NR 305 Week 3: Cardiovascular Assessment: Michael Granger (iHuman) (Graded)

Sample Answer for NR 305 Week 3: Cardiovascular Assessment: Michael Granger (iHuman) (Graded) Included After Question

NR305 Week 3 iHuman Nurse Notes Template 

Week 3 Cardiovascular Assessment: Michael Granger

Name:

Date: 24^th September 2023

 Complete each item below:  

Situation

• Michael Granger is a 69-year old male admitted for a heart failure exacerbation from the cardiologist’s office. He was diagnosed with stage II right-sided heart failure one year ago. He reports a recent weight gain of 8 pounds, bilateral lower extremity edema, and shortness of breath for two days. He weighs self-daily (qAM), is under strict I/O observation.  

Background

• Patient has a PMH of stage II right-sided heart failure diagnosed a year ago, he has hyperlipidemia, coronary artery disease (CAD), hypertension, and experienced a myocardial infarction three years ago. Currently using the following medications;
  • Aspirin 81mg PO daily
  • Fish oil 2400mg PO daily
  • Hydralazine 100mg PO TID
  • Metoprolol25mg PO BID
  • Simvastatin 40mg PO qPM
  • Spironolactone 25mg PO qAM
  • Valsartan 40mg PO BID

Social history:

• The patient is married and retired, currently, he lives with his wife. He is a social drinker and a chronic smoker. He however denies recreational/illicit drug use and abuse. He also does not exercise and exhibits non-compliance with dietary restrictions (low sodium diet).

Assessment

BP: 136/84mmHg

Pulse: 90

RR: 30

Temp: 98.8⁰F

HEENT: Head: atraumatic, normocephalic Eyes: PEBRL, vision 30/30 (RE) and 30/30 (LE), no periorbital edema, conjunctival pallor or bleeding.  Ears: hearing bilaterally intact, no signs of inflammation or fluid surrounding the tympanic membrane, TM is intact. Nose & Throat: are pink and moist mucus membranes, no oral sores, oral thrush, or exudates. No pain with neck movement, no carotid bruits, or JVD. No palpable masses or enlarged thyroid.

Respiratory: chest moves paradoxically with respiration, there are bilateral coarse crackles at lung bases on auscultation, no palpable lumps or masses. Lung fields are resonant n percussion.

Cardiovascular: S3 heart sound heard.  There is 2+ pedal edema to lower extremities. No rubs or gallop rhythm. s

Gastrointestinal: abdomen is non-distended without scars, lumps, or swellings. Normoactive bowel sounds, and without guarding, tenderness or rebound tenderness.

Musculoskeletal: symmetrical muscle development, muscle strength and tone 5/5, all joints have FROM.

CNS: patient is AOX4, CN 11-XII are intact, DTRs (deep tendon reflexes) grossly intact, sensory intact, patient follows both simple and complex commands.

Integumentary: color consistent with ethnicity, normal skin turgor, less than three seconds, without evidence of bruising or bleeding

Recommendation

• Address the patient’s edema by correcting fluid imbalance using IV frusemide
• Strictly monitor the patient’s input & output (I/O)
• Restrict the fluid intake for this patient
• Perform a PA and lateral views chest x-rays, a BNP (brain natriuretic peptide), complete blood count (CBC), and a basic metabolic profile (BMP).
• Elevate bilateral affected limbs
• Consider close cardiac monitoring.
• Administer oxygen at 2L via nasal cannula
• Position the head of bed (HOB) at high fowler’s position
• Order for a transthoracic echocardiogram, encourage the patient to continue with the present medication regimen, and educate the patient about smoking cessation and low sodium diet (LSD).
• Priority teaching topics for Mr. Granger’s discharge plan.
• Observing a strict low sodium diet- it will be essential to emphasize and teach Mr. Granger to decrease his daily sodium intake to be able to manage heart failure symptoms and prevent them from worsening. High intake of dietary sodium promotes retention of fluid, which is a cause for hospitalization among heart failure patients (Bowen et al., 2018). Potential barriers identified to prevent adherence to a LSD include; inadequate/lack of knowledge about LSD, limited time to prepare LSD, poor taste, and lack of support from family members.
• Smoking cessation- epidemiological studies reveal the association which exists between lifestyle habits such as obesity and smoking and heart failure exacerbations (Son & Lee, 2020). Tobacco smoking remains one of the most essential modifiable cardiovascular disease risk factor. Persistent smoking after a diagnosis of heart failure worsens outcomes in the long term and decreases the efficacy of treatment of heart failure. It also increases oxidative stress, diastolic, and systolic blood pressures (Son & Lee, 2020). Eventually, this can worsen renal and endothelial function, and cause vascular inflammation. Smoking cessation has been shown to slow down and prevent the adverse outcomes associated with the aforementioned processes.
• Findings in iHuman assessment prompting the selection of the identified discharge teaching topics.
  • The patient’s history revealed that he is a chronic smoker and has difficulties maintaining a strict low sodium diet. This is despite his underlying diagnoses of heart failure, coronary artery disease, hypertension, and hyperlipidemia, which pose an overall greater risk on his health.
• How to teach this information to Mr. Granger.
  • Tobacco smoking is the most preventable modifiable cause of cardiovascular death. It not only leads to permanent damage to the heart and blood vessels but also adds additional stress on the workload of the heart. As a result, the heart cannot meet the body’s oxygen demand which leads to fluid accumulation in vital organs (liver, lungs). Smoking cessation through nicotine replacement therapy (NRT) is a viable solution for patients diagnosed with cardiovascular conditions (Son & Lee, 2020). For NRT to be effective, you will have to identify and avoid triggers that encourage tobacco smoking and when you feel the urge to smoke, you can chew gum or lozenges. I will share with you the 1-800-QUIT-NOW, Quit Smoking for Good Pamphlet from the American Heart Association (AHA). It contains important and useful details for patients trying to quit smoking. You will also need a support group and family support to make this cessation journey easier.
  • Reducing your salt intake is necessary to prevent the heart and vital organs such as the kidneys from working harder and worsening your current health status. A practical intervention would be appreciating and consuming foods with low salt content to help your taste buds adjust. These foods include; pasta, oatmeal, poultry, milk, and eggs. Take time to read and understand food labels to know what is suitable or not for your consumption. Generally, avoid foods exceeding 350 mg of salt (Bowen et al., 2018).

References

Bowen, K. J., Sullivan, V. K., Kris-Etherton, P. M., & Petersen, K. S. (2018). Nutrition and cardiovascular disease—an update. Current atherosclerosis reports, 20, 1-11.

Son, Y. J., & Lee, H. J. (2020). Association between persistent smoking after a diagnosis of heart failure and adverse health outcomes: A systematic review and meta-analysis. Tobacco induced diseases, 18. https://doi.org/10.18332%2Ftid%2F116411

Assignment

Purpose

The purpose of this assignment is for learners to demonstrate completing a cardiovascular assessment on a virtual patient.

Course Outcomes

This assignment enables the student to meet the following course outcomes:

• CO 1: Demonstrate a head to toe physical assessment. (PO 1)
• CO 2: Differentiate between normal and abnormal health assessment findings. (PO 4)
• CO 4: Demonstrate effective communication skills during health assessment and documentation. (PO 3)
• CO 5: Identify collaborative opportunities for health promotion, risk reduction, and disease prevention. (POs 1, 2)
• CO 6: Demonstrate professional behavior and caring during patient interactions. (POs 6, 7)

Due Date

Sunday 11:59 p.m. MT at the end of Week 3

Total Points Possible

This assignment is worth 150 points.

• 100 points – Case Completion
• 50 points – Nurse Notes Responses

Late Assignment Policy

If the assignment is not submitted by due date, a late deduction will be applied. See rubric below.

Directions

1. Access the Michael Granger case assignment by locating the case in the Week 3 Module menu under Application to Practice. If prompted, select to load the case in a new browser window. Note: it may take a few moments for iHuman cases to load in our web browser.
2. Select Proceed and begin by answering the Prework questions. Your prework answers are not graded. The questions are intended to get you thinking about the case. You will continue to select the Proceed button to move you through the entire case.
3. Begin the case and complete these sections: (100 points total, immediate feedback/grade will be provided to you by iHuman when complete)
   • EHR Review
   • Health History
   • Physical Assessment
   • Note: there is no time limit on completing cases
4. As you move through your first attempt and once you complete the case, you will receive feedback from the “Expert” on the important findings that you included (or should have included), and information that should have been collected on the health history and physical assessment. The system will also tell you if you asked questions or performed assessments that are considered extraneous or inappropriate for that particular case. Review this information carefully and take notes to be used on your second attempt, if you would like to work toward a higher score.
5. If you must leave the case for any reason before you have totally completed it, the program will save your spot and will return you to the same point when you re-enter the case. (Look for the green “Resume” arrow at the bottom of the screen.) If you had fully completed a section, you will be able to review the section, but you will not be able to change your answers. You will only be able to move forward in the case.
6. Nurse Notes (50 points) are completed outside of iHuman and are graded by your instructor. To complete the Nurse Notes, download and save the required template below under Template. Rename the template as Your Last Name Week 3 Nurse Notes. This must be saved as a Microsoft Word document (.docx). Save it to your computer or flash drive in a location where you will be able to retrieve it later. Type your answers directly on the saved document. When your Nurse Notes answers are completed, save and close the template. Click the Submit button at the top of this page to upload your completed assignment. 
7. When you have completed a case review the final score and feedback provided by iHuman. You have the option to complete this case a second time before the submission deadline (total of 2 attempts) to improve your score. Your instructor will convert your highest score in iHuman to points earned in the grading rubric. Scores are adjusted based on your performance level. (See grading rubric.)

Template

Week 3 Nurse Notes TemplateLinks to an external site.

iHuman Support

Click the blue question mark icon at the bottom right of your iHuman screen at any time to access iHuman Resources. A menu will appear to assist with trouble shooting. Click “Help” from the menu to contact iHuman Support.

**Academic Integrity**

Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.

By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment.

Rubric

iHuman Case Assignments – Rubric

Criteria	Ratings	Pts
This criterion is linked to a Learning Outcome iHuman ScoreInstructor to enter student’s highest score achieved for the iHuman Case here.	100 pts i-Human score of 90-100 90 pts i-Human score of 80-89 80 pts i-Human score of 70-79 70 pts i-Human score of 60-69 60 pts i-Human score of 50-59 50 pts i-Human score of 40-49 40 pts i-Human score of 30-39 30 pts i-Human score of 20-29 20 pts i-Human score of 10-19 0 pts No Score	100 pts
This criterion is linked to a Learning Outcome SBAR Note1.All components of SBAR (Situation, Background, Assessment, Recommendations) addressed; 2. Appropriate information in each section; 3. All key findings mentioned; 4. Data is well organized and concise.	20 pts All four criteria met. 1. All components of SBAR (Situation, Background, Assessment, Recommendations) addressed; 2. Appropriate information in each section; 3. All key findings mentioned; 4. Data is well organized and concise. 18 pts One criterion is missing. 16 pts Two criteria are missing. 8 pts Three criteria are missing. 0 pts All criteria are missing.	20 pts
This criterion is linked to a Learning Outcome Paragraphs1.Thoroughly answers the questions in a detailed manner. 2. Fully demonstrates an understanding of ongoing patient needs. 3. Response includes specific resources or references as requested in the questions.	20 pts All criteria met 1.Thoroughly answers the questions in a detailed manner. 2. Fully demonstrates an understanding of ongoing patient needs. 3. Response includes specific resources or references as requested in the questions. 18 pts Answers the questions and demonstrates understanding of ongoing patient needs. Response includes specific resources or references as requested in the questions. Answer is not detailed. 16 pts Partially answers the questions and partially demonstrates understanding of ongoing needs. Resources or references included but are not specific to this case. 8 pts Minimally answers the questions and minimally demonstrates knowledge and understanding of course concepts. No resources or references included. 0 pts Did not answer the questions.	20 pts
This criterion is linked to a Learning Outcome Clarity of Writing1.Excellent mechanics; 2. Well organized, clear, and logical; 3. Professional writing style; 4. Proper grammar, punctuation, and spelling.	10 pts All criteria met 1.Excellent mechanics; 2. Well organized, clear, and logical; 3. Professional writing style; 4. Proper grammar, punctuation, and spelling. 8 pts One criterion is missing. 6 pts Two criteria are missing. 4 pts Three criteria are missing. 0 pts All criteria not met.	10 pts
This criterion is linked to a Learning Outcome Late Deduction	0 pts 0 points deducted Submitted on time. 0 pts Not Submitted on Time – Points deducted 1 day late= 7.5 deduction; 2 days late= 15 deduction; 3 days late= 22.5 deduction; 4 days late= 30 deduction; 5 days late= 37.5 deduction; 6 days late= 45 deduction; 7 days late= 52.5 deduction	0 pts
Total Points: 150

A Sample Answer For the Assignment: NR 305 Week 3: Cardiovascular Assessment: Michael Granger (iHuman) (Graded)

Title: NR 305 Week 3: Cardiovascular Assessment: Michael Granger (iHuman) (Graded)

Last week with the Michael Granger assignment I felt a lot more comfortable going through the history questions. I knew what base questions to ask and then pinpointed the areas that I needed more information on to perform the rest of the assessment. For example, Mr. Granger said that he had an 8-lb weight gain, leg swelling, and shortness of breath during the history questioning, so I made sure to focus on those areas and ask more in-depth questions. I was trying to figure out when the symptoms started, if he had tried to treat any of them, and if they got worse at certain times. This then helped in the physical assessment because I knew the areas I wanted to really focus on for abnormalities. I feel like this is a very realistic scenario because I have had several patients with these exact symptoms and experiences when I worked in the ICU.

One thing I would like to have done differently is to get a second opinion on the sounds in the heart. I have a terrible time distinguishing between different heart sounds, no matter how many videos I watch or audios I listen to. So, I would have liked to grab another nurse or even my charge nurse to listen to the sounds to verify what I was hearing, because the first time around I diagnosed the sound as a heart murmur. Listening to heart sounds and being able to differentiate between them is something that I have and will continue to work on. It is a necessary skill for our job, it’s just a tough one for me. I did receive feedback from iHuman on this one, which did not surprise me, because I labeled the heart sound incorrectly. The other piece of feedback that I received that did surprise me a little bit (but in retrospect shouldn’t have) was that I labeled the blood pressure as normotensive, and it was supposed to be high. I have been a nurse for a few years now and I know that the textbook blood pressure is 120/80, but I have had patients with blood pressures all over the place and we tend to not balk too much at a blood pressure that is like 138/88 or something along that line. Yes, that is high and coupled with Mr. Granger’s other symptoms is not ideal, so I understand why I got the feedback on that one.

From this simulation, I learned the importance of distinguishing between heart sounds and realizing that if I can’t figure it out, I need to ask for help in that area. I also learned that even though I have been doing this for a while now I still need to pay attention to all my patient’s symptoms collectively. I tend to focus on symptoms that are very severe and diminishing symptoms that I feel can be treated quickly. While this may work for a few patients it’s not good practice to maintain. I need to evaluate everything that is going on with my patients to figure out why they are having certain symptoms, be able to communicate with the doctor about what the patient may need, and, most importantly, for patient safety. I tend to get into a daily routine when I have patients with a lot of similar symptoms, and I need to remember that it is important to differentiate between my patients and treat their symptoms individually.