Critical Thinking Essay: Case Study.

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.Critical Thinking Essay: Case Study.

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Health History and Medical Information
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.Critical Thinking Essay: Case Study.
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.\”
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.
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 clinical manifestations present in Mrs. J.
2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.Critical Thinking Essay: Case Study.
3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
4. Taking into consideration the fact that most mature adults take at least six prescription medications, 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.Critical Thinking Essay: Case Study.
5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients\’ transition to independence.
6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.\’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.Critical Thinking Essay: Case Study.
You are required to cite to a minimum of two 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. An abstract is not required.Critical Thinking Essay: Case Study.

NURS 8410 Week 10 Discussion Post:

Desired Clinical Outcomes

The use of electronic medical records (EMR) to facilitate telemedicine visits will benefit both the patients and the clinic.  Telemedicine visits incorporate the ability to provide patient care services remotely, which will generate revenue for the struggling clinic.  Furthermore, telemedicine is a solution to closing the gap between the need for healthcare and access to available providers. Critical Thinking Essay: Case Study.

Evaluating Outcomes

Evaluation is the process of examining a program to determine what is working, what is not, and why.  This helps to determine the value or benefits of the program and becomes the blueprint for judgment and improvement (“Formative and Summative Evaluations in the Instructional Design Process”, 2015).  There are many phases of evaluation, for this practice problem the focus will be on formative and outcome evaluations.  Critical Thinking Essay: Case Study.Formative evaluations also known as the internal evaluation, begin with the conception of the program and is a method used to identify the worth of the program while the plan is forming and in progress (“Formative and Summative Evaluations in the Instructional Design Process”, 2015).  Formative evaluations permit the monitoring of how well the goals and objectives are being met and are needed to catch deficiencies so that proper interventions can take place (“Formative and Summative Evaluations in the Instructional Design Process”, 2015).  Outcome evaluations are used to assess the effectiveness of a program in producing change.  These evaluations focus on what happened to the participants and what differences the program made for them.  This is usually the standard evaluation requested by foundations to gauge the benefits of the program (MissionWorks, 2020).  The outcome evaluation is the most useful evaluation in trying to change policy.  The outcome evaluation should show that the initiation of EMR for telemedicine visits would close the gap between access to care for patients while generating revenue for the clinic. Critical Thinking Essay: Case Study.

As mentioned in previous discussions the COVID 19 pandemic has caused a strain on healthcare and revenue affecting this small practicum setting.  Providing telemedicine services that are billed at the same rate as face to face visits will help compensate for missed revenue.

New Practice Guidelines

A system would need to be developed to designate time slots for telemedicine visits with 15-minute grace periods before and after the scheduled visit times.  The provider should be able to access the patient’s EMR during the visit to answer any questions.  Initially, the program would be rolled out slowly with no more than 2 telemedicine visits scheduled per day, per provider to maintain quality visits and not make the provider or patient feel rushed.  A quality assurance/process Improvement (QAPI) leadership team will be developed.  This team’s role will be to ensure the improvement of quality measures with the EMR and telemedicine visits.  The leaders on this team are responsible for deciding which tools will be used to analyze problems, promote change and improvement, and assure that once quality goals are achieved, they are being maintained through control. Critical Thinking Essay: Case Study.

New Standards of Care

When implementing changes to clinical practice, there will likely be changes in the standards of care.  When using EMR to facilitate telemedicine visits some of the new standards would include using a service that has protocols in place to prevent unauthorized access and security features for protected health information. and system access specific to individual roles (“Ethical Practice in Telemedicine”, 2020).  Providers should uphold standards of professionalism in the same manner as to face-to-face visits, be forthcoming in regards to limitations in visits, have the means to obtain vital information, and ensure they have all needed information before making clinical decisions (“Ethical Practice in Telemedicine”, 2020). Critical Thinking Essay: Case Study.