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Assignment

Assignment

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Assignment: HW Set #2 – E3.10, E3.19, E16.16, E16.20

1.

Exercise 3.10

Cost Behavior

 

SmokeCity, Inc., manufactures barbeque smokers. Based on past experience, SmokeCity has found that its total annual overhead costs can be represented by the following formula: Overhead cost = $543,000 + $1.34X, where X equals number of smokers. Last year, SmokeCity produced 20,000 smokers. Actual overhead costs for the year were as expected.

 

Required:

1. What is the driver for the overhead activity?

_________________

 

For questions 2-4, Enter the final answers rounded to the nearest dollar.

 

2. What is the total overhead cost incurred by SmokeCity last year?

$ _________________

 

3. What is the total fixed overhead cost incurred by SmokeCity last year?

$ _________________

 

4. What is the total variable overhead cost incurred by SmokeCity last year?

$ _________________

 

For questions 5-8, round your answers to the nearest cent. Use those rounded figures in subsequent computations, if necessary.

5. What is the overhead cost per unit produced?

$ _________________ per unit

6. What is the fixed overhead cost per unit?

$ _________________ per unit

7. What is the variable overhead cost per unit?

$ _________________ per unit

8. Recalculate Requirements 5, 6, and 7 for the following levels of production: (a) 19,500 units and (b) 21,600 units.

19,500 Units 21,600 Units

Unit cost

$

_________________

$

_________________

 

Unit Fixed cost

_________________

_________________

Unit variable cost

_________________

_________________

The reason the unit costs changed in the way they did is because:

_________________

2.

Exercise 3.19

 

High-Low Method, Cost Formulas

 

The controller of the South Charleston plant of Ravinia, Inc., monitored activities associated with materials handling costs. The high and low levels of resource usage occurred in September and March for three different resources associated with materials handling. The number of moves is the driver.

The total costs of the three resources and the activity output, as measured by moves for the two different levels, are presented as follows:

 

 

Forklift depreciation:
  Number of Moves Total Cost
Low 6,500 $1,800
High 20,000 $1,800
Indirect labor
  Number of Moves Total Cost
Low 6,500 $74,250
High 20,000 $1,35,000
Fuel and oil for forklift:
  Number of Moves Total Cost
Low 6,500 $4,940
High 20,000 $15,200

 

 

 

Required:

If required, round your answers to two decimal places. Enter a “0” if required.

1. Determine the cost behaviour formula of each resource. Use the high-low method to assess the fixed and variable components.

Forklift depreciation:

$ _________________

$ _________________

$ _________________

Indirect labor:

$ _________________

$ _________________

$ _________________ + $ _________________ X

Fuel and oil for forklift:

$ _________________

$ _________________

$ _________________ X

2. Using your knowledge of cost behavior, predict the cost of each item for an activity output level of 9,000 moves. For interim computations, carry amounts out to two decimal places. Round your final answer to the nearest dollar.

Forklift depreciation $ _________________

Indirect labor $ _________________

Fuel and oil for forklift

$ _________________

3. Construct a cost formula that can be used to predict the total cost of the three resources combined. If required, round your answers to two decimal places.

Materials handling cost = $ _________________ + $ _________________ X

Using this formula, predict the total materials handling cost if activity output is 9,000 moves.

= $ _________________

 

3.

Exercise 16.16

CVP: Before- and After-Tax Targeted Income

 

Head-Gear Company produces helmets for bicycle racing. Currently, Head-Gear charges a price of $230 per helmet. Variable costs are $80.50 per helmet, and fixed costs are $1,255,800. The tax rate is 25 percent. Last year, 14,000 helmets were sold.

Required:

1. What is Head-Gear’s net income for last year?

$ _________________

2. What is Head-Gear’s break-even revenue? In your computations, round the contribution margin ratio to two decimal places.

$ _________________

 

3. Suppose Head-Gear wants to earn before-tax operating income of $900,000. How many units must be sold? Round to the nearest whole unit.

_________________ units

4. Suppose Head-Gear wants to earn after-tax net income of $650,000. How many units must be sold? Round to the nearest whole unit.

_________________ units

5. Suppose the income tax rate rises to 35 percent. How many units must be sold for Head-Gear to earn after-tax income of $650,000? Round to the nearest whole unit.

_________________ units

 

4.

Exercise 16.20

Contribution Margin, CVP, Net Income, Margin of Safety

Nail Glow, Inc., produces novelty nail polishes. Each bottle sells for $5.90. Variable unit costs are as follows:

Fixed overhead costs are $34,475 per year. Fixed selling and administrative costs are $6,720 per year. Nail Glow sold 35,000 bottles last year.

Required:

1. What is the contribution margin per unit for a bottle of nail polish?

$ _________________ per unit

What is the contribution margin ratio? Round your answer to four decimal places.

_________________

2. How many bottles must be sold to break even?

_________________ bottles

What is the break-even sales revenue? Round your answer to the nearest dollar, if rounding is required.

$ _________________

3. What was Nail Glow’s operating income last year?

$ _________________

4. What was the margin of safety in revenue?

$ _________________

5. Suppose that Nail Glow, Inc., raises the price to $6.50 per bottle, but anticipated sales will drop to 28,750 bottles. What will the new break-even point in units be? Round your answer up to the nearest whole number of units.

_________________

Should Nail Glow raise the price?

 

_________________

Assignment essay paper

Assignment

Create a 2-4 page resource that will describe databases that are relevant to EBP around a diagnosis you chose and could be used to help a new hire nurse better engage in EBP.Assignment

Introduction

Evidence-based practice (EBP) integrates the best evidence available to guide optimal nursing care, with a goal to enhance safety and quality. EBP is crucial to nursing practice because it incorporates the best evidence from current literature, along with the expertise of the practicing nurse. The concern for quality care that flows from EBP generates a desired outcome. Without these factors, a nurse cannot be an effective leader. It is important to lead not only from this position but from knowledge and expertise. To gain the knowledge, you require a good understanding of how to search for scholarly resources, as well as identify which databases and websites are credible for the purposes of implementing evidence-based changes in practice.Assignment

Your Online e-Portfolio

Creating an ePortfolio is not required in the BSN program, but you may find it helpful to create one to attach to your professional resume while job hunting. Online ePortfolios serve two key purposes: 1) to support learning and reflection, and 2) to be used as a showcase tool. Your learning journey can be documented, and ePortfolios contribute to lifelong learning and growth through reflection and sharing. Online ePortfolios can also be shared with employers and peers to present artifacts that demonstrate your accomplishments at Capella.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for providing patient-centered, competent care based on current evidence-based best practices. You will be required to do research, analysis, and dissemination of best evidence to stay abreast of these best practices. Understanding where to go to find credible sources and locate evidence, as well as which search terms to use, is the foundation of incorporation of best practices.

Scenario

You are supervising three nurses working on the medical-surgical floor of a local teaching hospital. This hospital is nationally recognized as a leader in education and has a computer lab with an online library where staff has access to medical research databases (that is, CINAHL, PubMed, Medline, and Cochrane library) and online sources of all hospital policies, procedures, and guidelines, and computers at nurse workstations that also have access to these resources. (For this scenario, use the Capella University Library to simulate the hospital’s online library.) You have given the nurses their patient assignments and you have all participated in shift report. A new nurse who just completed orientation and training a week ago approaches you and tells you that one of the assigned patients has a diagnosis he or she is very unfamiliar with. Knowing that patient-centered care based on best practices is imperative to positive patient outcomes, you want to assist this nurse to find research that can be utilized to provide the best care for this patient. Describe how you would communicate with this nurse to encourage him or her to research the diagnosis. Assume you will assist in the quest to locate evidence, then describe where you would go within the facility and what resources you would look for. These resources may include websites, journals, facility policies or guidelines, or any other sources of online information.Assignment

You may choose the diagnosis for the patient in this scenario or health care issue/diagnosis of your choice. Or you may choose something you would find interesting to research or that applies to a clinical problem/diagnosis you would be interested in addressing. Create a list of at least five sources that could be used to find evidence, with the best source listed first, and explain why the sources you chose are best to find evidence for the diagnosis you chose and the clinical scenario. You are only evaluating the sources of evidence (database, website, policy database or website, journal article, et cetera). You are not actually completing a search and selecting evidence. Consider the following examples: a nursing journal in CINAHL may not be the best source of evidence for information on how to administer medications through a central-venous catheter, whereas a hospital policy database found on a website may not be the best source of information on caring for a patient with a rare chromosomal abnormality.

Preparation

To help ensure you are prepared to complete this assessment, review the following resources related to the Capella library. These resources will provide you an overview of the types of tools, resources, and guides available in the library. This may be useful in forming a better understanding of the library to apply to the hypothetical situation laid out in the scenario of this assessment.Assignment

Remember, it is also appropriate to look toward databases and resources outside of the Capella library, such as organizational policies, professional organizations, and government health care resources.

You are encouraged to complete the Evaluating the Credibility of Evidence activity. This activity offers an opportunity to practice evaluating the credibility of evidence. These skills will be necessary to complete Assessment 1 successfully and is for your own practice and self-assessment. Completing this activity is also a way to demonstrate course engagement.

Instructions

The purpose of this assessment is to understand where to find evidence that can be applied to clinical scenarios and to learn effective communication and collaboration with clinical staff during the process of evidence location. As a baccalaureate-prepared nurse, you will not only use research for self-improvement in your clinical role, but you will also serve as a mentor to supervised nursing staff. Therefore, you will need to be able to communicate and collaborate effectively to guide them toward resources to find research, as well as support them through the initial evidence location process. In doing so, nurses can gain access to evidence that can be analyzed and utilized to stay current on best practices. This allows them to provide safe, patient-centered care and improve patient outcomes.

For this assessment:

Describe your role as a baccalaureate-prepared nurse supervising clinical staff nurses with regard to communication and collaboration in locating evidence for application to a nursing practice scenario.
Compile a list of five online databases or other online sources (that is, websites, journals, facility policies or guidelines, et cetera) that can be used to research evidence to apply to this scenario or clinical practice issue/diagnosis and describe to which of these you would direct a nurse colleague to search for evidence.
Describe where you might go in the work place to complete this research and how you would access the desired, relevant research within research databases or other online sources.

Be sure to address the following in this assessment, which correspond to the grading criteria in the scoring guide. Please study the scoring guide carefully so that you will know what is needed for a distinguished score.

o Describe communication strategies to encourage nurses to research the diagnosis/practice issue, as well as strategies to collaborate with the nurses to access resources.
o Describe the best places to complete research and what types of resources you would want to access to find pertinent information for the diagnosis/health care issue within the context of a specific health care setting.
o Identify five sources of online information (medical journal databases, websites, hospital policy databases, et cetera) that could be used to locate evidence for a clinical diagnosis/practice issue.
o Explain why the sources of online information selected should provide the best evidence for the chosen diagnosis/health care issue.
o Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.

Note: While you are not selecting and evaluating specific evidence to help with the clinical diagnosis/practice issue, you should still be citing the literature and best practices to support your description of your communication and collaboration approach. Additionally, it is appropriate to cite best practices related to EBP and evaluating databases to support your explanation as to why you selected the five sources of online information that you did.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Additional Requirements

Your assessment should meet the following requirements:

Length of submission: 2-4 pages (not including the title page or the reference page) description of communication, collaboration, and evidence location process, including a list of databases or other sources with description of why they are appropriate for clinical scenario diagnosis/health care issue (that is, something that would be useable in professional practice for other nurses). Be sure to include an APA-formatted reference page at the end of your submission.
Number of references: Cite a minimum of three sources of scholarly or professional evidence that supports your findings and considerations. Resources should be no more than five years old.
APA formatting: References and citations are formatted according to current APA style.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.
o Explain why the sources selected should provide the best evidence for the chosen diagnosis/health care issue.
Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision within the context of a specific health care setting.
o Describe the best places to complete research within the workplace environment and what types of resources one would want to access to find pertinent information for the diagnosis/health care issue.
Competency 4: Plan care based on the best available evidence.
o Identify five sources of online information (medical journal databases, websites, hospital policy databases, et cetera) that could be used to locate evidence for a diagnosis/health care issue and three out of five should be specific to the diagnosis/health care issue.
Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
o Describe communication strategies to encourage nurses to research a diagnosis/health care issue, as well as strategies to collaborate with the nurses to access resources.
o Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
o Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.

 

Assignment essay paper

Assignment

Week 9: Dissociative Disorders

Have you ever been driving and realized you don’t remember the Assignment last few minutes of driving? Or have you gotten so wrapped up in a book or movie that you lose some awareness of your surroundings? These are examples of common and very mild dissociation, or a disconnect or lack of continuity between thoughts, feelings, actions, and sense of self.

There are three major dissociative disorders defined in the DSM-5-TR: dissociative identity disorder, dissociative amnesia, and depersonalization-derealization disorder. Dissociative disorders Assignment may be associated with traumatic events in order to help manage difficult memories or experiences. Patients with these types of disorders are likely to also exhibit symptoms of a variety of other dysfunctions, such as depression, alcoholism, or self-harm and may also be more susceptible to personality, sleeping, and eating disorders.

This week, you will analyze issues related to the diagnosis and treatment of dissociative disorders as well as associated legal and ethical considerations.

Assignment: Controversy Associated With Dissociative Disorders

The DSM-5-TR is a diagnostic tool. It has evolved over the decades, as have the classifications and criteria within its pages. It is used not just for diagnosis, however, but also for billing, access to services, and legal cases. Not all practitioners are in agreement with the content and structure of the DSM-5-TR, and dissociative disorders are one such area. These disorders can be difficult to distinguish and diagnose. There is also controversy in the field over the legitimacy of certain dissociative Assignment disorders, such as dissociative identity disorder, which was formerly called multiple personality disorder.

In this Assignment, you will examine the controversy surrounding dissociative disorders. You will also explore clinical, ethical, and legal considerations pertinent to working with patients with these disorders.

Photo Credit: Getty Images/Wavebreak Media

To Prepare

Review this week’s Learning Resources on dissociative disorders.
Use the Walden Library to investigate the controversy regarding dissociative disorders. Locate at least three scholarly articles that you can use to support your Assignment. 

The Assignment (2–3 pages)

Explain the controversy that surrounds dissociative disorders.
Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.
Explain strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.
Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important.

RUBRIC

In 2–3 pages, address the following:
• Explain the controversy that surrounds dissociative disorders.

The response includes an accurate and concise explanation of the controversy within the field related to dissociative disorders.

• Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.

The response includes a thorough and well-organized explanation of the student’s professional beliefs about dissociative disorders. Rationale demonstrates critical thinking and is strongly supported with three scholarly references.

Explain strategies for maintaining the therapeutic relationship with a Assignment client that may present with a dissociative disorder.

The response includes an accurate and concise explanation of strategies for maintaining the therapeutic relationship with a client that may present with adissociative disorder.

 Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important.

The response includes an accurate and concise explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important.

Written 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.

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.

Assignment essay paper

Assignment

Week 9:Focused SOAP Note and Patient Case Presentation

IntroductionAssignment

At your practicum site, you have been strengthening your communication, assessment, diagnostic reasoning, and treatment skills. This week, you highlight these skills as you complete a focused SOAP note and present a patient case in a video, just as you did in Week 3 and Week 7. You also continue to track your clinical hours and patients in Meditrek.Assignment

Students will:

Describe clinical hours and patient encounters
Assess patients across the lifespan in mental health settings
Formulate differential diagnoses for patients across the lifespan in mental health settings
Develop plans of care for patients across the lifespan in mental health settings
Advocate health promotion and patient education strategies across the lifespan
Develop a case study presentation based on a clinical patient

Assignment 2: Focused SOAP Note and Patient Case Presentation

For this Assignment, you will document information about a patient that you examined during the last 3 weeks, using the Focused SOAP Note Template provided. You will then use this note to develop and record a case presentation for this patient. Be sure to incorporate any feedback you received on your Week 3 and Week 7 case presentations into this final presentation for the course. Assignment

To Prepare

Review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.
Select a child or adolescent patient that you examined during the last 3 weeks who presented with a disorder for which you have not already created a Focused SOAP Note in Weeks 3 or 7. (For instance, if you selected a patient with anorexia nervosa in Week 7, you must choose a patient with another type of disorder for this week.)
Create a Focused SOAP Note on this patient using the template provided in the Learning Resources. There is also a completed Focused SOAP Note Exemplar provided to serve as a guide to assignment expectations.
Please Note:
o All SOAP notes must be signed, and each page must be initialed by your Preceptor. Note: Electronic signatures are not accepted.
o When you submit your note, you should include the complete focused SOAP note as a Word document and PDF/images of each page that is initialed and signed by your Preceptor.
o You must submit your SOAP note using SafeAssign. Note: If both files are not received by the due date, faculty will deduct points per the Walden Grading Policy.
Then, based on your SOAP note of this patient, develop a video case study presentation. Take time to practice your presentation before you record.
Include at least five scholarly resources to support your assessment, diagnosis, and treatment planning.
Ensure that you have the appropriate lighting and equipment to record the presentation.

The AssignmentAssignment

Record yourself presenting the complex case for your clinical patient.

Do not sit and read your written evaluation! The video portion of the assignment is a simulation to demonstrate your ability to succinctly and effectively present a complex case to a colleague for a case consultation. The written portion of this assignment is a simulation for you to demonstrate to the faculty your ability to document the complex case as you would in an electronic medical record. The written portion of the assignment will be used as a guide for faculty to review your video to determine if you are omitting pertinent information or including non-essential information during your case staffing consultation video. 

In your presentation:

Dress professionally and present yourself in a professional manner.
Display your photo ID at the start of the video when you introduce yourself.
Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.
Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
Be succinct in your presentation, and do not exceed 8 minutes. Assignment Specifically address the following for the patient, using your SOAP note as a guide:
o Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
o Objective: What observations did you make during the psychiatric assessment? 
o Assessment: Discuss their mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and supported by the patient’s symptoms.
o Plan: In your video, describe your treatment plan using clinical practice guidelines supported by evidence-based practice. Include a discussion on your chosen FDA-approved psychopharmacologic agents and include alternative treatments available and supported by valid research. All treatment choices must have a discussion of your rationale for the choice supported by valid research. What were your follow-up plan and parameters? What referrals would you make or recommend as a result of this treatment session? 
o In your written plan include all the above as well as include one social determinant of health according to the HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking.
o Reflection notes: What would you do differently with this patient if you could conduct the session over? If you are able to follow up with your patient, explain whether these interventions were successful and why Assignment or why not. If you were not able to conduct a follow up, discuss what your next intervention would be.

Discuss Subjective data:
• Chief complaint
• History of present illness (HPI)
• Medications
• Psychotherapy or previous
psychiatric diagnosis
• Pertinent histories and/or ROS

The video accurately and concisely presents the patient’s subjective complaint, history of present illness, medications, psychotherapy or previous psychiatric diagnosis, and pertinent histories and/or review of systems that would inform a differential diagnosis

Discuss Objective data:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses

The video accurately and concisely documents the patient’s physical exam for pertinent systems. Pertinent diagnostic tests and their results are documented, as applicable.

Discuss results of Assessment:
• Results of the mental status examination
• Provide a minimum of three possible diagnoses in order of highest to lowest priority and explain why you chose them. What was your primary diagnosis and why?Assignment  Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and is supported by the patient’s symptoms.

The video accurately documents the results of the mental status exam.
Video presents at least three differentials in order of priority for a differential diagnosis of the patient, and a rationale for their selection. Response justifies the primary diagnosis and how it aligns with DSM-5 criteria.

Discuss treatment Plan:
• A treatment plan for the patient that addresses chosen FDA-approved psychopharmacologic agents and includes alternative treatments available and supported by valid research. The treatment plan includes rationales, a plan for follow-up parameters, and referrals. The discussion includes one social determinant of health according to the HealthyPeople 2030, one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health.

The video clearly and concisely outlines an evidence-based treatment plan for the patient that addresses FDA-approved psychopharmacologic agents and includes alternative treatments and rationale supported by valid research.

Discussion includes a clear and concise follow-up plan and parameters.

The discussion includes a clear and concise referral plan.

The paper discussion contains all 3 elements from the assignment directions including a discussion demonstrating critical thinking of the case related to the Healthy People 2030 social health determinates. Clearly and concisely relates discussion to the psychiatric and mental health field.

Reflect on this case. Discuss what you learned and what you might do differently.

Reflections are thorough, thoughtful, and demonstrate critical thinking.

The response clearly, accurately, and thoroughly follows the Focused SOAP Note format to document the selected patient case.

Assignment essay paper

Assignment

Assignment

Week (enter week #): (Enter assignment title)

Student Name

College of Nursing-PMHNP, Walden University

NRNP 6665: PMHNP Care Across the Lifespan I

Faculty NameAssignment

Assignment Due Date

Subjective:

CC (chief complaint):

HPI:

Substance Current Use:

Medical History:

Assignment

Current Medications:
Allergies:
Reproductive Hx:

ROS:

GENERAL:
HEENT:
SKIN:
CARDIOVASCULAR:
RESPIRATORY:
GASTROINTESTINAL:
GENITOURINARY:
NEUROLOGICAL:
MUSCULOSKELETAL:
HEMATOLOGIC:
LYMPHATICS:
ENDOCRINOLOGIC:

Objective:

Diagnostic results:

Assessment:

Mental Status Examination:

Diagnostic Impression:

Reflections:

Case Formulation and Treatment Plan: 

Assignment

References

Assignment

© 2021 Walden University      Page 1 of 3

Assignment essay paper

Assignment

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Rubric Criteria
Clinical Manifestations of Patient
12 points
Criteria Description
Description of subjective and objective clinical manifestations Assignment
5. Target
12 points
Subjective and objective clinical manifestations are thorough.

Cardiovascular Conditions Leading to Heart Failure and Interventions
18 points
Criteria Description
Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure. Explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the presented conditions.
5. Target
18 points Assignment
Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure, and an explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the conditions are thorough.

Evaluation of Nursing Interventions at Admissions
12 points
Criteria Description
Description of the benefit of the intervention at the time of admission using the nursing process. Explanation of any changes to the interventions to ensure patient independence and prevent readmission.
5. Target
12 points
Description of the benefit of the intervention at the time of admission using the nursing process and an explanation of any changes to the interventions to ensure patient independence and prevent readmission are thorough.

Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions
18 points Assignment
Criteria Description
Explanation of seven medications listed in the scenario, including the classification, action, and rationale for each. Discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions.
5. Target
18 points
Explanation of seven medications listed in the scenario, including the classification, action, and rationale for each, and discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions are thorough.

Health Promotion and Restoration Teaching Plan
18 points
Criteria Description
Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications. Explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission.
5. Target
18 points
Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications, and explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission are thorough.

COPD Triggers and Options for Smoking Cessation
18 points
Criteria Description Assignment
Discussion of options for smoking offered considering patient’s current and long-term tobacco use. Outline of COPD triggers that can increase exacerbation frequency, resulting in readmission.
5. Target
18 points
Discussion of options for smoking cessation offered considering patient’s current and long-term tobacco use, and outline of COPD triggers that can increase exacerbation frequency, resulting in readmission are thorough.

Thesis, Position, or Purpose
6 points
Criteria Description
Communicates reason for writing and demonstrates awareness of audience.
5. Target
6 points
The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.

Development, Structure, and Conclusion
6 points
Criteria Description
Advances position or purpose throughout writing; conclusion aligns to and evolves from development.
5. Target
6 points
The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.

Evidence
6 points
Criteria Description
Selects and integrates evidence to support and advance position/purpose; considers other perspectives.
5. Target
6 points
Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered.

Mechanics of Writing
3.6 points
Criteria Description
Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.
5. Target
3.6 points
No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.

Format/Documentation
2.4 points
Criteria Description
Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.
5. Target
2.4 points
No errors in formatting or documentation are present.

 

Assignment essay paper

Assignment

ORDER A PLAGIARISM FREE PAPER NOW

Cardiorespiratory ComplexitiesBy Andrea R. Johnson
Essential Questions
• What are the normal functions of the cardiac and respiratory systems?
• What significant findings should the nurse look for when a patient has coronary artery disease, a myocardial infarction, a cardiac arrhythmia, chronic obstructive pulmonary disease, asthma, or pneumonia?
• What factors should be considered when assisting patients’ transition to independence?
• How do nurses educate patients on the prevention of a cardiopulmonary condition?
• How do nurses help prevent patient readmission?Assignment
Introduction
Within the human chest cavity lie the heart and lungs; the complex systems that contain them are the cardiovascular and respiratory (pulmonary) systems. The cardiovascular system is comprised of the heart and the blood vessels, while the pulmonary system contains the lungs and thoracic cavity. Both systems can be affected by patient lifestyle, which can include exercise, diet, and avoidable risks, and by the comorbid conditions that cause or exacerbate cardiac, vascular, and pulmonary conditions. In this chapter, pathophysiology will be reviewed, nursing management of prevalent cardiovascular and respiratory problems will be discussed, and educational resources will be provided so nurses can help patients return to their optimal level of functioning.
Pathophysiology
Normal Function: Cardiovascular System
The heart is a hollow, four-chambered organ, which is normally about the size of a fist. It is located within the thoracic cavity, between the right and left lung. The cardiac septum separates the heart vertically, creating a right and left atrium and a right and left ventricle. There are four valves of the heart that keep the blood moving in a single direction. The sounds of the opening and closing of the valves create the “lub-dup” sound of the heart (Figure 1.1).Assignment
Cardiovascular Anatomy
Arteries take the oxygenated blood from the heart to the organs, branching into arterioles and capillaries. This is called perfusion. Arterial flow, which is felt through various pulse points, is strong, as the heart is an efficient pump.
Once the oxygen (O2) has left the blood through the capillaries, it becomes deoxygenated. Deoxygenated blood is then returned to the heart through the veins. The venous blood flow is much slower because venous blood pressure is much lower; therefore, a series of one-way valves prohibit blood from traveling backward and pooling.
Figure 1.1
Cardiac Circulation

Normal Function: Respiratory System
The respiratory system functions as a means of gas exchange between the air outside the body and the blood. The respiratory system is comprised of the upper respiratory tract (nares, paranasal sinuses, pharynx, and larynx) and lower respiratory tract (trachea, bronchi, bronchioles, and alveoli of the lungs) (see Figure 1.2). The gases that are exchanged are O2 and carbon dioxide, which help to regulate the pH of the blood and the body’s acid-base balance (Corroon & Hynes, 2014).
Figure 1.2
The Respiratory System

Arterial blood gases (ABGs) are a quick way of determining lung function, as well as how well the body is being oxygenated (see Table 1.1). ABGs are taken from a punctured artery, often by a respiratory therapist, at the patient’s bedside. The nurse should request an order from the medical provider whenever the patient has a change in respiratory condition.
Table 1.1
Normal Arterial Blood Gas Levels
Parameter Definition NormalAssignment
pH Concentration of hydrogen ions in the blood 7.35 – 7.45
PaCO2 Partial pressure of carbon dioxide dissolved in the arterial plasma 35 – 45
HCO3 Bicarbonate 22 – 26 mEq/L
Note. Adapted from M. Sole, D. G. Klein, & M. J. Moseley, Introduction to Critical Care Nursing (7th ed.). St. Louis, MO: Elsevier, 2017.
Ventilation occurs when a person breathes in and out, also known as inspiration and expiration respectively, moving air throughout the lungs (Corroon & Hynes, 2014). Perfusion is the blood flow through the capillary bed of the lungs or other tissues. In the patient with healthy lungs, there is a 1:1 ratio of ventilation to perfusion.
Diffusion is when O2 and carbon dioxide move back and forth across the alveolar-capillary membrane. This is also called air exchange and is how the lungs oxygenate the blood supply. PaO2 is the partial pressure of O2 in arterial blood, which shows the amount of O2 in the blood plasma. SpO2 (pulse oximetry) is the percentage of hemoglobin molecules, a part of the red blood cell, in which the O2 receptors are full. Each hemoglobin molecule has four O2 receptors.
Breath sounds are those auscultated through a stethoscope. Depending on the type of sound and location, the nurse can determine if additional assessment is necessary (see Table 1.2). Other indicators of poor oxygenation are cyanosis, inability to speak, and poor capillary refill.
Table 1.2
Normal/Abnormal Breath Sounds
Sound Description Respiratory Location Significance
Bronchial Tubular, hollow, higher in pitch, and loud. Over large airways (e.g., trachea or larynx). When heard over peripheral lung fields or bases, can indicate pneumonia.
Bronchovesicular Breezy and hollow. Large central airways (e.g., primary bronchi). When heard over peripheral lung fields or bases, can indicate consolidation.
Vesicular Breezy, softer, lower in pitch, medium intensity. Peripheral lung fields and bases. During shallow breathing, can be diminished or absent.
Crackles Bubbling or popping sounds. Throughout lung fields. Indicates alveolar opening upon inspiration (when fine) or atelectasis (when coarse).
Rhonchi Coarse, low in pitch. Throughout lung fields. Indicates inflammation or excess mucous.
Wheeze Whistling or musical sound heard when an airway is narrowed. Throughout lung fields. Indicates bronchospasm or obstruction of airway.
Stridor Crowing sound heard over upper airway. Upper airway. Indicates constriction or obstruction of larynx or trachea.
Pleural Friction Rub Grating vibration. Inflamed pleura rubbing together during inhalation and exhalation. Indicates inflammation of the pleura (such as occurs during pneumonia or tuberculosis).
Note. Adapted from M. Sole, D. G. Klein, & M. J. Moseley, Introduction to Critical Care Nursing (7th ed.). St. Louis, MO: Elsevier, 2017.
Abnormal Findings: Cardiovascular System
Findings that would indicate that a patient is having a cardiac event can be either subjective or objective. An example of a subjective finding is a patient complaint of chest pain of 8 on a 10-scale, with radiation to the jaw and left arm. An example of an objective finding would be a blood pressure reading of 156/82. While there are many abnormal cardiovascular conditions, exemplars to be discussed are coronary artery disease, chest pain either from angina or myocardial infarction (MI), and cardiac arrhythmias.
Abnormal Findings: Respiratory System
The tissue of the lungs is sensitive to environmental pollutants; therefore, exposure to pollutants, such as dust, mold, tobacco smoke, or cockroaches, can create both reversible and irreversible respiratory illnesses. When there is a ventilation/perfusion (V/Q) mismatch, breathing either exceeds or is exceeded by perfusion, causing abnormal lung function (see Table 1.3). Chronic obstructive pulmonary disease (COPD), asthma, influenza, and pneumonia, which can cause atelectasis, are all respiratory disorders which, when severe, can cause a V/Q mismatch and respiratory failure.
Table 1.3
Causes of Ventilation/Perfusion (V/Q) Mismatch
Inadequate Ventilation (V) Inadequate Perfusion (Q)
Blocked airways Too much pressure in the alveoli
Poor lung compliance Increased pressure in the pulmonary artery
Pulmonary edema Pulmonary embolism (PE)
Atelectasis
Note. Adapted from “Nursing Care and Conditions Related to the Respiratory System,” by A. M. Corroon & G. Hynes, in A. Brady, C. McCabe, & M. McCann (Eds.), Fundamentals of Medical-Surgical Nursing: A Systems Approach (pp. 243-283). Hoboken, NJ: John Wiley & Sons, 2014.
Prevalent Cardiological Problems
Coronary Artery Disease (CAD)
Coronary artery disease (CAD) is another name for atherosclerosis, which can affect the arteries of the entire cardiovascular system (American Heart Association [AHA], 2018a). Atherosclerosis occurs when plaque develops within the cardiovascular system because of damage from comorbid conditions, such as hypertension, hyperlipidemia, or diabetes. The plaque causes the arterial walls to harden and thicken, which narrows the lumen of the vessel (see Figure 1.3). CAD can be chronic, building up slowly over time until the arteries are partially or totally occluded, or can be acute, causing a thrombus from ruptured plague. A computed tomography (CT) scan with injected dye is often obtained to determine the degree to which coronary arteries are blocked and whether there is a likelihood of rupture. Rupture can occur at any place within the cardiovascular system, such as in the carotid arteries or within the aorta.
Figure 1.3
Arterial Plaque

Research Minute — Why “Door-to-ECG” in less than 10 minutes in the Emergency Department?
Yiadom et al. (2017) studied how long it took to identify that a patient was having an ST-elevated myocardial infarction (STEMI) by electrocardiogram (ECG) in seven different emergency departments (EDs) across the United States. The time ranged from 14 to 80 minutes prior to ECG assessment. “Door-to-ECG” time of less than 10 minutes allows for optimal STEMI patient outcomes with earlier detection. Remember the idiom “time is heart muscle,” because the longer it takes to implement cardiac interventions, the more heart damage occurs.
Chest Pain – Angina
When there is greater than a 70% blockage of the coronary arteries, angina can occur (Olson & Bowden, 2014). Angina refers to chest pain that is not indicative of a MI. Stable angina is the most common symptom of CAD, which results from myocardial ischemia. Ischemia occurs when the myocardial tissue is starved for O2, and necrosis has started to occur. Stable angina is often treated in an outpatient clinic as a chronic condition, when interventions such as angioplasty are impossible or ineffective.
The hallmark of stable angina is pain that occurs intermittently at the same time of onset, duration, and with the same intensity (Olson & Bowden, 2014). This can develop either from increased O2 demand or consumption, or decreased O2 supply. Stable angina usually occurs during exertion, which increases myocardial O2 demand, and is relieved by rest. Nurses evaluate chest pain using the PQRST acronym (see Figure 1.4).
Unstable angina is chest pain that is not predictable—it follows no regular pattern (National Heart, Lung, Blood Institute, n.d.). Unstable angina often leads to MI, as coronary vessels are blocked by blood clots or dislodged arterial plaque. When this occurs, the patient is usually treated with angioplasty and placement of a cardiac stent to reopen the artery and limit the cardiac damage. This process is also called revascularization.
Chest Pain – Myocardial Infarction
There are two types of MIs: ST-elevated myocardial infarctions (STEMI) and non-ST-elevated myocardial infarctions (NSTEMI). STEMIs are diagnosed by a cardiologist or other medical provider by viewing the ECG tracing and seeing that the ST-segment of the cardiac waveform does not return to baseline (see Figure 1.5). STEMIs occur when a coronary artery is fully occluded, starving the cardiac muscle of O2 and resulting in sudden cardiac cellular necrosis (Olson & Bowden, 2014). The damage caused by STEMIs affects the entire heart at a great depth (American College of Cardiology [ACC], 2016).
STEMIs require immediate revascularization, as the more time that passes the greater likelihood that the patient will suffer neurological complications or die. While the priority is getting the patient to the catheterization laboratory (cath lab) within 90 minutes, not every hospital has one at its disposal (ACC, 2016); therefore, some STEMIs are treated with thrombolytics instead of or prior to revascularization and stent placement.
NSTEMIs are the result of a severely narrowed coronary artery lumen, which is not fully occluded (ACC, 2016). In addition to not showing ST-elevation on an ECG tracing, NSTEMIs do not cause damage through the entire cardiac muscle. In addition, there are different types of clotting proteins and platelets at work, which is why NSTEMIs cannot be treated with thrombolytics. Patients who have confirmed NSTEMIs are treated with blood thinners, such as heparin, to avoid further occlusion of a coronary artery.
If the patient suffers sudden cardiac arrest at any time during a cardiac event, the patient may be a candidate for therapeutic hypothermia (ACC, 2016). Therapeutic hypothermia, also called targeted temperature management, is used to lower a patient’s core body temperature with the goal of reducing neurological complications after sudden cardiac arrest (AHA, 2018b). There are a variety of temperatures and lengths of time that a patient can be kept at that temperature, based on multiple patient factors.
Patient Education: Signs and Symptoms of MI

There are multiple signs and symptoms of MI, and patients must be educated to get emergency help immediately if they occur. According to the AHA (2016), common signs of MI include:
• Midsternal chest discomfort (which may feel like pain, pressure, squeezing, or fullness) that lasts for longer than a few minutes, but may go away and come back;
• Pain or discomfort in the jaw, shoulder, back, neck, or arms;
• Unexplained shortness of breath (with or without other chest signs); or
• Diaphoresis, nausea, or lightheadedness.
Myocardial Infarction in Women
While women may have the same signs of an MI as men, there are multiple differences. The chest pressure that is felt by men is often described as feeling like an elephant is sitting on the chest, but women often do not describe their chest discomfort as pressure (AHA, 2015b). In addition, women may experience fainting or pain in the lower chest and abdomen, with accompanying nausea and vomiting. Signs are often less severe than expected, sometimes being confused with gastric distress or an upper respiratory infection; therefore, it is imperative that nurses prepare women for what to expect because, while the signs may be less severe, the outcome may be just as deadly (AHA, 2015b).
Myocardial Infarction in Diabetic Patients
People with diabetes often have no idea they are having an MI because the neurovascular complications of diabetes often eliminate or dull the common signs of pain or pressure. According to the ADA (2018), diabetic autonomic neuropathy is an “independent risk factor for cardiovascular death and silent myocardial ischemia” (p. S44) and can also increase the likelihood that patients will be injured if they exercise to avoid cardiac disease. Therefore, it is imperative that all diabetic patients be educated on the need for cardiological investigation at least annually as well as before starting an exercise program to determine if CVD is present.
Figure 1.4
PQRST of Chest Pain Assessment

Note. Adapted from “Nursing Care and Conditions Related to the Circulatory System,” by K. Olson, & T. Bowden, in A. Brady, C. McCabe, & M. McCann (Eds.), Fundamentals of Medical-Surgical Nursing: A Systems Approach (pp. 284-320). Hoboken, NJ: John Wiley & Sons, 2014.
Table 1.4 discusses some of the laboratory values that a nurse can anticipate being ordered on a cardiac patient. It gives a brief description of the lab test, when it is ordered, and what is considered an abnormal result.
Table 1.4
Abnormal Cardiac Laboratory Values
Test Name What Is It? When Is It Ordered? Abnormal?
“Troponins” Cardiac-specific troponins T & I. Portions of cardiac proteins released when the heart is damaged. When it is suspected that a patient has had an acute MI. Any positive number; it often is all that is used for diagnosis of acute MI.
CK-MB Creatine kinase- muscle/brain. It is a cardiac enzyme test that predated the troponin test. During acute MI; but since it can also indicate noncardiac muscle damage, the troponin test (above) has become the gold standard. It is usually very low or undetectable in the blood, so positive is considered abnormal.
D-Dimer A protein that is found in the blood from clot breakdown. Ordered when venous thromboembolism (VTE) is suspected. Elevated in pulmonary embolus (PE), deep vein thrombosis (DVT), acute MI, unstable angina, and bleeding disorders. Negative is normal.
Brain Natriuretic Peptide (BNP) (or the newer NT-pro BNP) A lab value that evaluates the stretch of the cardiac ventricles. Ordered to evaluate and monitor heart failure. Note: If the patient is on an angiotensin receptor–neprilysin inhibitor (ARNI), the BNP levels will be increased. Therefore, the NT-pro BNP lab should be used. NT-pro-BNP > 300 should be further assessed.
Note. Adapted from “Nursing Care and Conditions Related to the Circulatory System,” by K. Olson, & T. Bowden, in A. Brady, C. McCabe, & M. McCann (Eds.), Fundamentals of Medical-Surgical Nursing: A Systems Approach (pp. 284-320). Hoboken, NJ: John Wiley & Sons, 2014; and “ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report From the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America,” by C. W. Yancy et al., in the Journal of the American College of Cardiology, 70(6) 776-803 (2017).
Cardiac Arrhythmias
An arrhythmia is an abnormal cardiac rhythm. While any abnormal heart rate is a concern, an arrhythmia should be confirmed with a 12-lead ECG (see Figure 1.6). This is because there is emergency nursing management of some arrhythmias. One such tachyarrhythmia, atrial fibrillation, has such requirements.
Atrial fibrillation (afib) cannot be counted using an apical or radial pulse, as it is irregularly irregular. This means that the atria and the ventricles are moving at different rates, which can only be seen with an ECG (see Figure 1.6). If an ECG is not obtained, the nurse may miss a rapid ventricular rate. The speed of the ventricles is important because it may not allow for adequate ventricular fill time, and there will not be enough oxygenated blood to send to the systemic circuit when the heart contracts; therefore, the rate must be controlled, usually through administration of intravenous medication.
During afib, the two atria beat chaotically, rapidly, and out of sequence with the ventricles, which can cause blood clots to form. If one of those clots goes to the pulmonary or neurovascular system, the patient can develop a pulmonary embolism (PE) or have a cerebrovascular accident, also known as a brain attack. To avoid this, patients will be placed on an anticoagulant medication, such as warfarin.
If the cardiologist feels that the patient may have already developed blood clots in the heart, a Transesophageal Echocardiogram (TEE) will be performed (see Figure 1.5). A TEE is performed by inserting a probe in the esophagus or stomach to create and record an ultrasound image (Stanford Medicine, 2018). TEEs are used to diagnose and manage multiple cardiac conditions including heart failure, supraventricular arrhythmias (including afib and atrial flutter), and physiological abnormalities such as valve disease (Stanford Medicine, n.d.).
Figure 1.5
Transesophageal Echocardiogram (TEE)

Note. Adapted from “Our Approach for TEE,” by Stanford Medicine on the Stanford Health Care website at https://stanfordhealthcare.org/medical-tests/t/transesophageal-echocardiogram/conditions.html
Figure 1.6
12-Lead Electrocardiogram (ECG)

Table 1.5
Vital Signs in the Adult Patient
Normal High/Possible Reason Low/Possible Reason
Heart Rate (in beats per minute [bpm]) 60-100 bpm HR > 100 bpm=
Tachycardia:
Caused by increased O2 demand, along with anxiety, hypertension, hyperthyroidism, hyperthermia, or exercise. Note: Accompanies increased myocardial oxygen demand. <60 bpm= Bradycardia:
Side effect of medication (such as a beta blocker); vagal response, or aging. Note: If the patient is symptomatic, may be signs of ACS.
Temperature (F= Fahrenheit; C= Celsius) 98.6 F or 37 C >100.4 F or 38 C
Infection; exertion. < 36.1 C
Hypothermia.
Blood Pressure (BP)
Systolic Blood Pressure (SBP) / Diastolic Blood Pressure (DBP) Varies: Mean Arterial Pressure (MAP) should be 70-100. MAP < 60 for an extended period is an emergency; it means that organs are not being perfused (given enough blood to do their job); 60-70 is low normal, but still safe. MAP > 100 occurs when patients have a big gap in their BP. This can overwork the organs through too much blood flow.
Respiratory Rate (in respirations per minute [rpm]) 12-20 rpm rpm < 12 is bradypnea and can cause a patient to become hypoxic and hypercapnic due to low inhaled O2 and high retained carbon dioxide (CO2). rpm > 20 is tachypnea (which is usually when respirations are shallow and fast). When respirations are fast and deep, it is usually called hyperventilation.
Note. Adapted from “Nursing Care and Conditions Related to the Circulatory System,” by K. Olson, & T. Bowden, in A. Brady, C. McCabe, & M. McCann (Eds.), Fundamentals of Medical-Surgical Nursing: A Systems Approach (pp. 284-320). Hoboken, NJ: John Wiley & Sons, 2014;
Nurses must be aware of multiple cardiac conditions, and this list of exemplars is not exhaustive. Nurses must also be aware that many cardiological conditions place patients at greater risk for additional chronic conditions, as each organ system is interdependent upon multiple others. In the next section, respiratory problems will be discussed, with chronic obstructive pulmonary disease, asthma, and pneumonia as exemplars.
Prevalent Lower Respiratory System Problems
Chronic Obstructive Pulmonary Disease (COPD)
COPD is another name for chronic, progressive, nonreversible, respiratory disease (Bostock-Cox, 2017). COPD includes emphysema and chronic bronchitis, as well as nonreversible asthma. Spirometry, with which COPD is diagnosed and managed, is a test where a patient blows into a machine called a spirometer. To have COPD, the ratio of FEV1/FVC must be 80% or less. FEV1/FVC is the forced expiratory volume (FEV1) of the first second of exhalation divided by the forced vital capacity (FVC), the amount that a patient blows during the entire test.
The 2017 Global Initiative for Obstructive Lung Disease (GOLD) recommendations suggest that nonpharmacological therapies, such as pulmonary rehabilitation (pulmonary rehab), relaxation, diet, and exercise, should be employed before medications (Bostock-Cox, 2017). Medications for COPD include:
• long-acting inhaled medications, such as beta agonists (LABAs) or muscarinic agonists (LAMAs), used alone or together;
• inhaled corticosteroids (ICS), such as fluticasone or budesonide; and
• short-acting inhaled medications (SABA), such as albuterol.
Comorbidities
Patients with COPD often have multiple comorbidities, such as cardiovascular disease (CVD), diabetes, anxiety, and depression (Bostock-Cox, 2017). In addition to administering medications, nurses should educate patients on pursed-lip breathing (see Figure 1.7). Pursed lip breathing allows patients to feel more in control of their COPD through controlled breathing. It increases alveolar airways, helps to remove carbon dioxide, and reduces anxiety.
Asthma
Asthma is a chronic, reversible airway disorder characterized by inflammation and bronchospasm. It can be diagnosed at any age, often affecting infants and adults alike. Allergens, exercise, or viral illness can trigger asthma, but the hallmark of the asthma exacerbation or asthma attack is the symptom of wheezing (see Table 1.2).
Medications used to treat and manage asthma exacerbation include SABAs, LABAs, and ICSs. If a patient is using a rescue inhaler (nebulized albuterol) more than two to three times per week, a preventive medication must be started. As mentioned above, asthma can be triggered by allergens, so management may also include nondrowsy antihistamines or even anti-inflammatory medications such as montelukast.
Asthma action plans (AAPs) are documents that tell patients what to do to prevent asthma attacks, what medications to take and when, and what to do in the event of an emergency (Wagner & Steefel, 2017). School personnel use AAPs to manage childhood asthma while the patient is in school; providers use them to adjust medications in family practice. AAPs must be created and adjusted for optimal quality of life for the patient with asthma.
Pneumonia
Pneumonia can be either viral, fungal, or bacterial, developed outside the hospital, called community-acquired pneumonia, or as a hospital-acquired illness (Corroon & Hynes, 2014). Regardless of the microorganism, the hallmarks of pneumonia are a sharp, piercing pleuritic chest pain, fever, anorexia, productive cough, and tachypnea (see Table 1.2). Auscultation of lung fields may indicate crackles, dullness, or absent breath sounds over peripheral lung fields. Viral pneumonia is one that occurs from infection with a virus. Examples include the influenza virus or rhinovirus, and because of fever, patients often complain of chills. Pneumonia is primarily diagnosed through chest x-ray, but sometimes a chest CT is ordered. Treatment of pneumonia depends on the organism of infection.
Restoration of Function
Patients may be forever changed after having a cardiac or respiratory event, exacerbation, or being diagnosed with a chronic cardiorespiratory condition. Acute care of a patient with an MI or pneumonia includes quick nursing assessment of patient symptoms, administration of O2, and intravenous medications; however, once the patient is stabilized, it is important that the nurse encourage the patient to participate fully in inpatient physical and occupational therapies, so that his or her physical condition does not further deteriorate. This is the most important first step in supporting the cardiorespiratory patient’s restoration of function.

Inpatient and outpatient nursing education must be consistent to ensure there is no confusion regarding the interventions that will return the patient to an optimal level of functioning. Patients must be educated to comply with all prescribed medications, therapies, specialist appointments, activity levels, and dietary changes. Each patient and family member should be given multiple credible, written and Web-based resources for self-education about the diagnosed condition to avoid future cardiorespiratory exacerbations or worsening of the condition. Nurses must also work to develop a therapeutic relationship by actively encouraging patient questions and evaluating patient understanding at each step in the educational process.
Transition to Independence

Patient independence is often jeopardized by a cardiorespiratory illness. Patients may have to change where they live if there are access problems, such as narrow stairs hallways; they need a great deal of help with their activities of daily living (ADLs); or if their employment is lost. Nurses should help patients stay as independent as possible, while advocating for patient safety.
Support—Psychosocial, Cultural, and Spiritual Considerations
According to the American Nurses Association (2015), nurses must consider the “culture, value systems, religious or spiritual beliefs, lifestyle, social support system, sexual orientation or gender expression, and primary language” of patients when planning their care (p. 17). The patient with the new cardiorespiratory illness will have a plethora of needs, most of which they had never considered prior to the occurrence of their illness. Nurses are uniquely qualified to educate patients on available resources.
Psychosocial Support
When learning to live with a cardiorespiratory diagnosis, patients will need an abundance of psychosocial support. It is vital that nurses show empathy when providing care, as the patient’s sense of self-worth has likely been altered. Many factors will determine the support patients have available at home, including culture, family dynamic, age, gender, spirituality, and religion.
Psychosocial support can come in the form of formal counseling or talk therapy, one-on-one or in a group. Many patients do not have insurance to cover medications or psychotherapy. If that is the case, patients and caregivers can join support groups through local chapters of the American Heart Association or COPD Foundation or through their religious/spiritual affiliations. Patients may even join a free online group for their condition, which can help people who live in remote areas or with mobility issues to connect with peers. Sharing feelings with others who are going through similar experiences can help to improve patient mood and self-esteem.
Cultural Considerations
Because of the constant migration of patients from around the world to the United States, cultural competence must be considered in a global context (Douglas et al., 2014). Cultural competence is the belief that people of all cultures deserve to be treated with dignity. The culturally competent nurse honors diversity by participating in positive cultural interactions and advocating for the removal of barriers to care for all people. Douglas et al. (2014) recommended the following guidelines for culturally competent practice:
1. Nurses must have knowledge of the values, practices, and family systems of culturally diverse patients, populations, and communities.
2. Nurses must be purposefully trained in care that is congruent with culture, during their initial nursing preparation and throughout their nursing career.
3. Nurses must regularly reflect on their cultural values and beliefs to ensure that they know the impact their heritage has on their practice.
4. Verbal and nonverbal communication should be used to identify culturally unique health care needs.
5. Nursing practice should use culturally sensitive skills to implement culturally congruent care.
6. Health care organizations should provide the resources to evaluate the language and cultural needs of their clients.
7. Nurses shall advocate for inclusion of their patients’ cultural beliefs and practices, recognizing that health care policies and delivery systems can negatively affect patient populations.
Health disparities are a sad fact of many chronic illnesses. Women, African Americans, and the poor are disproportionately affected by many chronic cardiorespiratory illnesses (Criner & Han, 2018). While improving access to care is known to remove some health inequities, many patients in the United States do not have health insurance. This is particularly distressing as chronic illnesses are very expensive to manage and treat.
Spiritual Considerations

Nurses provide spiritual care to patients through intentional use of presence and compassion (Bone, Swinton, Hoad, Toledo, & Cook, 2018). Prayer with patients and family, especially during a life-threatening illness, may be part of the holistic care that nurses offer. While helping others spiritually, nurses are often better able to personally cope with very sick or dying patients. Chaplains are an integral part of spiritual care, and nurses often employ them to help fulfill this vital patient need.
Contributing Factors to Consider
There are risk factors for CVD that can be changed through patient behavioral modification and those that cannot. According to Whelton et al. (2017), modifiable risk factors for CVD include:
• tobacco smoking (first or second-hand),
• appropriate self-management of diabetes mellitus,
• high cholesterol (hyperlipidemia),
• overweight or obesity,
• lack of physical activity, and
• eating an unhealthy (high carbohydrate, high fat) diet.
Fixed risk factors are those that are relatively unchangeable, such as patient age, gender, having obstructive sleep apnea, family history, and psychosocial stress (Whelton et al., 2018).
Patient education is empowering. It helps to avoid cardiorespiratory conditions altogether, but once a cardiorespiratory condition has been diagnosed, the patient goals change to educating the patient to appropriate self-management of the condition, thereby avoiding exacerbation and hospital readmission.
Patient Education: Hypertension

Hypertension increases the risk of CVD and many other chronic conditions, so nurses must stay abreast of the most recent guidelines for management. Patient education should include the stages of hypertension and whether the patient’s blood pressure is elevated (see Table 1.6). Once they are aware of where they fall in the guidelines, patients should be educated to modify hypertension risk factors. According to Whelton et al. (2018), this includes:
• reduction or elimination of dietary sodium;
• exercising 3 to 5 days per week for at least 30 minutes;
• reduction of daily alcohol consumption to two or fewer drinks for men, and no more than one drink for women;
• avoiding cigarette smoke; and
• weight loss.
Table 1.6
2017 Hypertension Guidelines
Type of Hypertension Systolic BP Diastolic BP
Normal Blood Pressure < 120mm Hg and < 80mm Hg
Elevated Blood Pressure 120-129mm Hg and < 80mm Hg
Stage 1 Hypertension 130-139mm Hg or 80-89mm Hg
Stage 2 Hypertension > or = to 140mm Hg or > or = to 90mm Hg
Hypertensive Crisis > 180mm Hg and/or >120mm Hg
Note. Adapted from “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary,” by Whelton et al., in the Journal of the American College of Cardiology, 2018, 71, 2199-2269.
Patient Education: HyperlipidemiaAssignment

Hyperlipidemia is the medical term for elevated serum cholesterol levels. Hyperlipidemia can be managed with medications (such as HMG-CoA reductase inhibitors, better known as “statins”) or with lifestyle management. Statins can be prescribed alone or in combination with other lipid-lowering medications. According to Ngo-Metzger and Gottfredson (2017), adults with high cholesterol should be treated with a statin, even if they have no history of CVD, if they are between 40 and 75 years of age or have abnormal lipids, diabetes, hypertension, or use tobacco.
In addition to using statins, lifestyle changes should be made, including:
• losing weight;
• eating a low fat, low sodium diet;
• increasing dietary fiber intake;
• increasing exercise; and
• avoiding alcohol consumption.
Patients often refuse to take statins because of their side effects. When educating patients about statins, nurses should explain that the side effect of joint ache is serious, but very rare. Patients who have this side effect will usually experience it in all their joints.
Patient Education: Diabetes

Diabetes mellitus is a complex comorbidity that increases the risk of CVD. According to the American Diabetes Association (2018), patient self-management education should include:
• education on diabetic nutrition, meal planning, and examples of each;
• that patient medications should be taken as prescribed;
• the need for weight loss if patient is overweight;
• the importance of physical activity;
• the importance of screening for and management of hypertension and hyperlipidemia;
• the importance of smoking cessation; and
• the necessity of regular provider appointments, at least twice annually.
Prevention and Health Promotion

Patients must be educated to avoid risks and engage in health promotion activities. Health promotion activities include:
• following recommended nutritional and exercise guidelines,
• losing weight,
• avoiding tobacco smoke,
• getting recommended immunizations, and
• taking all prescribed medications.
Nutrition: General Dietary Recommendations
The dietary recommendations for all Americans, according to the U.S. Department of Health and Human Services (HHS) and U.S. Department of Agriculture (USDA) (2015) specify the need to eat:
• a variety of vegetables in a variety of colors, from all subgroups;
• whole fruits and grains;
• dairy products that are reduced fat or nonfat, including fortified soy; and
• lean proteins, including seafood, lean meats, poultry, and nuts.
Trans fats, saturated fats, sodium, and added sugars should be eaten in only very small quantities. Less than 10% of calories each day should be from either saturated fats or added sugar, and less than 2,300mg of sodium should be consumed daily (U.S. Department of Health and Human Services [HHS] & U.S. Department of Agriculture [USDA], 2015). Alcohol, if consumed by adults, can be one drink per day for women and two drinks per day for men. The recommendation is that most of the foods that people consume be “nutrient dense,” meaning that the protein source is not diluted by fats, sodium, and sugars (HHS & USDA, 2015, p. xiv).
No matter what, serving sizes should be observed. Food labels indicate the size of each serving. Patients must be educated to multiply the number of servings they will eat by that item. For example, many products claim that they are “low sodium” on the label, but when determining the actual amount of sodium that will be consumed, it may turn out to be higher than the recommended daily amount.
Nutrition: Cardiorespiratory Requirements

Patients with cardiorespiratory conditions have some unique nutritional requirements. For example, the AHA (2018c) recommends that the cardiac patient consume no more than 1,500mg of sodium per day. Patients taking warfarin must avoid foods high in Vitamin K, as it reverses the anticoagulant effect of the medication, and increases the patient’s international normalized ration (INR) level. Nursing education should advise patients on warfarin to avoid green, leafy vegetables such as kale, collard greens, spinach, broccoli, chard, and asparagus. Patients on warfarin should also avoid drinking green tea (as it also lessens the effect of warfarin) or consuming alcohol or cranberry juice (which increases the effect) (Mayo Foundation for Medical Education and Research, 2018).
Patients with COPD have increased nutritional requirements because of the additional work of breathing (COPD Foundation, 2016). If dietary requirements are not met, musculature of the chest wall could deteriorate. If COPD patients are underweight, patients can be educated to add the following sources of additional calories: butter, margarine, mayonnaise, peanut butter, nuts, and high-fat ice cream (COPD Foundation, 2016). Meeting nutritional requirements is one way nurses can help to reduce hospital readmissions for the COPD patient.
Preventing Cardiorespiratory Illness Through Exercise/Mobility
When attempting to prevent cardiorespiratory illness, people must be active. The AHA (2015) offers the following recommendations for overall cardiac health:
• moderate-intensity aerobic activity should be performed a minimum of 30 minutes each day, at a minimum of 5 days per week, or
• vigorous aerobic activity should be performed for at least 75 minutes per day for a minimum of 3 days per week, and
• moderate- to high-intensity muscle strengthening should be performed at least 2 days per week.
The above list mentions two types of exercise, endurance/aerobic exercise and strength training (AHA, 2015c). Examples of moderate-intensity endurance exercise include water aerobics, gardening, or ballroom dancing. Examples of vigorous aerobic exercise include jogging or running, singles tennis, or jumping rope (AHA, 2015c).
Another fitness category is flexibility exercise, which includes stretching, yoga, and Pilates. Flexibility exercise can help maintain or improve mobility. If not stretched, muscle fibers shorten, hampering muscle contraction (President and Fellows of Harvard College, 2016). Stretching helps to increase the range of motion of all joints, reduce risk of injury, and improve balance. Stretching tips include:
• Start with warm muscles.
• Relax while stretching.
• Breathe normally throughout the stretch—usually exhaling while pulling.
• Hold each stretch for 10 to 30 seconds and repeat each stretch three to five times.
• Stretching should never hurt, but a pulling feeling is normal.
• Avoid locking joints (like knees) when stretching (AHA, 2015a).
Patients should be encouraged to do a variety of exercises to prevent boredom, and to not give up even if their routine is interrupted. Staying active is important to prevent cardiorespiratory illness or exacerbation.
Exercise Recommendations for Cardiorespiratory Patients

For the cardiac patient, exercise recommendations are changed by individual conditions. For example, the patient on an anticoagulant for afib needs to exercise in a safe environment, such as a pool, to avoid the risk of bleeding due to a fall. It is important that cardiac patients not exacerbate a cardiac condition, so they may have specific parameters placed on their exercise. Exercise can increase circulation, lower blood pressure, relieve stress, reduce depression, and reduce the likelihood of stroke (AHA, 2015c). The cardiac patient must get cardiology clearance before starting any program.
Patients with COPD and asthma should be encouraged to exercise, as it increases cardiac function, muscle mass and bone density, and overall mobility (Corbridge & Nyenhuis, 2017). In the COPD patient particularly, exercise increases the ability to perform ADLs, such as combing hair or reaching above the head (Corbridge & Nyenhuis, 2017). Respiratory patients should get clearance from their pulmonologist before starting any exercise program.
Exercise is a known trigger for bronchoconstriction, which is caused by the hyperventilation of cool, dry air (Corbridge & Nyenhuis, 2017); however, the asthma patient can be educated to avoid an exacerbation by premedication with an albuterol inhaler 15 to 20 minutes prior to exercise and performing 15 minutes of warm-up and cool-down exercises (Corbridge & Nyenhuis, 2017). The patient should be educated to focus on aerobic exercise, and patients should avoid exercising outside when pollution levels, such as ozone and particulates, are high. Finally, asthma patients should make sure to always have their rescue inhaler with them in case they become dyspneic during exercise.
The mental health benefits of exercise are well known. Cardiorespiratory patients often have psychological challenges, as they feel sidelined by their illnesses; however, improved mental health through exercise can benefit these patients as they are able to improve their overall fitness and mobility, and restore function.
Smoking Cessation
Cigarette smoke has long been recognized as an allergen and pathogen; however, the current use of inhaled nicotine, also known as e-cigarettes or vape, have started a new round of research, and a debate about whether e-cigarettes are safer. In the absence of reproducible research, many medical providers have suggested that e-cigarettes are safer than traditional cigarettes because liquid nicotine does not have many of the other dangerous ingredients; however, a few things are currently known:
• E-cigarettes come in fruit and candy flavors, so they are more enticing to young people.
• There is no guarantee that the vapor coming from an e-cigarette is only nicotine, as many police departments report illicit drugs being inhaled from the vape devices.
• Many states have outlawed flavored nicotine for use in the e-cigarettes.
Therefore, while the conversation about smoking cessation has traditionally been about quitting cigarette smoking, it is now about the cessation of any tobacco use. The risks of cigarette smoking are undeniable. COPD and CVD are largely diseases of the tobacco smoker, and addiction to cigarettes is worldwide (Criner & Han, 2018).
Immunizations
To promote health, nurses should encourage patients to get all recommended immunizations. If patients under the age of 18 have missed a dose of a recommended vaccination, the Centers for Disease Control and Prevention (CDC) has a schedule for patients to use to catch up on their immunizations. If patients are age 19 or older, the adult schedule should be followed (CDC, 2018). When offering a patient an immunization, a nurse must obtain a completed questionnaire and offer the most recent vaccine information statement.
Seasonal Influenza Vaccines and Pneumococcal Vaccines
The CDC (2017b) recommends that from early autumn until late spring all people in the United States who are candidates get the seasonal influenza (flu) vaccination. Seasonal flu can lead to severe morbidity and even death. Patients cannot get the flu from vaccination, as it uses a dead virus; however, there is a possibility that patients may experience a mild reaction as the body prepares for a reaction to a viral attack.
Bacterial pneumonia can also be prevented through vaccination. There are two pneumonia immunizations: The pneumococcal conjugate vaccine (PCV13) and the pneumococcal polysaccharide vaccine (PPSV23) (CDC, 2017a). As their names would imply, the PCV13 protects patients against 13 strains of bacteria and the PPSV23 against 23. Promoting health in patients would require education that all patients aged 65 and older, or younger patients with increased risk, which includes cigarette smokers, people living in a group home or facility, or patients with chronic illness, should get the pneumococcal vaccines (CDC, 2017a).
People that should avoid the pneumococcal vaccines are those who have had an allergic reaction to eggs (which is part of the manufacturing process) or have suffered anaphylaxis from a previous pneumonia vaccination (like Prevnar or PCV7) or diphtheria toxoid (CDC, 2017a). While immunizations are safe overall, expected side effects include edema or soreness at the injection site. Patients should be educated that it is safe to get both the influenza and either pneumococcal vaccine simultaneously. Immunizations can be received from primary care offices, as a patient in the hospital, or through a pharmacy. If a patient has no insurance, many community health centers or hospitals offer free or low-cost options.
Handwashing
Handwashing is the primary prevention method for all illnesses, including viral and bacterial infections. Nurses should recommend handwashing to patients and model good handwashing techniques, which include:
1. Wet hands with clean water.
2. Lather hands with soap, making sure to focus on all parts of the hand, including under the nails, the backs of the hand, and between each finger.
3. Scrub hands for a minimum of 20 seconds.
4. Use clean water to rinse hands.
5. Use a clean towel or air dryer to dry (CDC, 2016).
Patients should wash hands after touching an animal, food, waste, garbage, or a wound, as well as after coughing, sneezing, or blowing the nose (CDC, 2016). Nurses should perform hand hygiene using soap and water or with a hand sanitizing liquid or foam before and after patient care.
Medications
Patients with cardiorespiratory conditions can have many expensive medications. This will be a challenge for a low-income, poor, or homeless patient. Patients cannot take medication they cannot afford. This is particularly problematic for cardiorespiratory patients because new technology, research, legislative changes, and few cost restrictions make for very expensive medications. For example, the patient with COPD or asthma may have three different inhaled, prescription medications, all of which are likely to be name-brand medications and very expensive. Legislation that outlawed generic albuterol inhalers in the United States because of the environmental impact allowed pharmaceutical companies to get a new patent on inhaled albuterol. While the environmental impact was improved, the cost grew exponentially.
Nurses should encourage patients to be forthcoming with their ability to afford medications, as there are many resources available to reduce or eliminate their cost. The Partnership for Prescription Assistance (PPA) is a free service that acts as a clearinghouse for patients who cannot afford medications. Once the patient fills out an online form, PPA will direct them to local resources (Partnership for Prescription Assistance [PPA], n.d.). Through partnerships with many nationwide organizations, PPA places the cost of medications in reach for many. Each community has a variety of resources for affordable medications, including community centers and hospitals, low-cost medication lists at many big box stores, and pharmacy coupons to be used when the copays of many medications are too high.
Assignment
Medications must be used as prescribed to prevent exacerbation or rehospitalization; therefore, nurses must explain to patients that it is better to ask for samples or alternative medications than to use them less frequently than prescribed. In addition, patients must get concise written instructions for each inhaled medication, as many cardiorespiratory patients are confused about which inhaler is long acting and which is to be used during a dyspneic episode. If a patient complains that an inhaler is not working, that is a sign he or she needs further education.
Tobacco Cessation Medications
Education regarding tobacco cessation medication should include a list of medications for use in cessation. Chantix (varenicline) is a smoking cessation aid that allows for a low starter dose that a patient takes while continuing to smoke after establishing a “quit date.” On the “quit date,” the patient stops smoking cigarettes and takes the higher dose of medication. Patient education must include the fact that there are two dosages in the starter pack, and that following its completion, a continuing pack will be taken with only the higher dose of medication. Side effects of the medication are multiple, and patients should be encouraged to read the package insert and return to their prescription provider with any questions.
Nicotine patches and gum remain options to help patients stop smoking cigarettes, with many Medicaid plans paying for the medications in full (even though they are found over-the-counter at most pharmacies). If patients use a nicotine patch, patients must be educated to remove old patches every 24 hours and to place a new patch in a different location. Nicotine gum or lozenge directions on the package should be followed carefully. Patients must also be educated that they should never use nicotine patches, gum, or lozenges while using tobacco products.
Medication Side Effects
Patient education about any medication must include information about side effects, but cardiorespiratory medications have some that are unique. For example, albuterol rescue inhalers cause patients to get light-headed for a few moments after inhalation, so they should be advised to know how it would affect them before using them while driving. ICS inhalers are steroids, so they have the same effect as oral steroids, in that they will thin patient skin and compromise patient immunity.
Medications that lower blood pressure will often have the side effects of dizziness, while some in the diuretic class will increase urination. Other antihypertensives, such as angiotensin converting (ACE) inhibitors, cause mild angioedema, which causes the “ACE cough” that patients may experience. Beta-blockers, used in many patients to control blood pressure, will also slow the heart rate. Because of this side effect, many prescribers use this class of medications to control an elevated heart rate as well. Regardless of the medication, nurses should educate patients on expected side effects. While many of the side effects are well known, the patient should still be encouraged to notify their prescriber immediately when they occur, as many drugs have suitable alternatives.
Resources for Nonacute Care
The cardiorespiratory patient will have a variety of needs after being discharged from an acute care facility. This includes cardiac rehabilitation, pulmonary rehabilitation, or just the need for different types of durable medical equipment. Table 1.7 lists many of the resources that must be considered to help the patient transition back to self-care.
Table 1.7
Resources Needed for Nonacute Care
Durable Medical Equipment • Walkers, canes, or wheelchairs for balance or mobility
• Oxygen concentrators or supplies
• Portable oxygen tanks
Medication • Prescription medication assistance to avoid running out of medications
Transportation • Specialist appointments
• Primary care appointments
• Pharmacy
Living Conditions • Ramps, wheelchair accessible hallways/shower, if patient is in wheelchair
• Ability to move to a ground-floor apartment if respiratory status is compromised
• Family, group home, or skilled nursing facility, if patient is unable to live independently
Cardiac Rehab • Bridge to independence for patients with multiple cardiac conditions: post-MI, postcardiac catheterization
• Patients learn to self-manage conditions with the help of a team
Pulmonary Rehab • Bridge to independence for patients with COPD or pulmonary fibrosis
• Patients rehabilitate their lungs and learn to exercise and manage condition in a controlled environment
Return to Employment Issues • Time off needed for rehabilitation
• Change of duties and modification of workload
• Breathing difficulty may interfere with job performance
Checks for Understanding
1. What is the goal of nursing management in the care of patients with a cardiac or respiratory problem?
2. What modifiable risk factors should nurses educate patients about to prevent a cardiorespiratory condition?
3. How do nurses advocate for patients when they cannot afford medications?
4. What are the nutritional requirements of the patient with COPD?
5. What are ways to bridge cardiorespiratory patients to independence, while helping them manage their condition?
Conclusion
The aforementioned cardiorespiratory conditions are just some of the common disease processes. Each one has components that requires patients to perform self-care behaviors in order to sustain wellness. When nurses provide evidence-based education to patients, it allows them a measure of control over their condition and ultimately their lives.
Key Terms
Angioplasty: Surgical repair or unblocking of a coronary vessel.
Aorta: Main artery of the heart, which sends blood to the systemic circuit.
Arrhythmia: A condition in which the heart beats with an irregular or abnormal rhythm.
Arteries: Vessels that take blood away from the heart.
Asthma: Chronic, reversible airway disorder.
Atelectasis: Lung tissue collapse due to poor airflow.
Atherosclerosis: Plaque buildup that causes occlusions of the coronary arteries.
Atrial Fibrillation (afib): Arrhythmia that is irregularly irregular and can lead to blood clotting.
Cardiac Rehabilitation: A rehabilitation program for patients that have suffered a cardiac event.
Cardiac Stent: A tube made of metal or mesh that holds open an artery.
Cardiovascular Disease (CVD): Disease of the blood vessels and heart.
Carotid Arteries: Arteries on each side of the neck that lead to the brain.
Chronic Bronchitis: A type of COPD that causes a lot of mucous and irritation and inflammation of the bronchial tubes.
Chronic Obstructive Pulmonary Disease (COPD): Chronic, progressive lung disease that is nonreversible. COPD includes emphysema and chronic bronchitis.
Comorbidities: The presence of two or more chronic diseases in addition to a primary diagnosis.
Coronary Artery Disease (CAD): The chronic occlusion of the coronary arteries that may lead to myocardial infarction (MI) if untreated.
Cultural Competence: To be respectful and responsive to the health beliefs and practices as well as cultural and linguistic needs of diverse population groups.
Diffusion: Movement of gases (oxygen and carbon dioxide) back and forth across the alveolar-capillary membrane.
Emphysema: Chronic disease of the alveoli in the lungs.
FEV1/FVC: Forced expiratory volume of the first second of exhalation divided by the forced vital capacity; the amount of air that a patient blows during a spirometry test, which determines pulmonary function.
Fixed Risk Factors: Those that are unable or relatively difficult for patients to change.
Hyperlipidemia: Elevated serum cholesterol levels.
Ischemia: When tissue is starved for oxygen and necrosis has started to occur.
Modifiable Risk Factors: Those factors within a patient’s control that, if changed, will improve a patient’s condition.
Myocardial Infarction (MI): The occlusion of one or more major coronary arteries within the heart, leading to oxygen deprivation to an area of the heart and cardiac muscle death, if untreated; another name for heart attack.
Non-ST-Elevated Myocardial Infarction (NSTEMI): Type of heart attack in which the coronary artery is only partially occluded.
PaO2: Partial pressure of oxygen in arterial blood; oxygen in blood plasma.
Perfusion: Blood flow through the capillary beds of the lungs and other organs.
Plaque: Fatty substance that is in and on the walls of the vessels in atherosclerosis.
Pulmonary Rehabilitation: Rehabilitation for patients who have respiratory issues.
Signs: Objective findings based on clinician judgment or test results.
SpO2 (Pulse Oximetry): The percentage of hemoglobin molecules in which oxygen receptors are full.
Stable Angina: Chest pain that occurs intermittently with the same predictability.
ST-Elevated Myocardial Infarction (STEMI): Type of heart attack in which the coronary artery is 100% occluded, requiring revascularization and cardiac stent placement within 90 minutes of patient arrival.
Sudden Cardiac Arrest: When the heart stops during or after a heart attack.
Symptoms: Subjective terms that state what a patient experiences.
Targeted Temperature Management: Another name for therapeutic hypothermia, reflective of the fact that there is a range of temperatures and times at each temperature that are used, based on patient condition.
Therapeutic Hypothermia: When the core temperature of a patient is lowered to prevent neurological complications.
Unstable Angina: Chest pain that is unpredictable and follows no regular pattern.
Veins: Vessels that take deoxygenated blood back to the heart.
Ventilation: Breathing through inspiration and expiration.
Ventilation/Perfusion (V/Q) Mismatch: When there is not a 1:1 ratio of ventilation to perfusion.
References
American College of Cardiology. (2016). Heart attack treatment guidelines. Retrieved from https://www.cardiosmart.org/Heart-Conditions/Guidelines/Heart-Attack-Guidelines
American Diabetes Association. (2018). Standards of medical care in diabetes. Diabetes Care, 41(1), S1-S156. doi:org/10.2337/dc18-Sint01
American Heart Association. (2015a). Flexibility exercise (stretching). Retrieved from http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/Flexibility-Exercise-Stretching_UCM_464002_Article.jsp#.W06XwtJKjIU
American Heart Association. (2015b). Heart attack symptoms in women. Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Heart-Attack-Symptoms-in-Women_UCM_436448_Article.jsp#.W0YybdJKjIU
American Heart Association. (2015c). Moderate to vigorous—What is your level of intensity? Retrieved from http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/Moderate-to-Vigorous—What-is-your-level-of-intensity_UCM_463775_Article.jsp#.W06T59JKjIV
American Heart Association. (2018a). Coronary artery disease- coronary heart disease. Retrieved from http://www.heart.org/HEARTORG/Conditions/More/yHeartandStrokeNews/Coronary-Artery-Disease—Coronary-Heart-Disease_UCM_436416_Article.jsp
American Heart Association. (2018b). CPR & first aid: Emergency cardiovascular care. Retrieved from https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-9-acute-coronary-syndromes/?strue=1&id=1
American Heart Association. (2018c). The American Heart Association’s diet and lifestyle recommendations. Retrieved from http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.W0-9idJKjIU
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author.
Bone, N., Swinton, M., Hoad, N., Toledo, F., & Cook, D. (2018). Critical care nurses’ experiences with spiritual care: The spirit study American Journal of Critical Care, 27(3), 212-219. doi:10.4037/ajcc2018300
Bostock-Cox, B. (2017). The 2017 GOLD guideline on COPD: Implications for practice. Practice Nurse, 1, 30.
Centers for Disease Control and Prevention. (2016). Handwashing: Clean hands save lives. Retrieved from https://www.cdc.gov/handwashing/when-how-handwashing.html
Centers for Disease Control and Prevention. (2017a). Adults: Protect yourself with pneumococcal vaccines. Retrieved from https://www.cdc.gov/features/adult-pneumococcal/index.html
Centers for Disease Control and Prevention. (2017b). Key facts about seasonal flu vaccine. Retrieved from https://www.cdc.gov/flu/protect/keyfacts.htm
Centers for Disease Control and Prevention. (2018). Recommended immunization schedule for adults aged 19 years or older, United States, 2018. Retrieved from https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-compliant.html
COPD Foundation. (2016). Slim Skinny’s reference guide. Retrieved from file:///C:/Users/ajhom/Downloads/SSRG_NutritionTips_v1.3_WM.CV01.pdf
Corbridge, S. J., & Nyenhuis, S. M. (2017). Promoting physical activity and exercise in patients with asthma and chronic obstructive pulmonary disease. Journal for Nurse Practitioners, 13(1), 41-46.
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Criner, R. N., & Han, M. K. (2018). COPD care in the 21st century: A public health priority. Respiratory Care, 63, 591-600. doi:10.4187/respcare.06276
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Assignment

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Topic 1: Cardiorespiratory Complexities

Objectives: Assignment

i. Evaluate functions of the cardiac and respiratory systems based on findings.
ii. Develop a health promotion with a restoration teaching plan for a patient with cardiorespiratory complexities.
iii. Develop a method for patient education to prevent hospital readmission.

Assignment 1
Identify a cardiac or respiratory dysfunction and its cause. Outline the key steps necessary to prevent the dysfunction and improve health status. Assignment

Assignment 2
Discuss what resources are available for chronic cardiorespiratory issues to support patient independence and prevent readmission. Explain how readmission affects reimbursement. What implications does readmission have on the hospital, and on the patient?

Assignment 3
It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.
Evaluate the Health History and Medical Information for Mrs. J., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information Assignment
Health History
Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.
Subjective Data
1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.” Assignment
4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data
1. Height 175 cm; Weight 95.5kg.
2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin. Assignment
Intervention
The following medications administered through drug therapy control her symptoms:
1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:
1. Describe the subjective and objective clinical manifestations present in Mrs. J.
2. Describe four cardiovascular conditions in which Mrs. J is at risk, and that may lead to heart failure. What can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions?
3. By following the nursing process, were the interventions at the time of admissions beneficial for Mrs. J? Would you change any of the interventions to ensure patient independence and prevent readmission?
4. Explain each of the seven medications listed in the scenario above. Include the classification, the action, and the rationale for each of these. Discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence and prevent readmission. Assignment
6. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits.
You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

 

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10/14/22, 2:02 PMPreview Rubric: Difficult Conversations Proposal Rubric – Fa22 MGMT 492-20 BBA Capstone – Minnesota State University MankatoAssignment

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Difficult Conversations Proposal Rubric Course: Fa22 MGMT 492-20 BBA Capstone

Criteria Excellent Good Fair Opportunities Nothing to review

Introduction &

Conclusion: In opening,

student clearly

explained the book they

read and outlined the

main points they will beAssignment

covering in their

presentation.

Content: Concepts

outlined in the

introduction/backgroun

d were addressed in

order. Each had reason it

was included and

support. Support could

be examples from your

life, quotes from the

text, details of future

application on this

concept etc.

Meaningfulness: It

appears that the studentAssignment

did more than offer a

book report. They were

reflective while clearly

addressing a specific

audience from the

assignment directions.

Task Requirements

Format

References

20 points

Closely applies to material

covered during the course

(course content only, not

task)

15 points

Somewhat applies to

material covered during

the course (course contentAssignment

only, not task)

10 points

Met most requirements

and was fairly prepared

5 points 0 points

20 points

Followed the assignment

directions correctly to

include all bullet point

requirements

15 points

Included most, but missed

at least one major bullet

point requirement for the

assignment

10 points

Missed the requirements

of the assignment in three

or more bullet point areas

5 pointsAssignment

Met few requirements and

was fairly prepared

0 points

20 points

Followed the assignment

directions correctly to

include all bullet point

requirements

15 points

Included most, but missed

at least one major bullet

point requirement for the

assignment

10 points

Missed the requirements

of the assignment in three

or more bullet point areas

5 points

Met few requirements and

was fairly prepared

0 points

nothing submitted

20 pointsAssignment

Followed the assignment

directions correctly to

include all bullet point

requirements

15 points

Included most, but missed

at least one major bullet

point requirement for the

assignment

10 points

Missed 2-3 the

requirements of the

assignment more bullet

point areas

5 points

Missed 3+ of the

requirements of the

assignment more bullet

point areas

0 points

nothing submitted

20 points

Chapter 10 was followed

and APA format for

reference page, and in-text

citations

15 points

Format and citations wereAssignment

attempted but not correct

10 points

NA

5 points

Chapter 10 and APA

format not followed

0 points

nothing submitted

20 points

Above minimum required

15 points

Minimum required sources

10 points

Reference page and in text

5 points

Either no reference page,

0 points

Contains no references

 

 

10/14/22, 2:02 PMPreview Rubric: Difficult Conversations Proposal Rubric – Fa22 MGMT 492-20 BBA Capstone – Minnesota State University Mankato

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Total

Overall Score

sources cited within and

reference page correctly

formatted and submitted

cited within and reference

page correctly formatted

and submitted

citations attempted but

not formatted correctly

or in text citations

Level 4 100 points minimum

Level 3 75 points minimum

Level 2 5 points minimum

Assignment essay paper

Assignment

Melissa Diegnau, MBA

MGMT 492

Specifics for the Difficult Conversations Assignment

Difficult Conversations: (120 points) After reading this book, you will be asked to construct a business proposal that seeks change by applying both the concepts in the “difficult conversations” text as well as what has been learned regarding the proper format for business reports/proposals. Topics to consider—what they are, common problems, how we can improve them, etc. Most of what you discuss will come from ideas explored in the book Difficult Conversations, yet many of the things Assignment studied in this class, and the diversity and inclusion content from MGMT 490, can assist you in helping others productively manage conflict. Once you are comfortable with the required format/content, then think about how you can apply what you read to a current/past workplace situation and use the proposal to identify the current state, why change is needed, and how that change could be implemented based on what you read. This assignment is confidential, and only my eyes will see it. I am looking to see if the content in this book was meaningful and if you know how to better handle a real-world situation because of it. You will upload your document in your week. To ensure you are detailed, the final product should be 3-6 single-spaced pages with a minimum of six citations either from the book or other credible sources. In reading, I should clearly understand the situation, why these concepts would help, a walkthrough Assignment of concept application, and either results or anticipated results. I encourage all students to submit their topic choice before preparing their proposals.

 

What I would do if I were Preparing for this Assignment:

1. Carefully go through the book Difficult Conversations and select the quotations and ideas you believe support a workplace current or past conflict you can use as your inspiration to suggest workplace change.

2. To ensure maximum points, review the rubric under Assessments called Difficult Conversations before preparing your proposal.

3. Review chapters 9 and 10 in your text for visual formatting requirements for business reports and proposals, including spacing and heading. (I believe you will find Assignment chapter 10 the most helpful. Specifically, 10.9 for a works cited sample, and 10.2 and 10.4 for a format sample. Pages 288-290 discuss minimum content sections).

· This is an informal proposal, meaning TOC and title page are not needed but practice formal, third-person business writing.

4. You want to write formally, but for the purpose of this assignment, generate an informal letter proposal so you can focus on applying your effort to the book concept application and not creating a table of contents. Follow the format in the book regarding single-spacing, headings, etc., and be sure these elements are included:

· Introduction

· Background of the problem

· Proposal

· Staffing and budgeting needs

· Authorization

· Appendix (optional, not required)

· References, work cited page properly formatting giving proper credit to the quotations, graphics within the proposal.

Assignment · Be sure you properly cite within the proposal AND have a reference page

· If you are unsure of the proper format, follow the sample in your chapter, or go to https://owl.purdue.edu/owl/purdue_owl.html for guidance.

5. Be sure your proposal is detailed enough that I clearly understand the situation and can clearly see DC concepts directly applied as to how to improve this situation. Your proposal should be free of errors: grammar, punctuation, and spacing.

6. Upload your proposal in your week. This is confidential for my eyes to see only.

 

Tips:

1. Assume the audience has not read this book or situation you are analyzingAssignment

2. You are a manager/teacher/problem solver here—please be professional and thoughtful in your approach

3. Don’t recite the book; I’ve read it. Show that you read and mastered the concepts by applying them and citing them.

4. This should be fun, educational, and professional. Be creative.

5. Feel free to get help from friends. For example, if you wanted to include a survey, case study, or outcome from a role play, that is fine but not required.

6. You are welcome to cite more than just this book to support your proposal.

7. I should read it, understand the issue/need, see how the change would play out, what is needed to make the change, and, based on the problem, want to make the change.Assignment

8. Have fun…create something that teaches others a few things that might help them not avoid difficult conversations in the future but approach them more confidently and earn more positive results.