74-year-old male with a history of hypertension and smoking, is having dinner with his wife when he develops sudden onset of difficulty speaking, with drooling from the left side of his mouth, and weakness in his left hand. His wife asks him if he is all right and the patient denies any difficulty. His symptoms progress over the next 10 minutes until he cannot lift his arm and has trouble standing. The patient continues to deny any problems. The wife sits the man in a chair and calls 911. The EMS squad arrives within 5 minutes. Upon arrival in the ED, patient‘s blood pressure was 178/94, pulse 78 and regular, PaO2 97% on room air. Neuro exam – Cranial nerves- Mild left facial droop. Motor- Right arm and leg extremity with 5/5 strength. Left arm cannot resist gravity, left leg with mild drift. Sensation intact. Neglect- Mild neglect to left side of body. Language- Expressive and receptive language intact.
Mild to moderate dysarthria. Able to protect airway.
Please do a 1 to 2-page case study analysis. In your Case Study Analysis related to the scenario provided, explain the following:
• Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
• Any racial/ethnic variables that may impact physiological functioning.
• How these processes interact to affect the patient.
resources
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: the biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Chapter 15: Structure and Function of the Neurologic System
Chapter 16: Pain, Temperature Regulation, Sleep, and Sensory Function (stop at Sleep); Summary Review
Chapter 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function (start at Acute confusional states and delirium) (stop at Alterations in neuromotor functions); (Parkinson’s Disease); Summary Review
Chapter 18: Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction (stop at Degenerative disorders of the spine); (start at Cerebrovascular disorders) (stop at Tumors of the central nervous system); Summary Review
Chapter 44: Structure and Function of the Musculoskeletal System (stop at Components of muscle function); Summary Review
Chapter 45: Alterations of Musculoskeletal Function (stop at Bone tumors); (start at Disorders of joints); Summary Review
Chapter 47: Structure, Function, and Disorders of the Integument (section on Lyme Disease)
Chin, L. S. (2018). Spinal cord injuriesLinks to an external site.. Retrieved from https://emedicine.medscape.com/article/793582-overview#a4
An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs this understanding can also help educate patients and guide them through their treatment plans.
Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
Any racial/ethnic variables that may impact physiological functioning.
How these processes interact to affect the patient.
Scenario: A 58-year-old obese white male presents to ED with chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl.
All papers submitted must include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting
1. Assist with coordination of care for clients with musculoskeletal disorders.
2. Enhance understanding of the nursing process in coordinating care for a client.
Course Competency
· Explain components of multidimensional nursing care for clients with musculoskeletal disorders.
· Select appropriate nursing interventions when providing multidimensional care to clients experiencing alterations in mobility
Instructions
For this assignment you will pick a musculoskeletal disorder ( Osteoporosis ).
Develop a care map using the template directly after these instructions. For this assignment, include the following: assessment and data collection (including disease process, common lab work/diagnostics, subjective, objective, and health history data), three NANDA-I approved nursing diagnosis, one SMART goal for each nursing diagnosis, and two nursing interventions with rationale for each SMART goal for a client with a musculoskeletal disorder.
Use at least FOUR scholarly sources to support your care map. Be sure to cite your sources in-text and on a reference, page using APA format.
USED THE MAP FORMAT BELOW FOR THIS ASSISGNMENT
WRITE FROM NURSE PERSPECTIVE
NO CONSIDERATION FOR PLAGIARISM
DUE 8/7/2021
AssessmentandData Collection
Three NANDA-I Approved Nursing Diagnosis
One Smart Goal for EACH Nursing Diagnosis
Two Nursing Interventions with Rationale for EACH Nursing Diagnosis
Disease Process (short description of patho of disorder- cite this- do not copy and paste):Rheumatoid arthritis is an autoimmune process affecting synovial joints. It is chronic and systemic, causing inflammation and permanent joint damage (Ignatavicius et al., 2018)Common Labwork/Diagnostics:Labs:Rheumatoid factorANAESRAlbumin (Ignatavicius et al., 2018)Diagnostics:XraysArthrocentesis (Ignatavicius et al., 2018)Assessment Data (consider subjective, objective, and heath history):Subjective: joint pain, anorexia, fatigue, painful stiff joints (Ignatavicius et al., 2018)Objective: redness in joints, deformed joints, physical limitations, decreased mobility (Ignatavicius et al., 2018)
Nursing Diagnosis: Disturbed body image r/t alteration in body function AEB painful, deformed hand joints.Nursing Diagnosis:Nursing Diagnosis
SMART Goal: Patient will verbalize physical changes without making disparaging comments by 5/5SMART Goal:SMART Goal:
1. Intervention: Provide emotional support and encourage patientRationale: With deformed joints, this will improve patients self -concept (Phelps, 2021)2. Intervention Involve patient in planningRationale : This will increase patient compliance with activities to the best of their ability(Phelps, 2021)1.2.1.2.
3.
Module 05 Assignment – Designing a Care Map Rubric
Total Assessment Points – 65
Levels of Achievement
Criteria
Emerging
Competence
Proficiency
Mastery
Assessment / Data Collection(10 Pts)
Lacks basic factors of the disease process, common labs, diagnostic tests, and subjective, objective, and health history data.Failure to submit Assessment/Data Collection will result in zero points for this criterion.
Briefly identifies the factors including the disease process, common labs, diagnostic tests, and subjective, objective, and health history data.
Clearly identifies the factors including the disease process, common labs, and diagnostic tests, and subjective, objective, and health history data.
Thoroughly identifies all factors including the disease process, common labs, diagnostic tests, and subjective, objective, and health history data with a deep understanding.
Points – 7
Points – 8
Points – 9
Points – 10
Nursing Diagnosis (should fit the data)(10 Pts)
Nursing diagnoses are insufficient and/or do not fit the data.Failure to submit Nursing Diagnosis will result in zero points for this criterion.
Writes ONE NANDA-I approved nursing diagnosis in the correct format (including related to/as evidenced by) with a strong connection to identified data.
Writes TWO NANDA-I approved nursing diagnoses in the correct format (including related to/as evidenced by) with a strong connection to identified data.
Writes THREE NANDA-I approved nursing diagnoses in the correct format (including related to/as evidenced by) with a strong connection to identified data.
Points – 7
Points – 8
Points – 9
Points – 10
SMART Goal (should reflect the diagnosis and follow guidelines)(15 Pts)
The goals meet few SMART goal guidelines and/or are not related to the nursing diagnoses.Failure to submit SMART goals will result in zero points for this criterion.
Writes ONE goal for ONE nursing diagnosis and the goal meets all the SMART goal guidelines and are related to the nursing diagnosis.
Writes ONE goal for TWO nursing diagnoses and the goals meet all the SMART goal guidelines and are related to the nursing diagnoses.
Writes ONE goal for THREE nursing diagnoses and the goals meet all the SMART goal guidelines and are related to the nursing diagnoses.
Points – 11
Points – 12
Points – 13
Points – 15
Interventions and Rationale(20 Pts)
Lacks appropriate interventions and rationale to assist the client in resolving the issues leading to the problem.Failure to submit Interventions and Rationale will result in zero points for this criterion.
Writes 3 interventions with rationale to assist the client in resolving the issues leading to the problem with appropriate references.
Writes 5 interventions with rationale to assist the client in resolving the issues leading to the problem with appropriate references.
Writes more than 5 interventions with rationale to assist the client in resolving the issues leading to the problem with appropriate references.
Points – 15
Points – 16
Points – 18
Points –20
APA Citation(5 Pts)
APA in-text citations and references are missing.
Attempted to use APA in-text citations and references.
APA in-text citations and references are used with few errors.
APA in-text citations and references are used correctly.
Points- 2
Points- 3
Points- 4
Points- 5
Spelling and Grammar(5 Pts)
Numerous spelling and grammar errors, which detract from the audience’s ability to comprehend material.
Some spelling and grammar errors, which detract from the audience’s ability to comprehend material.
