NURS23921 The Realities Of Practice

Question 

Case Scenario 1 – Mr. Frank Jura

Mr. Frank Jura is a 54 year old male, currently admitted to the cardiac unit in response to an exacerbation of his unstable angina.  Mr. Jura also presents with uncontrolled Type II diabetes, hypertension, and is currently obese.

As a pregraduate PN student on the unit, you are assigned to Mr. Jura’s care for the duration of your shift.  You have negotiated the plan of care with your RN preceptor (who is also assigned to Mr. Jura), and divided the responsibilities of his care for the remainder of the 12-hour shift.  

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After completing your AM vitals, you notice that Mr. Jura’s blood pressure has been hovering just above high-normal range (around 145/90) as long as he has been admitted.  Curious at this trend, you examine his medication administration record and note that he is currently prescribed the following cardiac related medications/treatments:

  • Ramipril 2.5mg PO OD
  • Metoprolol 100 mg PO BID
  • Hydrochlorothiazide 20 mg PO OD
  • Transderm nitropatch 0.2 (0.2 mg/hour) – apply patch at 0800 and remove at 2000
  • Nitrospray,1 spray (0.3-0.6mg) SL q5 mins up to 3 times; use at first sign of angina

You inform your preceptor of your findings regarding his elevated blood pressure.  In response, your preceptor states:

 “Ah well, the poor guy is probably nervous….you know, being in the hospital and all.  I’ll just pop a PRN Ativan into his AM meds and that should help with his elevated blood pressure.”

Select one case study from the above listing, and complete the assignment focusing upon the following:

1. Deconstruct the case narrative, exploring the scenario from both the nursing, health and psychosocial perspectives.

2. Generate relevant and timely actions and recommendations to assist the patient (and their family) in the situation to obtain the highest level of wellness possible. 

3. Discuss your process of finding, retrieving, and analyzing best practice information to develop care plan for the patient and their family in the given case narrative.

4. Include discussion of at least one College of Nurses of Ontario Practice Standard or Guideline (http://www.cno.org/learn-about-standards-guidelines/publications-list/standards-and- guidelines/), and how the Standard or Guideline is relevant to the case scenario.

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