Review the Cognitive Assessment of the Older Adult recording of the webinar.

Description

Assignment Instructions

1. Complete the assigned readings outlined below.

2. Review the Cognitive Assessment of the Older Adult recording of the webinar.

3. Using the provided worksheet as a guide:

a. Apply the Analytic Framework: Screening for Cognitive Impairment in Older Adults (American Medical Association, 2020) to assess variables influencing cognitive assessment of the older adult in your community.

b. Document your findings on the worksheet.

c. Complete the Reflective Questions on the worksheet.

d. This learning activity is intended to provide a “mini” cognitive assessment of the older adult based upon your knowledge, resources, along with data and information available via the Internet.

e. This learning activity can be completed while maintaining any required measures for social distancing and/or quarantine.

4. Submit the worksheet along with your Practicum Log, noting the hours completed for the following activities:

a. Webinar attendance

b. Readings

c. Completion of worksheet as applied learning activity

**Worksheet and Instructions attached

What nutritional teaching is important for Mrs. Pelletier with her new diagnosis of osteoporosis?Discuss

Musculoskeletal Problems
Case Study: Osteoporosis
approx 30 min
Patient Profile

Mrs. Pelletier is a 75-year-old female who presents to the health care provider’s office for back pain. She has a history of hypertension, Crohn’s disease, and hypothyroidism. She is currently taking the following medications:

Metoprolol 50 mg PO twice daily
Sulfasalazine 500 mg PO twice daily
Prednisolone 5 mg PO twice daily
Levothyroxine 75 mcg PO daily,/li>
Subjective Data

Has had some mid-back pain for the past week, which is worse when standing or walking and is relieved a little by lying down
Her back pain at the moment is a level 4, on a 1 to 10 scale
Denies any recent injury to her back
Broke her wrist a few months ago, but doesn’t know how
Her Crohn’s disease just ‘flared up’ a couple of weeks ago
Lactose intolerant
Objective Data

Temperature 98.2° F, pulse 74, respirations 16, blood pressure 130/78
Height 5 feet 3 inches, Weight 100 lb, BMI 17.7 kg/m2
Kyphosis of the spine

Question 1
The health care provider suspects Mrs. Pelletier has osteoporosis. What are her risk factors for osteoporosis?

Mrs. Pelletier’s risk factors for developing osteoporosis are her gender (female), age (>65 yr), low body weight, Crohn’s disease (due to malabsorption problems), nontraumatic fracture of her wrist, and use of corticosteroids for her Crohn’s disease and levothyroxine for her hypothyroidism.
Rationale
No rationale provided.

Question 2
What studies could be done to support the diagnosis of osteoporosis?

Bone mineral density (BMD) measurements are typically used to assess the mass of bone or how tightly the bone is packed. Types of BMD studies include quantitative ultrasound (QUS) and dual-energy x-ray absorptiometry (DEXA).
Rationale
No rationale provided.

Question 3
Mrs. Pelletier’s diagnostic testing yielded a bone density T-score of -3. What does this mean?

A T-score of -3 means that Mrs. Pelletier’s BMD is 3 standard deviations below the mean BMD of young adult. Any score greater than 2.5 standard deviations is defined as osteoporosis.
Rationale
No rationale provided.

Question 4
Mrs. Pelletier is prescribed alendronate. What instructions should Mrs. Pelletier receive regarding taking this medication?

There are gastrointestinal side effects associated with taking bisphosphonates such as alendronate including dyspepsia, abdominal pain, and the most common one, esophageal irritation or esophagitis. To decrease these side effects, teach Mrs. Pelletier to take her alendronate with a full glass of plain water 30 minutes before food or other medications, and to remain upright for at least 30 minutes after taking it.
Rationale
No rationale provided.

Question 5
What nutritional teaching is important for Mrs. Pelletier with her new diagnosis of osteoporosis?

Treatment of osteoporosis focuses on adequate calcium intake. Teach Mrs. Pelletier to take calcium 1500 mg/day. Due to Mrs. Pelletier’s lactose intolerance, she is not able to consume dairy products to get her daily calcium intake. Foods that are high in calcium that do not have lactose include almonds, sardines, salmon, turnip greens, and spinach. Supplemental calcium is likely if dietary intake of calcium is inadequate. Vitamin D is also necessary for calcium absorption and function and may have a role in bone formation. The recommended dosage for postmenopausal women is 800-1000 IU/day.
Rationale
No rationale provided.

Question 6
What other teaching is appropriate for Mrs. Pelletier?

Moderate amounts of exercise are important to build up and maintain bone mass. The best exercises are weight-bearing exercises that force the individual to work against gravity. Exercises that are low impact, such as walking, hiking, weight training, and dancing, are recommended to avoid stress fractures associated with high-impact activities. Review with her general measures to reduce her risk of falling, including getting up slowly, wearing well-fitting shoes, removing any loose rugs in the house, making sure all of the walkways are kept clear, using grab bars and nonskid mats in the bathroom, and having appropriate lighting, particularly at nighttime.

Discuss the significance of the issue for nursing.

Description

An issue paper differs from a position paper or a discussion paper in that an issue paper consists of a balanced view of a situation or dilemma in which both sides of the situation are clearly articulated. Because authors will often disagree about the kinds of solutions that should be implemented in remedying the situation or dilemma, you are expected to provide an overview of the various points of view found in the literature regarding how this issue should be resolved. Based on your literature review, you will be expected to discuss how you believe this issue should be resolved and provide your own rationale.

Writing an Issue Paper

Searching The Literature

In writing an issue paper you will be expected to search for a variety of literature resources. you may also use the online Library from another University if you have access), and you may also use the Internet to search through any of the online scholarly databases. In addition, there are many links to articles and online databases in this resources site which you may use.

Defining the Issue

Once you have a sound understanding of your topic, you will need to clearly define the issue. Recall that an issue has two sides so your definition of the issue should include a balanced view.

For example: The electronic patient record has many advantages such as a time saver, clarity, and accessibility, but it also comes with the challenges associated with security, increased financial costs, and implementation problems. Your issue statement might be: Even though there are significant benefits to an electronic record, not every health region has the financial resources to implement the proper security protocols necessary to ensure patient privacy.

Framework of Your Issue Paper

Introduction

Introduce your issue

Identify both sides of the issue

Provide an issue definition

Discuss the significance of the issue for nursing.

Body of Paper

Describe your own opinions and beliefs about this issue

Analysis of the issue is completed through discussion of appropriate frameworks

Barriers to resolution are identified

Possible resolution strategies are explored

Conclusion

Briefly summarize your findings and give directions for future research, or recommendations for further study

[Reference: Pryor, J. (2004). Guidelines on writing a philosphy paper. Princeton University.]

Discuss the mechanism of action of each of the drugs you listed.

Mrs. Lyons is a 57-year-old African American female who recently developed headaches and had an elevated blood pressure reading at her work health fair. When she had her blood pressure taken at the health fair the reading was 168/99. She has gone back to the drug store 3 other times to take her blood pressure. The readings have been: 145/90, 150/89, 140/88. At the health fair she was told her BMI is elevated. Her cholesterol levels were also done at the health fair. The results were: total cholesterol level of 250, LDL 138, HDL 48, and Triglycerides 170.

She has not been to see a primary care provider in over 5 years. At her last office visit, which was 5 years ago, her blood pressure was (135/95). Her LDL and triglycerides were also elevated at that time. The patient was supposed to monitor her blood pressure at home and trial diet and lifestyle changes. She was supposed to return for a follow-up with her blood pressure log and for a recheck of her labs. She, unfortunately, did not do this.

Today in the clinic her vital signs are:
BP 146/92, HR 90, Temp 98.4, RR 12, O2 98%, Height 5’5, Weight 220 lbs, BMI 36.6

She is not currently taking any medications. She has NKDA. Family history: her brother and sister both have been diagnosed with hypertension and DM. Diagnoses for the patient are HTN, Obesity, and Hyperlipidemia.

Q1. Please briefly discuss the first-line treatment recommendations from JNC8, and the AHA/ACC for a patient with no other major comorbidities.

Q2. What are the recommended medications to start this specific patient on? Please provide the drug class, generic & trade name, and initial starting dose.

Q3. Please discuss the mechanism of action of each of the drugs you listed.

Q4. Please discuss the side effect profile of each medication you listed.

Q5. Are there any interactions between any of the medications you prescribed?

Q6. What other non-pharmacological interventions would be suggested?

Discuss how you, as an advanced professional nurse leader, would implement the four steps from the “IHI Framework for Improving Joy in Work” (see Supporting Documents) in the workplace, including one strategy for each of the four steps

C. Write a reflection paper (suggested length of 4-6 pages) discussing how to use social and emotional intelligence power skills to handle difficult workplace situations and implement joy in the workplace by doing the following:

1. Describe, using scholarly sources, how advanced professional nurses can manage difficult workplace situations by using each of the following social and emotional intelligence power skills:

• self-awareness

• self-management

• interpersonal communication

• executive function

• social awareness

2. Describe how you, as an advanced professional nurse, would use two of the social and emotional intelligence power skills in the workplace to achieve each of the following results:

• a professional presence

• enhanced mindfulness in healthcare

• a positive social presence to promote a sense of caring and belonging

• a culture of joy to solve the problem of incivility in the workplace and initiate organizational change

3. Discuss how you, as an advanced professional nurse leader, would implement the four steps from the “IHI Framework for Improving Joy in Work” (see Supporting Documents) in the workplace, including one strategy for each of the four steps