08 Oct This is just a discussion our focus is on Case Stu
This is just a discussion our focus is on Case Study 3. I have also uploaded and example discussion. Discussion: Examining Endocrine, Metabolic, and Hematologic Disorders In the United States, 25.6 million adults age 20 years or older have diabetes (American Diabetes Association, 2011). If not properly treated and managed, these millions of diabetic patients are at risk for several alterations including heart disease, stroke, kidney failure, neuropathy, and blindness. Proper treatment and management is the key for diabetic patients, and as the advanced practice nurse providing care for these patients, it is your responsibility to facilitate this process. Patient education is critical, as is working with patients to establish a regular pattern for daily activities such as eating and taking medications. When developing care plans for patients, you must keep the projected outcomes of treatment in mind, as well as patient preferences and other factors that might impact adherence to treatment and management plans. In this Discussion, you draw from your Practicum Experience and consider factors that impact the education and treatment of patients with diabetes. For this Discussion, consider the following three case studies of patients presenting with endocrine, metabolic, and hematological disorders. Case Study 1 An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia. Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily. There are no known drug allergies. The physical exam reveals a 5’2” older female. Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98%. Further examination reveals the following: Eyes: + pallor conjunctiva Cardiac: irregular rhythm. No S3 S4 or M. NO JVD Lungs: CTA w/o rales, wheezes, or rhonchi Abdomen: soft, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding Rectal: no stool in rectal vault Case Study 2 A 78-year-old female presents to the emergency room after a fall 3 days ago. She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell. She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell. Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals. There are no known drug allergies. The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24. The MCV is normal. Case Study 3 V.G. is a 47 year old African American male with type 2 diabetes diagnosed two years ago. He is for a follow up and complaining of increased tingling to the lower extremities. PMH: obesity, dyslipidemia, HTN. He quit smoking smoking two years ago. Denies any alcohol use. SH: lives with alone in a subsidized housing. He is a veteran and relies on food stamps and welfare. Works occasionally. MEDS: he lost his medications and hasn’t taken any in about a week. His chart indicates his is on Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD, PE: 5’9, BP: 160/100 RBG: 415. To prepare: • Review Part 17 and 21 of the Buttaro et al. text in this week’s Resources. • You will either select or be assigned to a patient case study for this Discussion. • Review the patient case study and reflect on the information provided about the patient. • Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation. • Consider types of physical exams and diagnostics that might be appropriate for evaluation of the patient in the study. • Reflect on a possible diagnosis for the patient. • Think about potential treatment options for the patient. Rubric Detail Select Grid View or List View to change the rubric’s layout. Name: NURS_6531_Week_10_Discussion_Rubric • Grid View • List View Outstanding Performance Excellent Performance Competent Performance Proficient Performance Room for Improvement Main Posting: Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. 44 (44%) – 44 (44%) Thoroughly responds to the discussion question(s) is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. supported by at least 3 current, credible sources 40 (40%) – 43 (43%) Responds to the discussion question(s) is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 75% of post has exceptional depth and breadth supported by at least 3 credible references 35 (35%) – 39 (39%) Responds to most of the discussion question(s) is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of post has exceptional depth and breadth supported by at least 3 credible references 31 (31%) – 34 (34%) Responds to some of the discussion question(s) one to two criteria are not addressed or are superficially addressed is somewhat lacking reflection and critical analysis and synthesis somewhat represents knowledge gained from the course readings for the module. post is cited with fewer than 2 credible references 0 (0%) – 30 (30%) Does not respond to the discussion question(s) lacks depth or superficially addresses criteria lacks reflection and critical analysis and synthesis does not represent knowledge gained from the course readings for the module. contains only 1 or no credible references Main Posting: Writing 6 (6%) – 6 (6%) Written clearly and concisely Contains no grammatical or spelling errors Fully adheres to current APA manual writing rules and style 5.5 (5.5%) – 5.5 (5.5%) Written clearly and concisely May contain one or no grammatical or spelling error Adheres to current APA manual writing rules and style 5 (5%) – 5 (5%) Written concisely May contain one to two grammatical or spelling error Adheres to current APA manual writing rules and style 4.5 (4.5%) – 4.5 (4.5%) Written somewhat concisely May contain more than two spelling or grammatical errors Contains some APA formatting errors 0 (0%) – 4 (4%) Not written clearly or concisely Contains more than two spelling or grammatical errors Does not adhere to current APA manual writing rules and style Main Posting: Timely and full participation 10 (10%) – 10 (10%) Meets requirements for timely and full participation posts main discussion by due date 0 (0%) – 0 (0%) NA 0 (0%) – 0 (0%) NA 0 (0%) – 0 (0%) NA 0 (0%) – 0 (0%) Does not meet requirement for full participation First Response: Post to colleague’s main post that is reflective and justified with credible sources. 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings responds to questions posed by faculty the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives 8.5 (8.5%) – 8.5 (8.5%) Response exhibits critical thinking and application to practice settings 7.5 (7.5%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting 6.5 (6.5%) – 7 (7%) Response is on topic, may have some depth 0 (0%) – 6 (6%) Response may not be on topic, lacks depth First Response: Writing 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues Response to faculty questions are fully answered if posed Provides clear, concise opinions and ideas that are supported by two or more credible sources Response is effectively written in Standard Edited English 5.5 (5.5%) – 5.5 (5.5%) Communication is professional and respectful to colleagues Response to faculty questions are answered if posed Provides clear, concise opinions and ideas that are supported by two or more credible sources Response is effectively written in Standard Edited English 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues Response to faculty questions are mostly answered if posed Provides opinions and ideas that are supported by few credible sources Response is written in Standard Edited English 4.5 (4.5%) – 4.5 (4.5%) Responses posted in the discussion may lack effective professional communication Response to faculty questions are somewhat answered if posed Few or no credible sources are cited 0 (0%) – 4 (4%) Responses posted in the discussion lack effective Response to faculty questions are missing No credible sources are cited First Response: Timely and full participation 5 (5%) – 5 (5%) Meets requirements for timely and full participation posts by due date 0 (0%) – 0 (0%) NA 0 (0%) – 0 (0%) NA 0 (0%) – 0 (0%) NA 0 (0%) – 0 (0%) Does not meet requirement for full participation Second Response: Post to colleague’s main post that is reflective and justified with credible sources. 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings * responds to questions posed by faculty the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives 8.5 (8.5%) – 8.5 (8.5%) Response exhibits critical thinking and application to practice settings 7.5 (7.5%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting 6.5 (6.5%) – 7 (7%) Response is on topic, may have some depth 0 (0%) – 6 (6%) Response may not be on topic, lacks depth Second Response: Writing 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues Response to faculty questions are fully answered if posed Provides clear, concise opinions and ideas that are supported by two or more credible sources Response is effectively written in Standard Edited English 5.5 (5.5%) – 5.5 (5.5%) Communication is professional and respectful to colleagues Response to faculty questions are answered if posed Provides clear, concise opinions and ideas that are supported by two or more credible sources Response is effectively written in Standard Edited English 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues Response to faculty questions are mostly answered if posed Provides opinions and ideas that are supported by few credible sources Response is written in Standard Edited English 4.5 (4.5%) – 4.5 (4.5%) Responses posted in the discussion may lack effective professional communication Response to faculty questions are somewhat answered if posed Few or no credible sources are cited 0 (0%) – 4 (4%) Responses posted in the discussion lack effective Response to faculty questions are missing No credible sources are cited Second Response: Timely and full participation 5 (5%) – 5 (5%) Meets requirements for timely and full participation Posts by due date 0 (0%) – 0 (0%) NA 0 (0%) – 0 (0%) NA 0 (0%) – 0 (0%) NA 0 (0%) – 0 (0%) Does not meet requirement for full participation Total Points: 100 Name: NURS_6531_Week_10_Discussion_Rubric
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