which of the following patients?

Question 15

A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient s heart rate, the nurse should prioritize the assessment of the patient’s

Question 16

A 58-year-old man is admitted to the emergency department. A diagnosis of severe digoxin toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The nurse will administer which of the following drugs?

Question 17

A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of

Question 18

A nurse is the cardiac care unit is preparing to hang an intravenous dose of dofetilide (Tikosyn) for a patient who has just been admitted. What is the most likely goal of this intervention?

Question 19

A patient has been prescribed lovastatin for a high cholesterol level. The nurse’s teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels because it

Question 20

A nurse is caring for a patient who is taking digoxin and a loop diuretic. Which of the following would be most important for the nurse to monitor?

Question 21

A nurse explains to a patient that nitroglycerin patches should be applied in the morning and removed in the evening. This medication schedule reduces the potential for

Question 22

A 77-year-old patient has a long-standing history of hypertension, a health problem that is being treated with metoprolol and a thiazide diuretic. Before administering the 8 AM dose of these medications, what assessments should the nurse perform and document? (Select all that apply.)

Question 23

Which of the following patients is most likely to benefit from the administration of an adrenergic agonist?

NURS6521N Advanced Pharmacology Week 5 Discussion Major Depressive Disorder

The patient is a 75-year-old patient who lost her husband 10 months ago and presents with complaints of insomnia. The questions I might ask the patient are:

• Can you tell me how I may be of assistance today? This is an open-ended question that can serve to create rapport and encourage the patient to give me a lot of information about herself with the knowledge that the doctor is ready to listen and help her.
• Do you live with someone at home? By asking this question, I will understand the type of support system the patient has at home and know which support to prescribe for the patient.
• Are you following your regimen correctly? This will help me know if the patient is compliant to her medication and whether the support at home is helping the patient follow her regimen correctly.
• How would you describe a well-rested sleep? This open-ended question would give me information regarding the patient’s expectations of enough sleep and this would be useful in designing an effective goal for her personal treatment plan.

The people in the patient’s life that I would need to speak to are her children, her close friends and neighbors. I could also speak to her aide if she has one.  these people will help me know the severity of the patient’s problem. Some of the questions I will ask them are;

• Based on your personal experience with her, can you describe her as a mother or friend or neighbor? This question will help me understand how the patient usually is so as to easily identify any anomalies from the subsequent history taken.
• Has the patient been behaving more differently recently or experiencing worse symptoms of depression since her husband’s death? This question will help me understand the changes that the people close to her have noticed and whether they have noticed if she is depressed or not.
• Does the patient complain about her medication or treatment regimen? This question will allow me to assess whether the patient is compliant or know the side effects the patient experiences, if any.
• Has the sleeping patterns changes recently? This question will help me understand the severity of insomnia.

The physical exams appropriate for this patient include heart rhythm, respiratory rate, pulse rate, and oxyhemoglobin saturation. This is done because anxiety disorders can affect the findings of these parameters.

 Tests such as Complete Blood count and Blood chemistry. Thyroid function tests assess possible contributing factors to her depression. Thyroid dysfunction can play a role in the pathogenesis of depression. Kidney function tests which test the ability of the kidney to eliminate waste from the body. These tests will include the urea, electrolytes and creatinine, and the GFR tests. Liver function tests which assess the liver enzymes. LFTs and KFTs test how well the body can metabolize and eliminate medications to be prescribed.

The diagnostic tests for this patient include polysomnography and actigraphy tests that are used to measure the patient’s sleep patterns. The actigraphy alone measures sleep efficiency, sleep latency, and total sleep time. The polysomnography will diagnose sleep disorders (Niel et al., 2020). Depression screening tests can also be done using different questionnaires to assess the level of her depression.

The patient’s differential diagnoses include:

• Generalized Anxiety Disorder (GAD),
• Major Depressive Disorder (MDD),
• Restless Leg Syndrome.

Major depressive disorder (MDD) is the most likely disease that could explain why the patient is experiencing insomnia. MDD usually presents clinically as insomnia, difficulty concentrating, loss of appetite, and hopelessness. The patient lost her husband of 41 years and it is possible that this contributed to her depression, which has also affected her sleeping pattern. Bennabi et al. (2019) states that patients with MDD are at risk of experiencing sleeping disorders.  Since the patient is responding to grief, her chances of developing MDD are high.

The pharmacologic agents that would be appropriate for the patient’s therapy are: 

• Selective serotonin uptake inhibitor (SSRIs). An example is Prozac. The required dose is 10 mg given PO qDay. The mechanism of action of SSRIs is by inhibiting the serotonin transporter (SERT) at the presynaptic axon terminal to prevent serotonin re-uptake. Inhibition of SERT results in an increased amount of serotonin in the synaptic cleft which then increase the serotonin levels, activity and effect in the brain.
• Tricyclic antidepressants (TCAs) are used to treat MDD. An example is Amitriptyline. The required dosage is 10-25 mg given PO qHS. The mechanism of action of TCAs is blocking the reuptake of both serotonin and norepinephrine neurotransmitters consequently increasing the levels of norepinephrine and serotonin levels in the brain.

In terms of treating MDD, both TCAs and SSRIs show equivocal efficacy. However, SSRIs are the preferred drug for treatment of MDD because of fewer and milder side effects associated with this type of antidepressant drug. TCAs cause more adverse effects because of their anticholinergic effect. Also, when considering the patient’s age, SSRIs are the preferred drug (Bauer et al., 2017). TCAs on an elderly client might result in adverse cardiovascular effects such as dysrhythmias or orthostatic hypotension that may lead to dizziness, falls, and fractures.

Various research has shown that other races such as Asians and African Americans resort to using other alternative medication to treat their depression and these medications require lesser drug dosages to achieve the desired effect. SSRI use for the white race is always on standard prescription values with regards to its dosage and schedule. Administering these drugs to elderly patients however warrant that a modification is done. This is done through dose adjustment to minimize the side effects and polypharmacy considerations for drug-drug interactions (Salehi, 2019). The drug contraindicates in the patients taking selective serotonin reuptake inhibitors are mirtazapine, and other vasoconstrictors and analgesics.

After administering these drugs, the patient will be assessed after a four-week interval to determine if the symptoms have improved. If the symptoms have not improved after four weeks, Prozac will be increased by 10-20 mg for four weeks until a maximum of 80 mg, which is the maximum recommended dose per day. If the symptoms improve within the first four weeks, the regimen will be maintained until the patient completes the dose. After completing the dose, the patient will sleep well and the symptoms of depression will be well managed. Once the desired outcome has been achieved the patient Prozac daily should be discontinued and started on Prozac weekly after one week. The patient should be closely monitored for any changes in behavior and suicidal tendencies within the first 4- 8 weeks. Prozac may also interfere with glycemic control as it may cause hypoglycemia especially in diabetic patients (DiVall & Woolley, 2019)

I have learnt that depression is a major illness that affects many patients and details in the history of a patient should be carefully examined to make the appropriate diagnosis and commence the proper treatment modalities.

References

Bennabi, D., Charpeaud, T., Yrondi, A., Genty, J. B., Destouches, S., Lancrenon, S., & Haffen, E. (2019). Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental. BMC Psychiatry, 19(), 262. https://doi.org/10.1186/s12888-019-2237-x

Bauer, M., Severus, E., Möller, H. J., Young, A. H., & WFSBP Task Force on Unipolar Depressive Disorders. (2017). Pharmacological treatment of unipolar depressive disorders: summary of WFSBP guidelines. International Journal Of Psychiatry In Clinical Practice, 21(3), 166-176. https://doi.org/10.1080/13651501.2017.1306082

DiVall, M. V., & Woolley, A. B. (2019). CHAPTER Pharmacologic Agents. Acute Care Handbook for Physical Therapists E-Book, 431.

Niel, K., LaRosa, K. N., Klages, K. L., Merchant, T. E., Wise, M. S., Witcraft, S. M., Hancock, D., Caples, M., Mandrell, B. N., & Crabtree, V. M. (2020). Actigraphy versus polysomnography to measure sleep in youth treated for craniopharyngioma. Behavioral sleep medicine, 18(5), 589-597. https://doi.org/10.1080/15402002.2019.1635133 Salehi, M., Hadizadeh, H., Chang, A., & Grados, M. A. (2019). Recommendations for prescribing SSRIs. Contemporary Pediatrics, 36(11), 24-27

Nurse coroners, also known as forensic nurses or death investigators, are not just ordinary nurses. They are highly skilled professionals who are crucial in investigating suspicious, unexpected, or unnatural deaths. Combining their nursing expertise with specialized knowledge in forensic science, they assist in determining the cause and manner of death, a task that requires a unique blend of medical and investigative skills.

What is a Nurse Coroner?

A nurse coroner is not a lone investigator. They are registered nurses with additional training in forensic science and death investigation. Working closely with medical examiners, law enforcement, and other professionals, they investigate deaths that fall under the coroner’s office’s jurisdiction. Nurse coroners are responsible for collecting and documenting evidence, interviewing witnesses, and assisting in autopsies, a role that requires strong teamwork and collaboration.

Coroner vs. Medical Examiner — What’s the Difference?

Coroners are elected or appointed officials responsible for investigating deaths within their jurisdiction. They may or may not have medical training, and in some cases, they rely on the expertise of nurse coroners or forensic pathologists to assist in their investigations.

Medical examiners are licensed physicians who have completed specialized training in forensic pathology. They are appointed to their positions and are responsible for conducting autopsies and determining the cause and manner of death in cases under their jurisdiction.

Where Do Nurse Coroners Work?

Nurse coroners typically work in coroner’s offices, medical examiner’s offices, or forensic laboratories. They may also be employed by hospitals, law enforcement agencies, or government organizations. Some nurse coroners may work as independent consultants, providing their expertise to various agencies on a case-by-case basis.

How Do You Become a Nurse Coroner?

If you’ve determined that forensic nursing is the right career path for you and are ready to embark on the journey to become a nurse coroner, follow the steps outlined below.

Step One: Get Your Nursing Degree

Begin by researching available nursing schools and consider the type of degree you wish to pursue. You have two options: an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN). An ADN program typically takes two years to complete and provides a foundation for further education, such as a bachelor’s degree. On the other hand, a BSN program requires four years of study.

Step Two: Get Your Registered Nurse License

Upon graduating from nursing school, your next step is to focus on the National Council Licensure Examination-Registered Nurse (NCLEX-RN). This standardized exam grants you a registered nursing license upon successful completion. Passing the NCLEX-RN is crucial for becoming a forensic nurse and should be manageable for committed students.

The exam allows a maximum of 5 hours and includes a few optional breaks. You will encounter up to 145 questions covering various topics, such as:

• Safe and Effective Care Management
• Physiological Integrity
• Psychosocial Integrity
• Health Promotion and Maintenance

The cost of the exam is $200.

Step Three: Acquire Some Experience

Most employers seeking forensic nurses prefer candidates with pertinent experience. Your ability to apply your knowledge in practical situations shows that you are prepared for the role. Aim to acquire as much relevant experience as possible in your chosen field to increase your chances of securing high-paying forensic nursing positions.

Step Four: Consider Applying for an Advanced Degree

You are a qualified and licensed registered nurse at this stage, ready to explore forensic nursing job opportunities. While there are several notable certifications available, the most significant ones pertain to sexual assault nurse examiners rather than nurse coroners. Any relevant forensic nursing certifications you can obtain will enhance your knowledge and strengthen your resume. 

However, the most impactful step is to pursue a master’s or doctoral degree. Advanced degrees in forensic nursing are available and can elevate your career to new heights. These programs open doors to research, teaching, and psychiatric nursing positions. Although these advanced degrees can improve your job prospects and potentially increase your salary, they do not guarantee employment. Moreover, you can still apply for nurse coroner positions without an advanced nursing degree.

How Many Years Does It Take to Become a Nurse Coroner?

The time it takes to become a nurse coroner can vary depending on your educational path and experience. Typically, it takes two to four years to earn a nursing degree, depending on whether you pursue an ADN or a BSN. After obtaining your registered nurse license, you must gain at least two years of experience working as a nurse. If you choose to pursue an advanced degree, this can add an additional two to six years to your timeline.

What Type of Nurse Works in the Morgue?

Nurse coroners, also known as forensic nurses or death investigators, are the primary nurses working in morgues or medical examiner’s offices. These nurses have specialized training in forensic science and assist in investigating deaths, including collecting evidence, documenting findings, and assisting in autopsies.

Other nurses may also work in morgues or related settings. For example, some hospitals may employ nurses in their pathology departments to assist with autopsies or post-mortem care. These nurses may have experience in surgical or critical care nursing and receive additional on-the-job training in forensic procedures.

Should I Become a Forensic Nurse?

Becoming a forensic nurse, or nurse coroner, can be a highly rewarding career choice for individuals passionate about nursing and forensic science. Forensic nurses play a vital role in the investigation of deaths and help to provide closure and justice for families who have lost loved ones.

However, it is important to consider this field’s unique challenges and demands before pursuing a career as a forensic nurse. Forensic nurses are exposed to death and trauma regularly and may work long or irregular hours, including nights and weekends. They must have strong emotional resilience and maintain objectivity and professionalism in difficult circumstances.

If you are considering a career as a forensic nurse, it may be helpful to speak with current professionals in the field to gain a better understanding of the day-to-day responsibilities and challenges of the job. You may also consider volunteering or interning in a coroner’s or medical examiner’s office to gain hands-on experience and determine if this career path suits you.

How Much Do Nurse Coroners Make?

The salary of a nurse coroner, also known as a forensic nurse, can vary based on factors such as education, experience, and geographic location. According to recent data, the average annual salary for a forensic nurse in the United States is approximately $70,000.

However, the pay scale for forensic nurses in America is quite broad, ranging from around $21,000 for entry-level positions to over $98,000 for experienced professionals. Most forensic nurses earn between $69,000 and $75,000 per year.

Glassdoor, a popular job and salary website, reported in December 2021 that the median annual salary for a forensic nurse was $78,640. When factoring in additional compensation, such as overtime and bonuses, the total annual pay for forensic nurses can reach an average of $103,927.

Forensic nurses in the 25th to 75th percentile of the profession can anticipate an annual salary range of $56,000 to $108,000, demonstrating the significant potential for income growth within this nursing specialty.

Ready to Become a Nurse Coroner?

If you are considering a career as a nurse coroner, it is important to consider this field’s unique demands and challenges carefully. However, if you have a strong interest in both nursing and forensics and are prepared to invest the time and effort required to pursue this career path, becoming a nurse coroner can be a highly fulfilling and impactful way to make a difference in your community.