NRS 455 Case Study: Mrs. R. GCU

Grand Canyon University NRS 455 Case Study: Mrs. R. GCU-Step-By-Step Guide

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How to Research and Prepare for NRS 455 Case Study: Mrs. R. GCU                         

Whether one passes or fails an academic assignment such as the Grand Canyon University NRS 455 Case Study: Mrs. R. GCU depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NRS 455 Case Study: Mrs. R. GCU                       

The introduction for the Grand Canyon University NRS 455 Case Study: Mrs. R. GCU is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NRS 455 Case Study: Mrs. R. GCU                       

After the introduction, move into the main part of the NRS 455 Case Study: Mrs. R. GCU assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NRS 455 Case Study: Mrs. R. GCU                       

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NRS 455 Case Study: Mrs. R. GCU                         

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NRS 455 Case Study: Mrs. R. GCU Included After Question

Case Study: Mrs. R.

Directions: Read the case study below. Evaluate the information and formulate a conclusion based on your evaluation. Complete the critical thinking table and submit this completed template to the assignment dropbox.

Case Study: Mrs. R.  

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mrs. R., presented below.

Health History and Medical Information

Mrs. R. is a 68-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms, including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

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 exhausted and cannot eat or drink by herself.

Objective Data

5. Height 175 cm; Weight 95.5kg.
6. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
7. 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.
8. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
9. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
10.  

Intervention

The following medications administered through drug therapy control her symptoms:

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. Oxygen delivered at 2L/ NC

A Sample Answer For the Assignment: NRS 455 Case Study: Mrs. R. GCU

Title: NRS 455 Case Study: Mrs. R. GCU

Critical Thinking Table

Clinical ManifestationsDescribe the clinical manifestations present in Mrs. R., focusing on the normal and abnormal findings and how this relates to his current condition.
Subjective
Objective
Cardiovascular Conditions Leading to Heart FailureDescribe cardiovascular conditions in which Mrs. R. is at risk.
Describe four cardiovascular conditions in which Mrs. R. is at risk and that may lead to heart failure.
Discuss any comorbidities Mrs. R. displays.
How do these conditions increase her chance of heart failure?
What can be done by way of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions.
Evaluation of Nursing Interventions at AdmissionsDiscuss the initial assessments and interventions provided to Mrs. R.
According to the nursing process, were the initial assessments and interventions at the time of admission beneficial for Mrs. R?
Discuss changes to any of the initial assessments or interventions you would make to ensure patient independence and prevent readmission.
Medications and Prevention of Problems Caused by Multiple Drug InteractionsExplain each of the seven medications listed in the case study and increase the incidence of polypharmacy.
Explain each of the seven medications listed in the case study. Include the classification, action, and rationale for each of these medications as they stem from pathophysiology for this patient’s condition (e.g., consider morphine use outside of pain management).
Discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
Health Promotion and Restoration Teaching PlanDevelop a multidisciplinary health promotion and restoration teaching plan for Mrs. R.
Discuss the steps needed to move the patient from acute care to subacute care, before discharging home and beginning a rehabilitation process.
Discuss alternative discharge options and qualifications to facilitate a smooth transition to the next level of care.
Explain how the rehabilitation resources, including medication management, and modifications will assist the patient’s transition to promote independence and prevent readmission.
Pathophysiological ChangesDiscuss the pathophysiological changes that come with Mrs. R.’s long-term tobacco use.
COPD Triggers and Options for Smoking CessationDiscuss options for smoking cessation education.
What options for smoking cessation should be offered to Mrs. R?
Explain the COPD triggers that can increase exacerbation frequency, resulting in readmission.

A Sample Answer 2 For the Assignment: NRS 455 Case Study: Mrs. R. GCU

Title: NRS 455 Case Study: Mrs. R. GCU

Critical Thinking Table

Clinical Manifestations Describe the clinical manifestations present in Mrs. R., focusing on the normal and abnormal findings and how this relates to his current condition.
Subjective	Subjective manifestations refer to the patient’s expression of his/her experiences with a disease. The abnormal subjective manifestations in Mr. R’s case study include anxiety, feeling that she cannot get enough air, feeling that her heart is running away, and feeling exhausted and unable to drink by herself. The above manifestations relate to Mr. R’s current condition. For example, he cannot get enough air because of pulmonary congestion. He also feels exhausted because of inadequate gaseous exchange in the lungs (Irgashev, 2023). He is feeling that his heart is running away because of abnormal heart functions, which cause palpitations.
Objective	The abnormal objective manifestations in the case study include an irregular heart rate of 118 beats/minute, respiratory rate of 34, blood pressure of 90/58, presence of S3 heart sounds and distant S1 and S2 heart sounds, and decreased peripheral pulses. They also include bilateral jugular vein distention, ventricular heart rate of 132, atrial fibrillation, pulmonary crackles, decreased breath sounds in the right lower lobe, coughing blood-stained sputum, SPO2 82%, and hepatomegaly. These symptoms relate to Mr. R’s current condition. For example, decreased cardiovascular functioning results in blood buildup in the lungs, hence, crackles and bloodstained sputum (Schwinger, 2021). The decreased cardiovascular function also impairs cardiac filling, hence, jugular venous distention.
Cardiovascular Conditions Leading to Heart Failure Describe cardiovascular conditions in which Mrs. R. is at risk.
Describe four cardiovascular conditions in which Mrs. R. is at risk and that may lead to heart failure.	Mrs. R is at risk of cardiovascular conditions, including cardiomyopathy, coronary artery disease, myocarditis, and poorly controlled hypertension. A failure in the heart muscle to pump blood will result in cardiomyopathy and worsening heart failure. Mrs. R is also at risk of coronary artery disease. Her history of smoking two packs of cigarettes daily places her at an increased risk of developing coronary artery disease. Myocarditis can also develop in Mrs. R. Myocarditis refers to the inflammation of the heart muscle. Mrs. R has a history of hypertension, which can cause myocardial functional and structural changes. These changes can result in myocarditis and heart failure (Townsend et al., 2022).  Mrs. R is at risk of poorly controlled hypertension and heart failure. She has not taken her antihypertensive medications for three days, which could worsen her hypertension.
Discuss any comorbidities Mrs. R. displays.	Mrs. R has COPD and congestive hepatomegaly as her comorbidities. Patients with a long history of heavy cigarette smoking have an increased risk of developing COPD. Statistics show that smoking contributes to 70% of all COPD cases in developed countries. Cigarettes contain chemicals that irritate the lung tissues and weaken their defense against infection. The chemicals also stimulate inflammatory processes, airway narrowing, and air sac destruction, which lead to COPD. Mrs. R has developed congestive hepatomegaly as a complication of heart failure. Heart failure causes a buildup of blood in the liver. This occurs from the pooling up of blood in the inferior vena cava, which affects other blood vessels, including the hepatic veins (Goel, 2021). Too much pressure on hepatic veins from blood buildup in the inferior vena cava causes congestive hepatomegaly.
How do these conditions increase her chance of heart failure?	Cardiomyopathy, coronary artery disease, myocarditis, and poorly controlled hypertension increase Mrs. R’s chances of heart failure. Cardiomyopathy affects the functioning of the heart muscles. This includes contraction and relaxation of the heart muscles. Impaired functioning of the heart muscles will affect cardiovascular filling and emptying, hence, increasing the risk of heart failure. Coronary artery disease will cause narrowing of the arteries, which will increase vascular pressure and resistance. These changes will cause increased cardiac workload, worsening Mrs. R’s risk of heart failure. Poorly controlled hypertension causes functional and structural changes in the heart muscles and tissue (Kario & Williams, 2021). For example, patients are at risk of myocarditis, which impairs normal cardiac filling and contraction, hence, heart failure.
What can be done by way of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions?	The patient should be administered IV furosemide, enalapril, and metoprolol for cardiomyopathy. These drugs will reduce fluid volume overload, and cardiac volume, and maintain normal blood pressure. Mrs. R should be administered furosemide, angiotensin-converting enzyme inhibitors, and beta-blockers for myocarditis. Mrs. R should be administered furosemide and beta-blockers for poorly controlled hypertension. She should also be administered aspirin, diuretics such as furosemide, blood thinning medications such as enoxaparin, statins, and antihypertensive drugs such as beta-blockers, calcium channel blockers, or angiotensin-converting enzyme inhibitors (Sindone et al., 2022). Some of the nursing interventions include daily weighing Mrs. R to detect fluid volume overload, health education on lifestyle and behavioral modifications, respiratory support, and educating on self-management of her comorbidities.
Evaluation of Nursing Interventions at Admissions Discuss the initial assessments and interventions provided to Mrs. R.
According to the nursing process, were the initial assessments and interventions at the time of admission beneficial for Mrs. R?	The initial assessments and interventions were beneficial for Mrs. R. Subjective data provided insights into Mrs. R’s experience with her health problems and their severity. The data also provided baseline information to determine her health needs. The objective assessment confirmed the subjective data. It also informed the body systems involved in Mrs. R’s problems. Interventions such as the administration of IV furosemide were appropriate to increase excessive fluid loss through the kidneys. Enalapril and metoprolol were appropriate to decrease cardiac workload through increased vasodilation and decreased cardiac contractility. Morphine was appropriate for pain reliever, anxiolytic, and inhibition of the sympathetic nervous system to lower afterload and preload. Inhaled corticosteroids and short-acting bronchodilators were appropriate to open the airways and improve respiratory function. Oxygen delivered 2L/NC was appropriate to increase body tissue oxygenation since the patient has a saturation of 82% and respiratory difficulties due to the disease process.
Discuss changes to any of the initial assessments or interventions you would make to ensure patient independence and prevent readmission.	Mrs. R has congestive hepatomegaly. She is at risk of developing hepatic encephalopathy. Therefore, I would prescribe oral lactulose 15-30 ml thrice daily to prevent ammonia buildup (Goel, 2021).
Medications and Prevention of Problems Caused by Multiple Drug Interactions Explain each of the seven medications listed in the case study and increase the incidence of polypharmacy.
Explain each of the seven medications listed in the case study. Include the classification, action, and rationale for each of these medications as they stem from the pathophysiology of this patient’s condition (e.g., consider morphine use outside of pain management).	Furosemide is a diuretic that works by inhibiting sodium and chloride reabsorption in the ascending loop of Henle, hence, increasing fluid loss with sodium and chloride. Furosemide was prescribed to treat fluid volume excess from heart failure. Enalapril is an angiotensin-converting enzyme inhibitor that blocks the conversion of angiotensin 1 to angiotensin II. The inhibition prevents vasoconstriction. It was prescribed to cause vasodilation, creased cardiac preload, and increased blood and oxygen supply to the heart. Metoprolol is a beta-1-receptor blocker that inhibits beta-1-receptors to cause decreased cardiac output from its negative chronotropic and inotropic effects. Metoprolol was prescribed to lower cardiac workload by inhibiting increased excitation of the cardiac muscles. IV morphine sulfate was prescribed as an anxiolytic and a depressant of the sympathetic nervous system. The suppression of the sympathetic nervous system would lower cardiac preload and afterload. ProAir HFA is a short-acting bronchodilator that acts on beta-2-adrenergic receptors to cause bronchial smooth muscle relaxation. ProAir HFA was prescribed to treat airway inflammation and to increase airflow to the lungs. Floven HFA is a corticosteroid that was prescribed to inhibit anti-inflammatory and vasoconstriction activity in the respiratory system (Remien & Bowman, 2024). It works by inhibiting inflammatory cells such as mast cells, monocytes, and eosinophils in the respiratory system.
Discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.	One of the nursing interventions that can help prevent problems caused by multiple drug interactions is patient education. Mrs. R should be educated on the appropriate use of the prescribed medications and avoiding over-the-counter medications to prevent multiple drug interactions. The other nursing intervention is implementing the use of screening tools to identify and address polypharmacy in older patients. Tools such as NO TEARS can be used in healthcare settings to help identify and eliminate any drug with an increased risk of adverse outcomes if prescribed for older patients. The other strategy is encouraging interprofessional collaboration in drug prescribing, dispensing, and use by elderly patients. Interprofessional strategies such as involving pharmacists in patient education on drug safety reduce the risk of polypharmacy among older patients (Drenth-van Maanen et al., 2020; Hailu et al., 2020). The last strategy is adopting deprescribing. Deprescribing entails identifying and discontinuing any medication whose harm is more than its benefits and those having unclear patient benefits.
Health Promotion and Restoration Teaching Plan Develop a multidisciplinary health promotion and restoration teaching plan for Mrs. R.
Discuss the steps needed to move the patient from acute care to subacute care, before discharging home and beginning a rehabilitation process.	Qualified providers should assess and make decisions related to Mrs. R’s movement from acute care to subacute care before their discharge home and the start of the rehabilitation process. The assessment determines Mrs. R’s health status, needs, and functioning ability. The second step would be discussing and involving Mrs. R in the decision-making process. The third step is planning for the patient transfer and determining any need for support such as caregiver training. The fourth step entails planning for follow-up appointments. Providers should also determine whom the patient should contact should they require any assistance.
Discuss alternative discharge options and qualifications to facilitate a smooth transition to the next level of care.	The alternative discharge options for Mrs. R include respite care, rehabilitation facilities, and home healthcare facilities. Mrs. R can be discharged for home healthcare if she has a caregiver who can meet her health needs at home. This includes a skilled provider who will administer intravenous medications at home should she be discharged with such medications. Mrs. R can be discharged to rehabilitation facilities to help her overcome her substance use problem. She can be discharged from the hospital to respite care should she have difficulties in meeting their daily needs due to her illness. The qualifications for a smooth transition to the next level of care include care coordination, multidisciplinary collaboration, active patient involvement, and ready access to patient data for different providers involved in Mrs. R’s care.
Explain how the rehabilitation resources, including medication management, and modifications will assist the patient’s transition to promote independence and prevent readmission.	Rehabilitation resources such as medication management promote optimum disease management and improved treatment adherence. Treatment adherence would reduce the risk of adverse outcomes in Mrs. R’s management, hence, reducing the hospitalization rate and emergency department visits. Resources such as telehealth would ensure Mrs. R’s timely access to specialized care and support, which would lower the risk of adverse events (Kitzman et al., 2021). Telehealth facilitates virtual patient-provider interaction, assessment, treatment, monitoring, and evaluation.
Pathophysiological Changes Discuss the pathophysiological changes that come with Mrs. R.’s long-term tobacco use.
Long-term tobacco use is associated with significant adverse health effects. Studies have shown that long-term tobacco use causes endothelial dysfunction. It also predisposes individuals to thrombotic and atherogenic problems that are associated with ischemic conditions such as stroke and coronary syndrome. Long-term tobacco use also affects the blood-brain barrier. Evidence shows that tobacco smoke causes leaky brain micro-vessels and altered blood-brain barrier integrity. This leads to an increased risk of silent cerebral infarction and stroke. The additional effects of long-term tobacco use include insulin resistance, hemodynamic alterations, alterations in the lipid profile, and hypercoagulable state in the affected patients (El-Mahdy et al., 2021).
COPD Triggers and Options for Smoking Cessation Discuss options for smoking cessation education.
What options for smoking cessation should be offered to Mrs. R?	Several options for smoking cessation exist for Mrs. R. They include nicotine replacement therapy, bupropion, varenicline, or behavioral therapies.
Explain the COPD triggers that can increase exacerbation frequency, resulting in readmission.	Some of the COPD triggers that can increase exacerbation frequency and result in readmission include cigarette smoking, illnesses such as pneumonia, exposure to dust or fumes, allergens, and extreme temperature changes (Ji et al., 2022). These triggers are stressors that cause inflammatory processes that are associated with COPD development and symptoms.

References

Drenth-van Maanen, A. C., Wilting, I., & Jansen, P. A. F. (2020). Prescribing medicines to older people—How to consider the impact of ageing on human organ and body functions. British Journal of Clinical Pharmacology, 86(10), 1921–1930. https://doi.org/10.1111/bcp.14094

El-Mahdy, M. A., Mahgoup, E. M., Ewees, M. G., Eid, M. S., Abdelghany, T. M., & Zweier, J. L. (2021). Long-term electronic cigarette exposure induces cardiovascular dysfunction similar to tobacco cigarettes: Role of nicotine and exposure duration. American Journal of Physiology-Heart and Circulatory Physiology, 320(5), H2112–H2129. https://doi.org/10.1152/ajpheart.00997.2020

Goel, S. K. (2021). Hepatic parameters in congestive heart failure patients: A prospective study. Journal of Advanced Medical and Dental Sciences Research, 9(4). http://jamdsr.com/uploadfiles/37vol9issue4pp162-166.20211215042656.pdf

Hailu, B. Y., Berhe, D. F., Gudina, E. K., Gidey, K., & Getachew, M. (2020). Drug related problems in admitted geriatric patients: The impact of clinical pharmacist interventions. BMC Geriatrics, 20(1), 13. https://doi.org/10.1186/s12877-020-1413-7

Irgashev, I. E. (2023). “Pathological Physiology of Heart Failure.” American Journal of Pediatric Medicine and Health Sciences (2993-2149), 1(8), Article 8.

Ji, S., Dai, M.-Y., Huang, Y., Ren, X.-C., Jiang, M.-L., Qiao, J.-P., Zhang, W.-Y., Xu, Y.-H., Shen, J.-L., Zhang, R.-Q., & Fei, G.-H. (2022). Influenza a virus triggers acute exacerbation of chronic obstructive pulmonary disease by increasing proinflammatory cytokines secretion via NLRP3 inflammasome activation. Journal of Inflammation, 19(1), 8. https://doi.org/10.1186/s12950-022-00305-y

Kario, K., & Williams, B. (2021). Nocturnal Hypertension and Heart Failure: Mechanisms, Evidence, and New Treatments. Hypertension, 78(3), 564–577. https://doi.org/10.1161/HYPERTENSIONAHA.121.17440

Kitzman, D. W., Whellan, D. J., Duncan, P., Pastva, A. M., Mentz, R. J., Reeves, G. R., Nelson, M. B., Chen, H., Upadhya, B., Reed, S. D., Espeland, M. A., Hewston, L., & O’Connor, C. M. (2021). Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. New England Journal of Medicine, 385(3), 203–216. https://doi.org/10.1056/NEJMoa2026141

Remien, K., & Bowman, A. (2024). Fluticasone. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK542161/

Schwinger, R. H. G. (2021). Pathophysiology of heart failure. Cardiovascular Diagnosis and Therapy, 11(1), 263–276. https://doi.org/10.21037/cdt-20-302

Sindone, A. P., De Pasquale, C., Amerena, J., Burdeniuk, C., Chan, A., Coats, A., Hare, D. L., Macdonald, P., Sverdlov, A., & Atherton, J. J. (2022). Consensus statement on the current pharmacological prevention and management of heart failure. Medical Journal of Australia, 217(4), 212–217. https://doi.org/10.5694/mja2.51656

Townsend, N., Kazakiewicz, D., Lucy Wright, F., Timmis, A., Huculeci, R., Torbica, A., Gale, C. P., Achenbach, S., Weidinger, F., & Vardas, P. (2022). Epidemiology of cardiovascular disease in Europe. Nature Reviews Cardiology, 19(2), 133–143. https://doi.org/10.1038/s41569-021-00607-3

Case Study: Mrs. R. – Rubric

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Rubric Criteria

Total130 points

Criterion	1. Unsatisfactory	2. Insufficient	3. Approaching	4. Acceptable	5. Target
Clinical Manifestations of Mrs. R.	0 pointsSubjective and objective clinical manifestations are not present.	4.88 pointsSubjective and objective clinical manifestations are incomplete or incorrect.	5.14 pointsSubjective and objective clinical manifestations are present but lack detail.	5.79 pointsSubjective and objective clinical manifestations are detailed.	6.5 pointsSubjective and objective clinical manifestations are thorough.
Cardiovascular Conditions and Comorbidities	0 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is not present.	4.88 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is incomplete or incorrect.	5.14 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is present but lacks detail.	5.79 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is detailed.	6.5 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is thorough.
Medical and Nursing Interventions	0 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is not present.	14.63 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is incomplete or incorrect.	15.41 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is present but lacks detail.	17.36 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is detailed.	19.5 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is thorough.
Evaluation of Nursing Interventions at Admissions	0 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is not present.	14.63 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is incomplete or incorrect.	15.41 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is present but lacks detail.	17.36 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is detailed.	19.5 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is thorough.
Changes to Initial Assessments	0 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is not present.	14.63 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is incomplete or incorrect.	15.41 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is present but lacks detail.	17.36 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is detailed.	19.5 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is thorough.
Medications and Nursing Interventions	0 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is not present.	4.88 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is incomplete or incorrect.	5.14 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is present but lacks detail.	5.79 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is detailed.	6.5 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is thorough.
Health Promotion and Restoration Teaching Plan	0 pointsMultidisciplinary health promotion and restoration teaching plan is not present.	4.88 pointsMultidisciplinary health promotion and restoration teaching plan is incomplete or incorrect.	5.14 pointsMultidisciplinary health promotion and restoration teaching plan for the patient, including a description of the steps needed to move the patient from acute care through the rehabilitation process, necessary modifications, and maintenance of medications, is provided but lacks detail.	5.79 pointsMultidisciplinary health promotion and restoration teaching plan is provided for the patient and includes a detailed description of the steps needed to move the patient from acute care through the rehabilitation process, necessary modifications, and maintenance of medications.	6.5 pointsMultidisciplinary health promotion and restoration teaching plan is provided for the patient and includes a thorough description of the steps needed to move the patient from acute care through the rehabilitation process, necessary modifications, and maintenance of medications.
Alternative Discharge Qualifications and Rehabilitation Resources	0 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is not present.	14.63 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is incomplete or incorrect.	15.41 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is present but lacks detail.	17.36 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is detailed.	19.5 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is thorough.
Options for Smoking Cessation	0 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is not present.	4.88 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is incomplete or incorrect.	5.14 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is present but lacks detail.	5.79 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is detailed.	6.5 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is thorough.
COPD Triggers	0 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is not present.	4.88 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is incomplete or incorrect.	5.14 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is present but lacks detail.	5.79 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is detailed.	6.5 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is thorough.
Mechanics of WritingIncludes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.	0 pointsErrors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.	5.85 pointsFrequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.	6.16 pointsOccasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.	6.94 pointsFew mechanical errors are present. Suitable language choice and sentence structure are used.	7.8 pointsNo mechanical errors are present. Appropriate language choice and sentence structure are used throughout.
Format/DocumentationUses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.	0 pointsAppropriate format is not used. No documentation of sources is provided.	3.9 pointsAppropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.	4.11 pointsAppropriate format and documentation are used, although there are some obvious errors.	4.63 pointsAppropriate format and documentation are used with only minor errors.	5.2 pointsNo errors in formatting or documentation are present.

Rubric Criteria

Total130 points

Criterion	1. Unsatisfactory	2. Insufficient	3. Approaching	4. Acceptable	5. Target
Clinical Manifestations of Mrs. R.	0 pointsSubjective and objective clinical manifestations are not present.	4.88 pointsSubjective and objective clinical manifestations are incomplete or incorrect.	5.14 pointsSubjective and objective clinical manifestations are present but lack detail.	5.79 pointsSubjective and objective clinical manifestations are detailed.	6.5 pointsSubjective and objective clinical manifestations are thorough.
Cardiovascular Conditions and Comorbidities	0 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is not present.	4.88 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is incomplete or incorrect.	5.14 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is present but lacks detail.	5.79 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is detailed.	6.5 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is thorough.
Medical and Nursing Interventions	0 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is not present.	14.63 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is incomplete or incorrect.	15.41 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is present but lacks detail.	17.36 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is detailed.	19.5 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is thorough.
Evaluation of Nursing Interventions at Admissions	0 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is not present.	14.63 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is incomplete or incorrect.	15.41 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is present but lacks detail.	17.36 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is detailed.	19.5 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is thorough.
Changes to Initial Assessments	0 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is not present.	14.63 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is incomplete or incorrect.	15.41 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is present but lacks detail.	17.36 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is detailed.	19.5 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is thorough.
Medications and Nursing Interventions	0 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is not present.	4.88 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is incomplete or incorrect.	5.14 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is present but lacks detail.	5.79 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is detailed.	6.5 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is thorough.
Health Promotion and Restoration Teaching Plan	0 pointsMultidisciplinary health promotion and restoration teaching plan is not present.	4.88 pointsMultidisciplinary health promotion and restoration teaching plan is incomplete or incorrect.	5.14 pointsMultidisciplinary health promotion and restoration teaching plan for the patient, including a description of the steps needed to move the patient from acute care through the rehabilitation process, necessary modifications, and maintenance of medications, is provided but lacks detail.	5.79 pointsMultidisciplinary health promotion and restoration teaching plan is provided for the patient and includes a detailed description of the steps needed to move the patient from acute care through the rehabilitation process, necessary modifications, and maintenance of medications.	6.5 pointsMultidisciplinary health promotion and restoration teaching plan is provided for the patient and includes a thorough description of the steps needed to move the patient from acute care through the rehabilitation process, necessary modifications, and maintenance of medications.
Alternative Discharge Qualifications and Rehabilitation Resources	0 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is not present.	14.63 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is incomplete or incorrect.	15.41 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is present but lacks detail.	17.36 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is detailed.	19.5 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is thorough.
Options for Smoking Cessation	0 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is not present.	4.88 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is incomplete or incorrect.	5.14 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is present but lacks detail.	5.79 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is detailed.	6.5 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is thorough.
COPD Triggers	0 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is not present.	4.88 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is incomplete or incorrect.	5.14 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is present but lacks detail.	5.79 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is detailed.	6.5 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is thorough.
Mechanics of WritingIncludes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.	0 pointsErrors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.	5.85 pointsFrequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.	6.16 pointsOccasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.	6.94 pointsFew mechanical errors are present. Suitable language choice and sentence structure are used.	7.8 pointsNo mechanical errors are present. Appropriate language choice and sentence structure are used throughout.
Format/DocumentationUses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.	0 pointsAppropriate format is not used. No documentation of sources is provided.	3.9 pointsAppropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.	4.11 pointsAppropriate format and documentation are used, although there are some obvious errors.	4.63 pointsAppropriate format and documentation are used with only minor errors.	5.2 pointsNo errors in formatting or documentation are present.

Case Study: Mrs. R. – Rubric

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Rubric Criteria

Total130 points

Criterion	1. Unsatisfactory	2. Insufficient	3. Approaching	4. Acceptable	5. Target
Clinical Manifestations of Mrs. R.	0 pointsSubjective and objective clinical manifestations are not present.	4.88 pointsSubjective and objective clinical manifestations are incomplete or incorrect.	5.14 pointsSubjective and objective clinical manifestations are present but lack detail.	5.79 pointsSubjective and objective clinical manifestations are detailed.	6.5 pointsSubjective and objective clinical manifestations are thorough.
Cardiovascular Conditions and Comorbidities	0 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is not present.	4.88 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is incomplete or incorrect.	5.14 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is present but lacks detail.	5.79 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is detailed.	6.5 pointsDescription of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is thorough.
Medical and Nursing Interventions	0 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is not present.	14.63 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is incomplete or incorrect.	15.41 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is present but lacks detail.	17.36 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is detailed.	19.5 pointsExplanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is thorough.
Evaluation of Nursing Interventions at Admissions	0 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is not present.	14.63 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is incomplete or incorrect.	15.41 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is present but lacks detail.	17.36 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is detailed.	19.5 pointsEvaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is thorough.
Changes to Initial Assessments	0 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is not present.	14.63 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is incomplete or incorrect.	15.41 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is present but lacks detail.	17.36 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is detailed.	19.5 pointsExplanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is thorough.
Medications and Nursing Interventions	0 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is not present.	4.88 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is incomplete or incorrect.	5.14 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is present but lacks detail.	5.79 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is detailed.	6.5 pointsExplanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is thorough.
Health Promotion and Restoration Teaching Plan	0 pointsMultidisciplinary health promotion and restoration teaching plan is not present.	4.88 pointsMultidisciplinary health promotion and restoration teaching plan is incomplete or incorrect.	5.14 pointsMultidisciplinary health promotion and restoration teaching plan for the patient, including a description of the steps needed to move the patient from acute care through the rehabilitation process, necessary modifications, and maintenance of medications, is provided but lacks detail.	5.79 pointsMultidisciplinary health promotion and restoration teaching plan is provided for the patient and includes a detailed description of the steps needed to move the patient from acute care through the rehabilitation process, necessary modifications, and maintenance of medications.	6.5 pointsMultidisciplinary health promotion and restoration teaching plan is provided for the patient and includes a thorough description of the steps needed to move the patient from acute care through the rehabilitation process, necessary modifications, and maintenance of medications.
Alternative Discharge Qualifications and Rehabilitation Resources	0 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is not present.	14.63 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is incomplete or incorrect.	15.41 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is present but lacks detail.	17.36 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is detailed.	19.5 pointsDiscussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is thorough.
Options for Smoking Cessation	0 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is not present.	4.88 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is incomplete or incorrect.	5.14 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is present but lacks detail.	5.79 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is detailed.	6.5 pointsDiscussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is thorough.
COPD Triggers	0 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is not present.	4.88 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is incomplete or incorrect.	5.14 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is present but lacks detail.	5.79 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is detailed.	6.5 pointsExplanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is thorough.
Mechanics of WritingIncludes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.	0 pointsErrors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.	5.85 pointsFrequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.	6.16 pointsOccasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.	6.94 pointsFew mechanical errors are present. Suitable language choice and sentence structure are used.	7.8 pointsNo mechanical errors are present. Appropriate language choice and sentence structure are used throughout.
Format/DocumentationUses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.	0 pointsAppropriate format is not used. No documentation of sources is provided.	3.9 pointsAppropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.	4.11 pointsAppropriate format and documentation are used, although there are some obvious errors.	4.63 pointsAppropriate format and documentation are used with only minor errors.	5.2 pointsNo errors in formatting or documentation are present.