NURS 317 Fundamentals of Nursing Care in the Context of Older and Adults

NURS 317 Fundamentals of Nursing Care in the Context of Older and Adults

Order ID	53563633773
Type	Essay
Writer Level	Masters
Style	APA
Sources/References	4
Perfect Number of Pages To Order	5-10 Pages
Description/Paper Instructions Order ID 9692690742 Subject Nursing Topic Nursing care plan Type Term paper Level University Style APA Sources 3 Language English(U.S.) Description 1. please see the attached rubric, care plan and template 2. Three sources/references not more than five years 3. Please use the template to write the care plan according to the rubric. NURS 317 Fundamentals of Nursing Care in the Context of Older and Adults University of Maryland School of Nursing NURS 317: Fundamentals of Nursing Care in the Context of Older and Adults Nursing Care Plan Template The following template is aligned with the grading rubric for the Nursing Care Plan assignment and serves to guide the collection of patient data for the assignment. Refer closely to the grading rubric to ensure that all required information is included in the proper presentation format. Utilize primary and secondary sources for data collection. Patient Introduction — written in narrative format Include: demographics of age, gender,  and reason for admission, history of present illness, , functional level, allergies, and code status. Physical Assessment and Interpretation — written in tabular form Include: Assessment from care plan information Provide nursing diagnoses, written in proper format (NANDA dx, r/t aeb), when deviations from normal are present Assessment (Date/Time of assessment) NANDA Problem(s) Psychosocial Assessment: (General description of emotional/psychosocial status) Subjective/Complaints (in patient’s own words): Behavior/Affect: Communication:   Vital Signs: T:     P:         R:       BP:        Saturation:   Neurological: Subjective/Complaints (in patient’s own words): Pain (rate, location, description): Level of Orientation: Pupils (each eye) — size and reaction: Movement/Strength/Sensation (each extremity): Cranial Nerves: Glasgow Coma Scale:   Musculoskeletal: Subjective/Complaints (in patient’s own words): Use of Assistive Devices: Posture/Gait: Assess ROM/Palpate joint movement (describe abnormalities of limbs/joints): Extremity Movement/Grade Strength (5/5 normal):   Cardiovascular: Subjective/Complaints (in patient’s own words): Skin color: Heart Sounds (51, S2): Peripheral Pulses/Edema (each extremity/grade): Devices (Pacemaker or other):     Respiratory/Thorax: Subjective/Complaints (in patient’s own words): Oxygen Delivery (device and flow rate or %): Inspect thorax/skin: Symptoms, i.e. cough, wheezing, nasal flaring, etc. (if sputum, describe): Breath Sounds (anterior and posterior):   G-I/Abdominal: Subjective/Complaints (in patient’s own words): Symptoms, i.e. nausea, emesis, diarrhea, anorexia, etc.: Dietary Intake (type of diet): Appearance of abdomen: Bowel Sounds (all 4 quadrants): Date of Last BM (appearance): Ostomy type/location/appliance:   G-U: Subjective/Complaints (in patient’s own words): External Inspection: Urine Color and Amount: Odor:   Integument: Subjective/Complaints (in patient’s own words): Skin Color/Temperature (all surfaces): Hair (condition, texture, presence/absence): Nail (condition, color, thickness):   Knowledge: Can patient accurately describe situation?     Diagnostic Data — written in tabular format/significance written in narrative Include: relevant normal and abnormal lab, radiographic, diagnostic (ie, EKG) results, from multiple dates. Interpret the results and discuss the significance for the patient under study. Include a source for the stated reference range. Diagnostic Results Reference Range* Interpretation                 *Reference Source: Pathophysiology — relationships presented in flowchart/description in narrative Include: four (4) pathophysiologic factors affecting the patient’s condition (concept map format) and describe Morbidity and Mortality — written in narrative format Include: population data describing incidence, prevalence of death and disease associated with the pathology identified in the flowchart Medications — written in tabular format Include: Trade and generic name, administration information, classification, mechanism of action, and the indication or reason why the patient is receiving the medication. Avoid the use of unaccepted abbreviations (ie, BID)   Drug Generic/Trade Administration Classification MOA Indication             Nursing Diagnosis Statement — written in narrative format Include: two (2) relevant physical and two (2) relevant psycho-social diagnosis statements, supported by the assessment data, written in proper format Plan — written in tabular format Include: One (1) plan for a physical diagnosis and one (1) plan for a psycho-social diagnosis. The plan is to include the nursing diagnosis statement, outcomes/goal, interventions, and evaluation Outcomes/Goal — written in tabular form Include: One goal (long term) and three (2) outcomes for each plan. Outcomes are short term, specific, measurable, achievable, realistic, and provide a time for achievement Interventions — written in tabular form Include: independent or dependent (require provider orders) actions aimed at addressing or eliminating the “related to” in the nursing diagnosis statement. Provide rationales and citations for interventions Evaluation — written in tabular form Include: conclusion regarding the achievement of the outcome: met, partially met, not met. Provide evidence to support the conclusion and modifications to the plan Nursing Diagnosis Statement: Goal: Long term Outcomes Interventions Evaluation                                 Format — assignment reflects conventions of scholarly writing (spelling, grammar) submitted in APA format, meeting page and citation requirements Fundamentals of Nursing Care in the Context of Older Adults  NURS 317 Care Plan Grading Rubric Student: Section Description of Full Points Possible Points Points Earned Patient introduction No initials, please refer to ‘Patient’ as identifier ·         Full sentences ·         Grammatically correct ·         Only acceptable abbreviations Includes, in order: Age range (20-45, 46-65, 66-88, >85) Gender, race (only if applicable to the diagnosis) Reason for admission and history of present illness Family and social history Functional level Allergies Code status 2   Assessment and interpretation Physical assessment is complete, accurate, and organized. Problems identified are in keeping with the data recorded and are stated as a NANDA Diagnosis. 3   Diagnostic data Lab and radiology data results are correctly interpreted in light of the patient’s history and current condition. Normal and abnormal interpretation of lab and radiology data is interpreted and discussed for significance to patient status and disease pathology. Preferably looking at multiple dates for comparative analysis. If lab/diagnostic data is unavailable, discuss what would be warranted or recommended with appropriate cited rationale. 7   Pathophysiology Concept map Pathophysiology flowchart – (In fundamentals, does not have to be the patient’s reason for admission) Pathophysiology of the most relevant disease process must be described (not defined) ·         At least 4 pathophysiologic factors affecting this patient’s condition needs to be described ·         Illustrates interrelationships among the factors (risk factors, causes, what increases or decreases severity, what might protect against poor outcomes.) 10   Morbidity and mortality ·         Full sentences ·         Grammatically correct ·         Only acceptable abbreviations Morbidity and mortality statistics are given for the pathophysiological disease process discussed in concept Map. ·         incidence and/or prevalence, risk factors ·         considers patient age, gender, race, socioeconomics ·         population groups affected ·         resulting morbidity and mortality 5   Medications Medication list correctly identifies the mechanism for action, drug classification, and purpose of each medication specific to this particular patient 7   Diagnosis Two physical and 2 psychosocial diagnoses are identified. Not necessarily related to physical diagnosis or pathophysiology concept map 5     Diagnoses are in keeping with assessment data recorded within paper 5     Diagnoses are high priority and amenable to nursing intervention 5     Diagnoses use NANDA labels and are correctly expressed (i.e., include etiology and/or defining characteristics as appropriate – PES as discussed in lecture problem, etiology and sign/symptoms) 5   Plan A plan is written for one physical and one psychosocial diagnosis 5   Outcome or goals Outcome statements ·         address the nursing diagnosis ·         are realistic and patient specific ·         are measurable, observable and stated with appropriate time frame ·         Must have at least 1 long term goal and 3 short goals for each problem identified 6   Implementation (Intervention) Interventions are ·         appropriate to address the nursing diagnosis ·         safe, patient specific and appropriate ·         some are original or innovative (need to be stated with own rationale) ·         Rationales are given for each intervention and are appropriately cited via APA format ·         Article is incorporated into this section of the paper (EBP) 6     Interventions take into account this patient’s unique strengths, resources, or preferences 5     Evaluation A statement as to whether goals were met or not met is made for each outcome; if met quantify or qualify the degree to which the outcome was achieved. 6     The degree to which outcomes were achieved is quantified and/or qualified 5     Suggestions for improving the plan of care are noted and demonstrate reflective practice on the part of the student 6   APA Format ·         Spelling, ·         Grammar ·         Punctuation Clarity of writing are all part of APA style Must have at least three references- (unless a seminal paper, none older than 5 years). References must be properly cited using APA format. At least one reference must be an article that is addressed within interventions. https://owl.english.purdue.edu/owl/resource/560/01/ Page limit: 10-15 pages maximum 7   TOTAL Points   100   Comments: Faculty Signature: _________________________________ MJ is a 85-90 year old female resident of a Nursing Home for 3 years Widow with 1 daughter who visits regularly Admitted for frequent falls and weakness             DX: CVA’s multiple, thyrotoxicosis, type II diabetes mellitus, hearing impairment. She hypertension, dyslipidemia, malignant neoplasm breast cancer, vascular dementia Functional status:  dependent in bathing, dressing, toileting and mobility, hard of hearing Allergies: Penicillin Code Status: DNR Assessment Physical Assessment (11/15/19 & 11/22/19 0900) Psychosocial Assessment: Denies any depression or anxiety Behavior is calm and cooperative Pleasant demeanor Affect is blunted Has good eye contact Speech is sparse, slow, and requires great effort Able to give one-word or short answers that are appropriate but lack normal tone Seems to understand most language spoken to her when wearing hearing aid Vital Signs: T: 98 F P:78 R: 20 BP: 123/61 O2: 96% on room air. Administer 2L of oxygen via nasal cannula PRN if O2 is below 93% Neurological: No reports of loss of consciousness or seizures Lightheadedness with frequent turning during bed bath History of cerebral vascular accidents (CVAs) History of dysphagia Alert and oriented x1-2 Normocephalic Uses hearing aid in left ear Pupils are equal, round, reactive to light, and accommodation (PERRLA) No conjunctival icterus or pallor Light touch, sharp and dull sensations present in extremities No signs of peripheral neuropathy Chart showed positive Babinski test CN I-XII intact Glasgow Coma Scale score 14 Musculoskeletal: Complains of muscle weakness in legs Needs full assistance with ADLs Non-ambulation Wheelchair dependent, able to self-propel Posture in WC is upright Chart states positive crepitus in metatarsophalangeal joint (first MPJ) with dorsiflexion and plantar flexion Neck supple, full ROM 4+/5 bilateral upper extremity strength 2+/5 lower extremity strength Cardiovascular: No chest pain or palpitations History of hypertension Skin color brown and warm S1 and S2 sounds present, murmurs absent S3 or S4 sounds absent No bruits in carotid arteries Carotid pulse 2+ bilaterally No edema in lower extremities Peripheral pulses palpable (DP, PT, and radial) No reported pacemaker or other cardiac devices Respiratory/Thorax: No reported shortness of breath Complains of chronic cold with persistent cough Absence of sputum and blood with cough O2 treatment of 2L of oxygen via nasal cannula PRN if O2 is below 93% Symmetric chest expansion Skin is brown, warm, and smooth No cyanosis or pallor Symmetric thorax Scar over left breast from lumpectomy Anterior and posterior breath sounds clear to auscultations bilaterally G-I Abdominal: No reported GERD or changes in bowels Denies nausea, vomiting, or diarrhea Admits to not wanting to eat food offered History of DMT2 Reports defecating 1x per day On low carbohydrate and low cholesterol diet Abdomen is soft, round, and nontender on inspection Abdominal fold present No hair growth Bowel sounds present in all four quadrants No guarding or tenderness with palpation Date and appearance of last BM not obtained Ostomy not applicable G-U: Denies burning or pain with urinating Frequency and urgency normal Incontinent Wears Depends Adult Diaper External inspection – skin color is even with normal hair distribution, no swelling or lesions present, and perineum intact and smooth Urine is clear, odorless Minimal urine output in diaper, but specific amount not obtained Integument: Complains of hair loss and dry skin Skin is uniformly brown and warm equal bilaterally Skin has lighter pigmentation on palmar surface of hand Skin texture is thin and well hydrated except on hands and feet where it is dry and cracking Absence of hair growth on body and face Significant hair loss on scalp Remaining hair texture is coarse and graying Nails are yellow, thick, and long Capillary refill intact Turgor appropriate and intact Knowledge: Patient has intermittent confusion about where she is and why she is there, but can typically accurately describe her situation. Patient consistently states her daughter is 24 years old, although her chart says her daughter is in her 50’s Diagnostic tests 12/12/18 Chest x-ray: no active cardiopulmonary disease or any radiographic evidence of active TB or pneumonia Diagnostic Results Reference Range* Sodium 141 mEq/L 136 – 142 mEq/L Potassium 4.2 mEq/L 3.5 – 5.0 mEq/L Chloride 103 mEq/L 96 – 106 mEq/L Carbon dioxide 24 mEq/L 22 – 28 mEq/L Glucose 183 mg/dL 70 – 110 mg/dL HgA1c 7.5% 4 – 5.6% Albumin 3.6 g/dL 3.5 – 5.0 g/dL BUN NH 16 mg/dL 8 – 23 mg/dL Creatinine NH 0.74 mg/dL 0.6 – 1.2 mg/dL Calcium 9.3 mg/dL 8.2 – 10.2 mg/dL Aspartate aminotransferase (AST) 15 U/L 10 – 40 U/L Alanine aminotransferase (ALT) 17 U/L 10 – 40 U/L Alkaline phosphatase 74 U/L 50 – 120 U/L Total Protein 6.6 g/dL 6.0 – 8.0 g/dL Cholesterol 139 md/dL <200 mg/dL Triglycerides 273 mg/dL 10 – 190 mg/dL HDL 43 mg/dL 40 – 60 mg/dL LDL 41 mg/dL <100 mg/dL WBC 8.1 μL−1 4.5 – 11 μL−1 RBC 4.03 μL−1 3.9 – 5.5 μL−1 HGB 11.4 g/dL 12 – 15.5 g/dL HCT 36.1% 35% – 45%   DRUG Generic/Trade Administration Acetylsalicylic acid (Aspirin) 81 mg, by mouth (PO), once a day (QD). Therapeutic dose. Letrozole (Femara) 2.5 mg PO QD Therapeutic dose Glyburide (Glynase) 2.5mg PO QD Therapeutic dose Metformin (Glucophage) 500 mg extended release PO QD Therapeutic dose Losartan (Cozaar) 25 mg PO QD Therapeutic dose Simvastatin (Zocor) 20 mg qhs PO Therapeutic dose   Spacing Double Pages 10
RUBRIC Quality of Response No Response Poor/Unsatisfactory Satisfactory Good Excellent Content (worth a maximum of 50% of the total points) Zero points:  Student failed to submit the final paper. 20 points out of 50:  The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50:  The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately.  Elements of the required response may also be lacking. 40 points out of 50:  The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples.  The answer is complete. 50 points:  The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples.  No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points:  Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points:  Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points:  References to scholarly sources are occasionally given; many statements seem unsubstantiated.  Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points:  Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented.  APA 6th Edition is used with only a few minor errors.  There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points:  Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented.  APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points:  Student failed to submit the final paper. 5 points out of 20:  The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors  10 points out 20:  The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization;  and/or some grammatical, spelling, punctuation errors 15 points out of 20:  The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points:  The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points:  Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. The can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements.  The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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