Using+the+Nursing+Process


 * Instructor:** Betty Rickey RN, MSN


 * Course Name**: NUR 101AW Nursing Fundamentals


 * Objective:** As a group, apply the Nursing Process to a scenario.


 * Description of previous assignment**: Scenarios basically done in class or on a discussion board.


 * Rationale for assignment revision**: Sometimes it's the same students who answer the questions because they are excited to learn and share their thoughts. I would like to see all students get involved in the learning process.


 * Technology to be used**: Blog [|http://blogger.com]


 * Instructions students will need to use technology**: I will instruct the students to go to [|http://blogger.com] and follow this site's instructions on how to create their own blog. They will then be asked to send the instructor their blog's URL website. It will be optional for them to post it for peers to read at first. Later, once they are comfortable with the technology and sharing, I will ask them to allow peers into their blog site to review and collaborate by sharing their understanding of the Nursing Process according to the assigned scenario.


 * Brief description of content students will need to accomplish assignment** (textbook, websites, lectures, videos, resources): 1. Students will refer to their textbooks related to their patient for precise information on use of the Nursing Process as they examine the pathophysiology, medical and nursing diagnostics, therapies along with high risks and expected patient outcomes.


 * Instructions for students to complete assignment**: As a group, the students will need to develop a blog as stated above. **1**. Each student will be assigned to a group. **2**. Each group will be required to post to their blog according to their assigned week's responsibility. **3.** After they have posted their use of the Nursing Process on their assigned scenario, the instructor will give comments. The group needs to identify which of Gordon's Functional Health Assessment Patterns they would focus on and what questions wouldthey ask along with expected answers they give for trying to solve this patient's problems. Then judgments must be formed based on that Pattern (s) data. A Nursing Dx, patient goals, Nursing Interventions with Assessment, Action, and Teaching included, then expected patient outcomes under Evaluation. **4.** Then that week's Bloggers, will be required to invite peers to review their use of the Nursing Process. **5.** Each student must post constructive criticism/critique of the Blogger's use of the Nursing Process. **6.** Once the Bloggers have read their critiquing, they must alter their blog as they would continue to monitor and/or alter nursing interventions if the patient did not meet their goals.


 * Grading criteria, rubric, and assessment**: Will be created and placed in the Course Supplement. These will be discussed during week one of the course.

Your grandma has come down with a cold. Apply the nursing process to grandma who is 76 yo, lives by herself. She has had a cold for about 3 weeks, with a productive cough, chest discomfort when she coughs, VS are stable which includes that she is afebrile. She seems alittle confused by questions you ask her on what she's done today, which is abnormal for her. She also wonders where her mother is, who you know died 10 years ago.
 * Week 1:**

Sam, a 86 yo farmer, complains of abdominal cramping, slight nausea, but no vomiting for the last couple of days. Last BM was 4 days ago. Usually goes every day. Has not had much of an appetite since his wife died 2 weeks ago. He lives alone, is quieter than usual. You were following up with him as you were his wife's hospice nurse in their home.
 * Week 2:**

Mr. T, a 74 yo male was admitted to your medical unit 2 days ago, after being diagnosed with extensive cellulitis in the right ankle. He is also diabetic and has a history of CHF. He admits pain at a 1/5 and is not sure how this happened. He does not wear shoes around the house as he knows he should. He was a truck driver for about 40 years. His blood sugars have been between 160-250 for the past 2 days. The cellulitis has gone down slightly, but he continues to having pitting edema RLL and a darken area has begun in the center of the cellulitis about the size of a dime. He is on antibiotics, Lanoxin, Lasix, and Lantus with a sliding scale for his blood sugar checks.
 * Week 3:**

Ms. Sally, is a 84, who was admitted to your telemetry unit with swollen ankles up to the knees bilaterally and SOB. Her rhythm is atrial fib with a controlled ventricular response. BP: 162/82-84 (irreg-irreg)-28, 97.2F. Lungs have crackles bilateral bases to mid scapular area. She is on 3L O2 nc with a KVO IV. She c/o SOB when she gets up to the bathroom, when eating and you also note SOB when she's talking to you at length about her condition. Her CXR shows CHF. CBC: WBCs and platelets are WLN, but the H&H are low. Her Na+ is 138, K+ is 3.2 and Cl- 104.
 * Week 4:**

Mr. T's Chest X-Ray report shows left lung pneumonia.
 * Week 5:**

You have a patient in this picture. Mr. T, 62yo, was admitted to your medical unit yesterday c/o of SOB, weakness, productive yellowish-green cough for 4 days, right sided chest pain when taking a deep breath. He has a history of COPD: Emphysema for the past 20 years. He also has a 60 pack year smoking history. His last admit was 2 months ago with an exacerbation of COPD. What data do you not have here, that you'd like?

State the Gordon's Patterns you would focus your assessment on as you care for Mr. T. As you use the Nursing Process, include what you expect to find in your assessment including physical exam, diagnostics including labs and CXR reports, environmental and work history. Later, you were looking in a textbook and you noted this picture: How could you use this picture to assist Mr. T in smoking cessation? Left side is a normal pink lung, right side is an emphysemic blackish lung.

Mr. Smith, comes into your agency for complaints of low back pain. Doctor, after multiple tests, decides Mr. Smith requires a laminectomy. Before he goes to surgery, you ask him to rate his pain, which he does at a 4/5. You medicate him for pain. About 2 hours later, he c/o that the pain has not gone away and it's gone down his legs and especially has settled in the left calf. You are busy with several other patients and do not assess him further other than what he tells you. You believe he is not expressing his pain accurately and you tell him, he'll just have to wait for that same pain med again which can't be given for 2 more hours. You do not offer him other meds that could calm his pain down because you believe he's not in that much pain. Doctor makes rounds about 1 hour later and finds that Mr. Smith's pain is a 5/5. He discovers his patient's left calf very edematous, dusky in color and has no pedal pulses palpable. First of all, what ethical and/or legal ramifications are present? How would you use the nursing process to assist Mr. Smith?
 * Week 6/7:**