In a short essay (500-750 words), answer the Question at the end of Case Study 2. Cite references to support your positions.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to LopesWrite.

This is the case study:

Max Points: 20.0

Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions.

Case Scenario

Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.

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 so exhausted she cannot eat or drink by herself.

Objective Data

1. Height 175 cm; Weight 95.5 kg
2. Vital signs: T 37.6 C, 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 4 cm below costal margin

Critical Thinking Questions

What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)

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.

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 rationale for each of the interventions you recommend.

Public health is an essential function of the government on a par with, and for reasons similar to, national defense and law enforcement. Specific public health needs, such as sanitation systems and clean water, cannot be met by individuals acting alone. The government is required to organize community efforts as well as compel cooperation when necessary; otherwise, individuals would be free to benefit from, but not contribute to, the resulting public good.

Considering the above, respond to the following:

• What are the key roles for government in serving the public’s health? Why?

Submission Details:

• Post your response to the Discussion Area by the due date assigned. Respond to at least two posts by the end of the week.
• Give examples and reasons in support of your responses.
• Write your initial response in 300–500 words.

(3 pages)

You are attending a general meeting with management to discuss proposed changes in the Quality Assurance program secondary to a “never event” occurring in your organization [you can consider any never event offered by the AHRQ]. After the presentation and during a question and answer period, several nurses indicate that the “never event” occurred because of inadequate staffing. Several surgeons joined the nursing staff in these allegations.

1. What would your response be to their statements?
2. Discuss what a “never event” is.
3. Discuss what never event occurred that was discussed at this meeting. You must pick one never event such as wrong site surgery, wrong medication given, wrong blood transfusion given, etc.
4. Discuss how you would go about examining the validity of their statements.
5. What measures you would implement on an ongoing basis to prevent a recurrence of the “never event”.

In this module, you also learned about 4 approaches to quality assurance- TQM, CQI, Lean & Six Sigma.

1. Which of these approaches would lend to preventing a “never event”? Justify your answer.

Cantrell, S. (2016). Tooling up to prevent never events. Northfield: Healthcare Purchasing News.

Dimsdale, J. E. (2017). Assuring quality health care outcomes: lessons learned from car dealers? Patient Related Outcome Measures, 8, 1–6.

Gleeson H, Calderon A, Swami V, et al. (2016). Systematic review of approaches to using patient experience data for quality improvement in healthcare settings. BMJ Open 2016;6:e011907.

Ha, C., McCoy, D. A., Taylor, C. B., Kirk, K. D., Fry, R. S., & Modi, J. R. (2016). Using Lean Six Sigma methodology to improve a mass immunizations process at the United States Naval Academy. Military Medicine, 181(6), 582-588.

Health and medicine – health organization and management; University of Malta details findings in health organization and management (continuous quality improvement in a Maltese hospital using logical framework analysis). (2017). Health & Medicine Week, , 5215.

Module 2 DQ 1 and DQ 2

Tutor MUST have a good command of the English language

These are two discussion questions

Your DQ1 and DQ2 posts must be at least 150 words and have at least one reference cited for each question. In-text citation, please

Tutor MUST have a good command of the English language

Sources need to be journal/scholarly articles. 

Use only articles that are published between 2015-2018 (except for your theory articles which will be older as you must cite primary sources).

No textbook or direct quotes

Please separate the two DQ with their references

Topic 2 DQ 1

How could you use descriptive epidemiological methods in your practice? Provide an example where you could use descriptive epidemiology to improve care. Explain your rationale.

Topic 2 DQ 2

Which epidemiological study design would you use to evaluate an intervention in your practice? Provide a description of the chosen population and the identified intervention. Provide support as to why you believe that the design you chose is the best option including the strengths and weaknesses of the design you have chosen.