NUR 540 Milestone One Assignment

NUR 540 Milestone One Assignment

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

In this milestone, you will review the subject of your unfolding case study and begin to evaluate Ms. Larsen. You will submit the Introduction and Assessment portions of the final project. This milestone is designed for you to begin to demonstrate the application of pathophysiology to a case analysis.

Case Study Part I

Millie Larsen is an 84-year-old African American female who is both a widower and grandmother. She is moderately obese (BMI of 32), and she has continued to smoke one pack of cigarettes a day for the past 40 years. She awakens one morning with weakness on her left side. She is having difficulty with word choice, and her speech seems to be slurred. When she attempts to walk to the bathroom, she stumbles a few times and falls once. Her daughter Dina, who lives next door and is visiting for breakfast, suspects that she has suffered a stroke and calls 911. Emergency personnel arrive within minutes of her call and transport Ms. Larsen to the emergency room (ER) of the nearest hospital.

The EMT team calls ahead to the ER, informing the department of a potential cerebral vascular accident (CVA) victim. Upon arrival, Ms. Larsen continues to deteriorate by becoming more disoriented and increasingly agitated with the staff and her daughter. She continues to have slurred speech and difficulty finding words. The physician orders a non-contrast head CT. It has now been 90 minutes since the onset of the symptoms. The triage nurse has managed to obtain the following medical information from Dina about Ms. Larsen:

Past Medical History Home Medications
Hypertension   Indomethacin (Indocin) 25 mg three times a day
Hypercholesterolemia   Aspirin 81 mg daily
  Smokes one pack per day x 40 years (40 pack years)   Lisinopril (Prinivil) 20 mg daily
Osteoporosis   Simvastatin (Zocor) 40 mg daily
  Type II diabetes mellitus   Metformin (Glucophage) 500 mg twice a day

Other pertinent information that was revealed during the interview with Dina is that Ms. Larsen lives in her own home in a small rural community. Ms. Larsen is a recent widower who lost her husband of 55 years to cancer about three months ago. Ms. Larsen lives alone in their small home with a pet cat named Snuggles. Dina is Ms. Larsen’s only support system and is concerned that her mother is not always diligent at following the healthcare provider’s recommendations in controlling her longstanding Stage II hypertension and diabetes. In addition, Dina has attempted to encourage her to stop smoking on several occasions.

Current Vital Signs: BP: 168/88, Pulse: L arm, 110 irregular, RR 20; Temp 37.9°C oral; Random blood glucose: 89; Pain level: 2 out 5 using the numerical rating scale. Heinrich II Fall Risk Score = 8.

Approximately 60 minutes since Ms. Larsen arrives at the ER, she has settled back in the holding area awaiting a bed in the step-down area of the hospital. The nurse calls Dina back to visit with her mother. Dina finds her mother lying in bed with the head of the bed elevated, a nasal cannula in place, and an IV infusing into her right arm, and she is connected to telemetry. The nurse informs Dina that the results of the head CT point to “no bleed” and was interpreted by the neurologist on the stroke team, who will be in shortly to discuss the plan of care for Ms. Larsen. In a few minutes, the stroke team meets with Dina, and the neurologist discusses the plan to begin ischemic stroke protocol. In addition, Ms. Larsen will be admitted to the hospital as soon as a bed becomes available.

Dina is confused and concerned. She has many questions as the team begins the next phase of treatment for Ms. Larsen.

Imagine you are a graduate nurse working in the emergency room and helping to prepare Ms. Larsen’s admission to the hospital. You will evaluate some of the key elements of Ms. Larsen’s history and background that may have led to her current medical condition.

Specifically, the following critical elements must be addressed:

  1. Introduction
  • Discuss the role of ethnicity, culture, and socioeconomic status as each relates to the development of chronic disease for this case, including how these factors may increase the risk of an individual developing chronic disease.
  • Based on your patient’s case, demonstrate how cellular changes can affect the cardiovascular system and other systems of the human body. Explain how early interventions may affect the processes of reversible and irreversible cellular injury to the vascular region.
  1. Assessment
  1. Prioritize key elements of the patient’s health history that are important for designing a plan of care. Provide rationales that support the prioritization of the elements.
  1. Based on your understanding of physiology, determine the elements of the physical exam that would be used to collect assessment data for a focused exam related to the patient’s loss of blood supply to her vascular region.
  1. Explain the expected physical assessment findings of the patient’s focused exam and how it might compare to someone with normal physiology.

Rubric

Guidelines for Submission: This milestone must be 1–2 pages in length (plus a cover page and references) and should use double spacing, 12-point Times New Roman font, and one-inch margins. All references should be cited according to APA style.

Critical Elements Proficient (100%) Needs Improvement (75%) Value
Introduction: Ethnicity, Discusses how ethnicity, culture, and Discusses how ethnicity, culture, and 15
Culture, and socioeconomic status influence the socioeconomic status influence the  
Socioeconomic Status development of chronic disease, including development of chronic disease, including  
  how these factors may increase the risk of how these factors may increase the risk of  
  an individual developing chronic disease an individual developing chronic disease,  
    but discussion is cursory or illogical or  
    contains inaccuracies  
Introduction: Cellular Demonstrates how cellular changes can Demonstrates how cellular changes can 15
Changes affect the cardiovascular system and other affect the cardiovascular system and other  
  systems of the human body systems of the human body, but discussion  
    is cursory or illogical or is not specific to  
    the patient’s case  
Critical Elements Proficient (100%) Needs Improvement (75%)
Introduction: Early Explains how early interventions may Explains how early interventions may
Interventions affect the processes of reversible and affect the processes of reversible and
  irreversible cellular injury to the vascular irreversible cellular injury to the vascular
  region region, but explanation is cursory or
    illogical or contains inaccuracies
Assessment: Key Prioritizes key elements of the patient’s Prioritizes key elements of the patient’s
Elements health history that are important for health history that are important for
  designing a plan of care, including designing a plan of care, but elements are
  rationales that support the prioritization of not prioritized appropriately or do not
  the elements have rationales that support the
    prioritization
Assessment: Elements Determines the elements of the physical Identifies elements of the physical exam
of the Physical Exam exam that would be used to collect that would be used to collect assessment
  assessment data for a focused exam data but does not determine all elements
  related to the patient’s loss of blood for a focused exam related to the patient’s
  supply to her vascular region loss of blood supply to her vascular region
Assessment: Physical Explains the expected physical assessment Explains the expected physical assessment
Assessment findings of the patient’s focused exam and findings of the patient’s focused exam and
  how it might compare to someone with how it might compare to someone with
  normal physiology normal physiology, but explanation is
    cursory or illogical or contains inaccuracies
Articulation of Submission has no major errors related to Submission has major errors related to
Response citations, grammar, spelling, syntax, or citations, grammar, spelling, syntax, or
  organization organization that negatively impact
   

readability and articulation of main ideas

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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