NRS 455 Case Study: Mrs. R. GCU

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.

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

LISTGRIDPRINT TO PDF

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.