Name: N407 Critical Thinking Homework



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N407 Critical Thinking Homework

Chapters 1 and 5
What age related changes and principles of care do I know so far that apply to this scenario? For example, “Excess body weight has important functional considerations;” “Older people must be encouraged to take responsibility for healthy aging,” or, “Common causes of disability in the elderly include degenerative joint disease and diabetes.”

Principles of Gerontology





Nutrition





Psychology and Cognitive Function





Pharmacology





Skin and Sensation





Genitourinary and Renal Systems





Cardiovascular System





Respiratory System





Musculoskeletal System





Neurological System





Pain Management





Elder Mistreatment





Multisystem Problems





End of Life Care




Scenario: 72 year old Mr. Kennedy is having his annual health screening. He is 68” tall and weighs 172#, 9 pounds more than last year. He states, “I guess getting fat is part of getting old!” When you ask about his diet, he admits he doesn’t pay much attention to it. He travels during the day giving lessons and when he returns home, it’s hard to count grams of carbohydrates, sugars, and protein. His fasting glucose is 144 mg/dl.


Question: How do you respond to Mr. Kennedy’s comment? What nursing actions would you include in his nursing care plan?

N407 Critical Thinking Homework

Chapters 6 and 7
What age related changes and principles of care do I know so far that apply to this scenario?

Principles of Gerontology





Nutrition





Psychology and Cognitive Function





Pharmacology





Skin and Sensation





Genitourinary and Renal Systems





Cardiovascular System





Respiratory System





Musculoskeletal System





Neurological System





Pain Management





Elder Mistreatment





Multisystem Problems





End of Life Care




Scenario: You are admitting 74 year old Mr. Kennedy to the Med-Surg unit for treatment of a lower respiratory infection. He is pleasant but rather quiet. When you ask if there will be anyone visiting her soon, he tells you, “Well, no. Most of my friends have moved away or died. My son lives nearby, but he won’t be in.” As you perform the medication reconciliation, he tells you that in addition to Metformin, he is prescribed Pamelor and Celexa by 2 different physicians.


Question: What is your assessment of Mr. Kennedy’s likely psychological status? What further actions will you take? Of the medications listed on your List of Selected Medications for this system, which one do you believe would be most appropriate? Why?

N407 Critical Thinking Homework

Chapters 12 and 14
What age related changes and principles of care do I know so far that apply to this scenario?

Principles of Gerontology





Nutrition





Psychology and Cognitive Function





Pharmacology





Skin and Sensation





Genitourinary and Renal Systems





Cardiovascular System





Respiratory System





Musculoskeletal System





Neurological System





Pain Management





Elder Mistreatment





Multisystem Problems





End of Life Care




Scenario: 76 year old Mr. Kennedy comes in for regular diabetes screening. Normally very positive and gregarious, he tells you when you walk in, “Speak up! You’re mumbling!” He becomes angry and rips off his glasses, saying, “These darned things don’t work.” He states he doesn’t need his Metformin anymore because he feels fine.


Question: As the assigned Registered Nurse, what is your assessment of and response to Mr. Kennedy? Of the medications listed on your List of Selected Medications for this system, which one do you believe would be most appropriate? Why?

N407 Critical Thinking Homework

Chapter 17
What age related changes and principles of care do I know so far that apply to this scenario?

Principles of Gerontology





Nutrition





Psychology and Cognitive Function





Pharmacology





Skin and Sensation





Genitourinary and Renal Systems





Cardiovascular System





Respiratory System





Musculoskeletal System





Neurological System





Pain Management





Elder Mistreatment





Multisystem Problems





End of Life Care




Scenario: 78 year old Merv usually enjoys being active, teaching piano, and seeing his students. Today, he refuses to leave home and cancels his appointments. When you, as the Home Health Registered Nurse, remind him how much people count on his lessons, he replies, “I can’t. I’m embarrassed to say I keep dribbling today.”


Question: As the assigned Home Health Registered Nurse, what further information do you want to obtain from Merv? What physical assessment will you complete? What actions will you take? Of the medications listed on your List of Selected Medications for this system, which one do you believe would be most appropriate? Why?

N407 Critical Thinking Homework

Chapter 15
What age related changes and principles of care do I know so far that apply to this scenario?

Principles of Gerontology





Nutrition





Psychology and Cognitive Function





Pharmacology





Skin and Sensation





Genitourinary and Renal Systems





Cardiovascular System





Respiratory System





Musculoskeletal System





Neurological System





Pain Management





Elder Mistreatment





Multisystem Problems





End of Life Care




Scenario: 80 year old Merv just returned from his annual camping trip with his motorcycles. He said he had a great time, but he’s irritated because he came back with shortness of breath, fatigue, and swelling of his lower legs.


Question: As the Clinic Registered Nurse, what further information do you want to obtain from Merv? What tests do you anticipate for him? What is his likely medical diagnosis? What will you include in your Nursing Care Plan? Of the medications listed on your List of Selected Medications for this system, which one do you believe would be most appropriate? Why?

N407 Critical Thinking Homework

Chapter 16
What age related changes and principles of care do I know so far that apply to this scenario?

Principles of Gerontology





Nutrition





Psychology and Cognitive Function





Pharmacology





Skin and Sensation





Genitourinary and Renal Systems





Cardiovascular System





Respiratory System





Musculoskeletal System





Neurological System





Pain Management





Elder Mistreatment





Multisystem Problems





End of Life Care




Scenario: 82 year old Merv is a patient in your emergency department. You learn he is living alone. He states he has been busy with a jazz gig at a local coffee house and with his music students. He has an intermittent cough that is both blood-tinged and yellow. He shows you an expired packed of Erythromycin that he has been taking.


Question: What further questions will you ask of Merv? What assessments will you perform? Based on your assumptions, what further orders will you anticipate from the physician? What initial medical diagnosis/ses do you consider? Of the medications listed on your List of Selected Medications for this system, which one do you believe would be most appropriate? Why?

N407 Critical Thinking Homework

Chapter 18
What age related changes and principles of care do I know so far that apply to this scenario?

Principles of Gerontology





Nutrition





Psychology and Cognitive Function





Pharmacology





Skin and Sensation





Genitourinary and Renal Systems





Cardiovascular System





Respiratory System





Musculoskeletal System





Neurological System





Pain Management





Elder Mistreatment





Multisystem Problems





End of Life Care




Scenario: 84 year old Merv has played piano and marimba since his teens. He now plays primarily for enjoyment, but he plays every day. His daughter, Laura, has moved in with him and brings him to the clinic because he complains of pain in his elbows and hands. Merv’s physician has ordered an xray of his elbows and hands. Merv states cheerily he thinks he just needs to rest. His medicines now include Metformin, Metoprolol, Celebrex, and Methotrexate. His vitals are Ht: 65” Wt: 140lbs BP 148/80 Pulse 72.


Question: What do you think might be involved in Merv’s health status? What will you explain to him? What are your recommendations for his self-care? Of the medications listed on your List of Selected Medications for this system, which one do you believe would be most appropriate? Why?

N407 Critical Thinking Homework

Chapter 22
What age related changes and principles of care do I know so far that apply to this scenario?

Principles of Gerontology





Nutrition





Psychology and Cognitive Function





Pharmacology





Skin and Sensation





Genitourinary and Renal Systems





Cardiovascular System





Respiratory System





Musculoskeletal System





Neurological System





Pain Management





Elder Mistreatment





Multisystem Problems





End of Life Care




Scenario: Laura states 86 year old Merv is increasingly pleasantly forgetful. Her daughter calls you at the urgent care center and asks you what she should do. Merv won’t eat at home. He often walks to the senior center to eat, but today was late in coming home. Laura found Merv sitting at the side of the road, staring straight ahead. He is slow in answering Laura’s questions. He is still taking Metformin, Metoprolol, Celebrex, and Methotrexate.


Question: What are the possible causes of Merv’s situation? What do you advise Laura to do? Of the medications listed on your List of Selected Medications for this system, which one do you believe would be most appropriate? Why?

N407 Critical Thinking Homework

Chapters 9 and 10
What age related changes and principles of care do I know so far that apply to this scenario?

Principles of Gerontology





Nutrition





Psychology and Cognitive Function





Pharmacology





Skin and Sensation





Genitourinary and Renal Systems





Cardiovascular System





Respiratory System





Musculoskeletal System





Neurological System





Pain Management





Elder Mistreatment





Multisystem Problems





End of Life Care




Scenario: Laura had to leave town to see her mother. Nick said he would stay with 88 year old Merv while she was gone. Merv has come to your emergency department complaining of difficulty breathing. When you ask him when he last took his prescribed furosemide, he states, “I’m not sure.” His son, Nick, interrupts, “You know, the medicine I give you every day.” Merv replies, “Oh, that’s right.” Nick states he can’t wait until Laura gets back because he’s tired of Merv “bangin’ on that piano” all day.


Question: What is your initial assessment of Merv’s situation? What will you do next? What care do you anticipate next? Of the medications listed on your List of Selected Medications for this system, which one do you believe would be most appropriate? Why?

N407 Critical Thinking Homework

Chapters 11 and 24
What age related changes and principles of care do I know so far that apply to this scenario?

Principles of Gerontology





Nutrition





Psychology and Cognitive Function





Pharmacology





Skin and Sensation





Genitourinary and Renal Systems





Cardiovascular System





Respiratory System





Musculoskeletal System





Neurological System





Pain Management





Elder Mistreatment





Multisystem Problems





End of Life Care




Scenario: You are a home health Registered Nurse visiting 90 year old Merv at home. Laura tells you that Merv has not eaten for 24 hours and he hasn’t voided hardly at all. Because he has end stage COPD and heart failure, he is receiving O2 by nasal cannula at 3 LPM. He complains of severe muscle and joint pain in his elbows and hands and states the medication he requests every 6 hours does not help. Laura thinks maybe it’s time for a meeting with the health care team.


Question: What further information will you need regarding Merv’s status? What assessments will you perform? How are Merv’s body systems responding? What will you include in the nursing care plan for Merv and Laura? Of the medications listed on your List of Selected Medications for this system, which one do you believe would be most appropriate? Why?

Write your response on this page and on the back if you need. Do not write on any other pages! Your response should be thorough and succinct, written professionally, using correct medical and nursing terminology. Remember, LESS IS MORE!



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