Question

Care Assignment: Branching Exercise: Cardiac Case 2 For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented. Photo Credit: yodiyim –  To prepare: • Review the interactive media piece/branching exercise provided in the Learning Resources. • Reflect on the patient’s symptoms and aspects of disorders that may be present in the interactive media piece/branching exercise. • Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the interactive media piece/branching exercise. • You will be asked to develop a set of admission orders based on the patient in the branching exercise. The Assignment Using the Required Admission Orders Template, write a full set of admission orders for the patient in the branching exercise. • Be sure to address each aspect of the order template • Write the orders as you would in the patient’s chart • Make sure the order is complete and applicable to the patient • Any rationale you feel the need to supply should be done at the end of the order set – not included with the order • Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is appropriate standard of care for this patient. • A minimum of three current, evidenced based references are required. By Day 7 of Week 4 Submit your completed Assignment by Day 7 of Week 4 in Module 2. Submission and Grading Information To submit your completed Assignment for review and grading, do the following: • Please save your Assignment using the naming convention “MD2Assgn2+last name+first initial.(extension)” as the name. • Click the Module 2 Assignment 2 Rubric to review the Grading Criteria for the Assignment. • Click the Module 2 Assignment 2link. You will also be able to “View Rubric” for grading criteria from this area. • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “MD2Assgn2+last name+first initial.(extension)” and click Open. • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. • Click on the Submit button to complete your submission. Grading Criteria To access your rubric: Module 2 Assignment 2 Rubric Check Your Assignment Draft for Authenticity To check your Assignment draft for authenticity: Submit your Module 2 Assignment 2 draft and review the originality report. Submit Your Assignment by Day 7 of Week 4 To participate in this Assignment: Module 2 Assignment 2

Answer

Care Admission Orders for a Cardiac Case: Advanced Care of Adults in Acute Care Settings I

Primary Diagnosis: Hypertensive stroke/ Acute MI (in diabetes mellitus and hypertension)

Status/Condition (Critical, Guarded, Stable, etc.): Critical.

Code Status: DNR (Do Not Resuscitate)

Allergies: NKA to foods, medications, and environmental allergens

Admit to Unit: High Dependency Unit (HDU).

Activity Level: Drowsy, not alert.

Diet: Hypertensive and diabetic diet

IV Fluids: 

• Critical Drips (If ordered, include type and rate. Do not defer to ICU protocol.): 
• Physiological (isotonic) saline at 10 dpm.

Respiratory: Oxygen (If ordered, include type and rate.), pulmonary toilet needs, ventilator settings: 

• SpO₂ = 88% at RA
• Supplemental oxygen at 2L/ min by face mask

Medications

1. Metoprolol (Lopressor) 50 mg orally q 6 hrs for 48 hours
2. Aspirin 160 mg per day orally
3. Humulin N 0.5 IU per kg/ day
4. Calcium 500 mg orally daily (Katzung, 2018)

Nursing Orders

• Take (record) vital signs hourly
• Perform skin care on pressure areas while turning the patient every two hours
• Catheterize with an indwelling Foley’s catheter
• Fit with adult pampers for toileting
• Maintain a strict input and output chart
• Liquid feeds via nasogastric tube (NGT) every 4 hours
• Catheter care (daily) to prevent CAUTI

Follow-Up Lab Tests:

• Diagnostic testing (CXR, US, 2D Echo, etc.): 
• Plain antero-posterior chest X-ray
• 2D echocardiogram
• Electrocardiogram (ECG)
• MRI of the head
• Full blood count (FBC)
• Cardiac enzymes

Consults:

• Nutrition consult for composition of the liquid feeds
• Cardiology consult for interpretation of the echo readings
• Family consult to determine the holder of medical power of attorney (MPOA)

Patient Education and Health Promotion

• Because of the DNR advance directive, no active patient education or health promotion is needed (Fine, 2020).
• Family therapy to cope with the impending loss of a loved one. 

Discharge Planning and Required Follow-Up Care:

• Patient is critically ill and is under a DNR directive
• Poor prognosis (Hammer & McPhee, 2018)
• In case of discharge; to continue with current medications at home
• Review in two weeks

References Fine, L.E. (February 14, 2020). End of life decisions: Powers of attorney & living wills.