TRINITY VALLEY COMMUNITY COLLEGE ASSOCIATE DEGREE NURSING PROGRAM LEVEL II Clinical Activity: Perfusion 1.) Comparisons of patients with Congestive Heart 2.) Comparison of patients on Anti-HTN Medications
Course Outcomes which will be met with the completion of this worksheet: I. Assess A. Subjective/objective patient data by interview, comprehensive physical assessment, observation, reading patient records, and interacting with other members of the health care team. (A.1) C. Corroborate assessment findings with the patient and other health care professionals. (A.1)
II. Analyze A. Data obtained during assessment by recognizing significant information, organizing patterns or clusters, identifying strengths, and reaching conclusions (according to Maslow, Erickson, Selye,) (A.2) B. Use references when formulating, and validating patient problems with evidence (actual, potential, and, high risk). (A.2)
III. Plan A. Prioritized, individualized, and systematic nursing care for patients with common health needs. (A.2, A.4, B.2)
IV. Implement F. Communicate with other health care professionals by documenting, reporting and conferring. (A.3,B.2)
V. Evaluate B. Recognize patterns in patient’s health status. (A.5)
Activity: This activity is to be done in a group of 2-3 students. Each student should keep their own notes during the activity.
Choose 2 patients with congestive heart failure. Research the pathophysiology for congestive heart failure.
Collect information on all assigned patients such as the patients’ history, other pre-existing conditions, diet, medications, treatments, diagnostics, lab, activity orders, etc.
Perform a lung and heart focused assessment on each patient….split this up so the patient only has ONE student doing this assessment.
Compare and contrast each patient (team work). Complete the questions and be prepared to present the groups findings in a clinical post conference as directed by the instructor.
182 1.) Comparison of two patients with Congestive heart failure.
Pt #1 Initials ______Pt #2 Initials ______
Primary Dx: Congestive Heart Failure Primary Dx: Congestive Heart Failure
Classification: Classification:
Vitals (Include pain score): Vitals (Include pain score):
Other medical diagnoses and preexisting conditions: Other medical diagnoses and preexisting conditions:
Medications specific to treat CHF: Medications specific to treat CHF: (Name, dosage, route, frequency and rationale) (Name, dosage, route, frequency and rationale)
183 Diet: Diet:
Rationale for diet: Rationale for diet:
Activity Orders: Activity Orders:
Rationale: Rationale:
Treatments: Treatments:
1. 1.
2. 2.
3. 3.
Rationale: Rationale:
1. 1.
2. 2.
3. 3.
184 Tests and Labs: Document the results of these labs Tests and Labs: Document the results of these labs and tests and tests
CXR: CXR:
BNP: BNP:
CMP: CMP:
CBC: CBC:
ECHO or TEE: ECHO or TEE:
Focused Assessment Findings: Focused Assessment Findings: Heart: Heart:
Lungs: Lungs:
185 CHF Comparison Questions
1. Go back to the above chart and highlight similarities in one color and differences in another color.
2. What common threads did you find? What differences did you find?
3. Why are the assessment findings different?
4. What are the differences in treatment?
5. What are the differences in prescribed medications?
186 2.) Comparison of Two patients with diagnoses of hypertension
If you can use the same patients. Patient One Rm: Initials: Patient Two Rm: Initials: Work with a partner and collect data, one patient for each of you DX: Hypertension DX: Hypertension and then compare your results.
Focused Assessment, if not already done (heart & lungs):
Lab Values, if not already done:
Vitals, if not already done:
Look at several days of blood pressure readings. Is the patient’s blood pressure currently being controlled? Why or Why not?
List all Ace Inhibitors, beta blockers, and Calcium Channel Blockers the patients are on. (List drug class, drug name, and dose/frequency)
Do you know your ABC’s?
187 Write a paragraph or list bullet points explaining how each of the following classes of meds work. Write in layperson’s words like if your patient asked you, “How does this medication work?”
Ace Inhibitor
“Nurse, how does this blood pressure medication you are going to give me work?
What are the adverse side effects of this medication?
What do you assess/evaluate for a patient with this medication class (focused assessment of heart and lungs, lab values, vitals)?
Beta Blockers
“Nurse, how does this blood pressure medication you are going to give me work?
What are the adverse side effects of this medication?
What do you assess/evaluate for a patient with this medication class (focused assessment of heart and lungs, lab values, vitals)?
Calcium Channel Blockers
“Nurse, how does this blood pressure medication you are going to give me work?
Which disease(s) is it commonly prescribed for and why?
What do you assess/evaluate for a patient with this medication class (focused assessment of heart and lungs, lab values, vitals)?
188