Write a nursing portfolio essay


Each student will complete an ePortfolio via Blackboard that reflects his/her progress throughout the nursing program and demonstrates achievement of the nursing program outcomes (course objectives). The portfolio is worth up to 100 points of the course grade. Please refer to the Course Calendar for the due date.


The portfolio is a compilation of work that is used to document intellectual growth and achievement throughout the nursing program. Students are given the opportunity to summarize change and progression in their abilities and perspectives by addressing each program outcome.


The portfolio must be written using APA format. For each program objective (10 objectives), write a narrative statement that describes how you met each objective. Limit the entire narrative to no more than 2000 words. Include examples or supporting evidence to show progression in your abilities and perspectives. Electronic versions of supporting evidence will be attached as per Blackboard ePortfolio design. Graded or ungraded versions of supporting evidence are acceptable.

Following your introductory paragraph, the portfolio is designed to align with the course objectives of NUR423. There are 10 major segments: one for each clinical objective. For each segment, you will need to include:

1. A brief statement describing the purpose of given objective in your professional development

1. Then identify supporting evidence and how each contributes to meeting the given objective

1. Then briefly explain how the chosen evidence items (e.g. artifacts) illustrate your change and progression in the program

For example, if you are trying to show progress in critical thinking from the sophomore to senior level, you may want to include in your summary statement how your critical thinking improved over the nursing program, your perspectives on critical thinking and how the specific assignments helped you accomplish each program outcome. Individual supporting evidence will be presented with each course objective in the respective portfolio section.

*Refer to the posted instructional video for additional details.

Evidence of growth in the following areas must be demonstrated:

· Global Perspectives, Critical Thinking, and Use of Technology

· Sound Decision-making to Design, Coordinate, Manage and Evaluate Nursing Care

· Caring, Compassionate, and Culturally Appropriate Patient-centered Care in Diverse Settings

· Effective Communication, Collaboration & Negotiation

· Professional Values and Behaviors

· Promoting Healthy Lifestyles Through Health Promotion, Risk Reduction, and Disease Prevention Education

· Incorporating Evidence-based Knowledge and Theory in Nursing Practice

· Demonstrating Leadership and Collaboration with Health Care Partners

· Allocating and Managing Resources to Ensure Patient Safety and Quality Care

· Engaging in Life-long Learning and Scholarly Inquiry

The following items are strongly recommended for inclusion:

· Philosophy of Nursing (2)

· Oral Presentation Materials

· Teaching Plan

· Case Study

· Clinical Care Plans (2)

· Clinical Maps (2)

· Research Integrated Focused Review of Literature (1)

· Research Critique (1)

· Major Nursing Projects (2) i.e. Community Assessment, IPR, Controversial Topic Presentation

· Major Academic Non-Nursing Projects (2) i.e. Nutrition, Statistics, etc.


Student ___________________________________ Faculty ___________________________________

Total Earned Points _______/ 100 Portfolio Grade ___________


The portfolio is a two-part work product. Students will compile and submit a collection of papers and other projects completed during their BSN educational experience that demonstrate growth towards professional nursing, as described by the JU School of Nursing program objectives.

1. The first part consists of a narrative in which students summarize their accomplishments and professional growth in a series of paragraphs with each paragraph reflecting one of the ten JU School of Nursing BSN program outcomes. For each program outcome, students should discuss at least two assignments from different courses and how the assignments demonstrate professional growth toward that outcome. This narrative component should be no longer than 2000 words in length in the Blackboard Portfolio and should be prepared using appropriate APA style formatting. Each item of supporting evidence must be clearly identified in the narrative discussion, connected to their source and consistently labeled throughout the portfolio.

2. The second part consists of supporting evidence. Electronic versions of supplemental materials discussed in the assignment narrative should be included as supporting evidence after the narrative component. Graded copies are preferred though not required. See examples of assignments that should be included.

The grade will be calculated based on the number of points earned for each criterion. In order to receive a passing grade, the student must achieve a score in each area of at least 7.0 for each program outcome and total score of at least 70. Note: Up to 10 points will be deducted for incorrect APA format/grammar.

Grading CriteriaDemonstrates growth in:Possible ScoreEarned Score
Global Perspectives, Critical Thinking, and Use of Technology10
Sound Decision-making to Design, Coordinate, Manage and Evaluate Nursing Care10
Caring, Compassionate, and Culturally Appropriate Patient-centered Care in Diverse Settings10
Effective Communication, Collaboration & Negotiation10
Professional Values and Behaviors10
Promoting Healthy Lifestyles Through Health Promotion, Risk Reduction, and Disease Prevention Education10
Incorporating Evidence-based Knowledge and Theory into Nursing Practice10
Demonstrating Leadership and Collaboration with Health Care Partners10
Allocating and Managing Resources to Ensure Patient Safety and Quality Care10
Engaging in Life-long Learning and Scholarly Inquiry10

Course Objectives: BASIS OF PORTFOLIO

1. Synthesize knowledge from the liberal arts and sciences and nursing science to understand global perspectives, stimulate critical thinking, and use current technologies. E.g Culture, essential careplan, caremaps (ssential vs critical care), compare scores on assignment , philosophy leadership & foundation of nursing


ARTIFACT 2: Critical Care Map

DIFFEREENCE BTW MAPS: Using map to illustrate disease process and Nursing process

More details about disease process, link between symptoms, risk factor, pathophysiology, and interventions

2. Make sound decisions in the use of patient information and health care technology to design, coordinate, manage and evaluate nursing care for individuals, families and populations.

Artifact I: Nursing Assessment (!st semester of Nursing school)

Damilola Mohammed

Mr. JU Complete Health Assessment

Jacksonville University

June 14th, 2017


I. Biography Data:

Name: Mr. Ju

Address: 2800 University Boulevard North

Marital Status: Divorced

Mr. Ju is a 56-year-old black American male, divorced, moved to the United States ten years ago and he presently employed as an IT analyst.

Source: Mr. JU is a reliable source

Reason for seeking care: Chest pain

History of present illness: “I started experiencing pain after eating the night before, and I occasionally have Heartburn when I eat.” He drinks a cup of milk, ice and self-medicated antacid to relieve pain. Pain sharp and was rated four(4) on a scale of 1-10.

II. Past Health History

Past Illness: Pneumonia at age 6, Chicken Pox, Malaria.

Accident/Injury: Bicycle accident resulting in mild knee bruise (scar is still visible).

Chronic Illnesses: None

Hospitalizations: Malaria at age 15

Obstetric History: None

Immunization: Childhood vaccination (BCG, OPV, Hepatitis B, Yellow Fever, Measles). He tested positive for TB skin test, but subsequent chest x-ray is normal. Last tetanus shot and varicella zoster virus vaccine was ten years ago.

Last Examination: Last Physical exam was ten months ago and visited the dentist for teeth straightening and cleaning in 2014.

Allergies: Client is not aware of any drug allergy. But he once had an allergy to nuts which caused pimples irritation on the face. Prescribed medication by the Dermatologist was used to treat it. Nasal allergy (He claims it started since he moved to Florida). Skin pigmentation around the neck due to jewelry.

Current Medications: Anti-histamine(Nasacort) to reduce sneezing, Alka-Seltzer for Heartburn.

III. Family History Genogram:

Mr. Ju is the only child of his parent who is still both alive, and he has two kids (twin girls) from his marriage, but now divorced. His family Genogram is below.

Review of SystemsPhysical assessmentFindings/Conclusion
SKIN:Cleanse skin daily with soap only. He claims: “sponge makes my body itch.” He Uses anti-dandruff shampoo for hair, does pedicure once a month.Visited dermatologist three (3) years ago for skin related allergiesSkin is Dark brown color and normal temperature. Visible acne (whiteheads) on the skin around the nose. Visible dark spot on the face because of previous skin allergies.Sign of Onychophagy (Nail biting) but no clubbing. Capillary refill is less than 3 seconds. Dark brown color birthmark on the skin of his upper arm.Abnormalities- Whiteheads and nail biting which make him susceptible bacteria or skin infection.
HEAD:Client reports an occasional headache when tired and hungry. Self-medication for his headache is Aspirin. No history of head injury, dizziness or vertigo.Normocephalic skull, No lesion or lumps, and temporal artery tenderness. The face is symmetry and no involuntary muscle movement, dyskinesia or nodding.Hair coverage is regular.Normal findings
EYES:No eye pain or discharge. No history of wearing glasses but he claims he might need one soon.Sign of Strabismus on the left eye which does not affect his visual acuity. 20/20 vision using a magazine. Eye redness and claims it does not hurt.Abnormalities: Eye checkup is needed to avoid developing Amblyopia. Eyeglasses might be required.
Ears:No pain in the ear. Had a history of ear infection as a child causing swelling and producing Pus. The infection has been treated and no hearing loss.Ears are symmetric. No mass, lesion, tenderness, discharge and no visible cerumen.Normal findings
NOSE:The client uses Nasacort once daily for nasal allergy (Sneezing). He also experiences occasional nasal bleed; states that “it occurs if you hit my head.”No deformity or tenderness. The septum is midline; no sign of perforation and sinuses are not inflamed.No abnormal findings
MOUTH:Client complains about dry mouth which also causes unpleasant odorLip was slightly dry. Buccal mucosa and throat look normal. No bleeding, lesion or inflamed tonsils (graded 1+). The tongue is symmetry and Uvula rise to the midline.Mild yellow stained on lower set of teethAdequate attention to the lips to avoid fissures. A dental exam is advised to clean teeth.
NECK:No pain swallowing or during range of motionNormal carotid artery pulsation and no bruits. Thyroid region looks elevated which might be mistaken for a “full neck,” and he expresses pain during deep palpation.Elevated Thyroid can be early stages of Goiter; medical checkup was advised
BREASTS:Patient deferredPatient deferred
RESPIRATORY/ THORAX:Occasional chest pain which is not localized and no radiation. Had a history of Pneumonia has a child which was treated.He claims he experiences anxiety which makes him hyperventilate and feel tired. No history of smoking or trauma to the chest.Chest expansion is symmetric and no abnormal muscle use.No abnormal lung sound.Lab and imaging test is recommended for chest pain.Reduce intake of Ice.
CARDIOVASCULAR:Heart rate increases with anxiety effect.No noticeable pulsation, S3 0r S4 sounds or murmur using bell and diaphragm of the stethoscope. Radial pulse was regular.Monitor vital signs to note any abnormalities.Cholesterol screening
PERIPHERAL VASCULAR:Client has no complaintsPeripheral pulses are presents. Patient deferred palpation of the femoral pulse.
ABDOMEN:He experiences no food intolerance or constipation. No pain with swallowing but experiences heartburn. Routine bowel movements early in the morning after drinking water.Bowel sounds are present in all quadrant of the abdomen.Encourage continued use of his antacids(Alka-Seltzer) to control heartburn.
URINARY SYSTEM:Frequency is normal and no pain associated with it. No unusual color or history of urinary disease.Patient deferredNo abnormal findings.Hydration is important.
GENITALIA:Client expressed awareness of personal hygiene.Patient deferredScreening for prostate cancer from 50 years above.
SEXUAL HEALTH:Client claims he is sexually active but safePatient deferredPatient Deferred
MUSCULOSKELETAL:His family has a history of Rheumatoid Arthritis, but he feels no pain in his joints or during range of motions.Joints on upper and lower extremities are symmetric. No swelling, mass and abnormal curvature. There is slight crepitation around the Temporal Mandibular Joint. No pain for neck, shoulder, and hip range of motion.Encourage more physical activities.
NEUROLOGICNo history or depression or mental breakdown, seizures or fainting.The client was oriented and conscious of place and time. Appearance, behavior, and speech are normal. Gait and cranial nerves are normal except for the accommodation of the left eye. Reaction to light touch and was able to identify pen on his palmNo abnormal finding with client’s mental status

DRTs: 2+

2+ 2+ 2+

2+ 2+

2+ 2+

Functional Assessment

Mr. JU currently works as an IT analyst on contract for a transportation company; within five years of graduating from the university he has changed job roles and worked with different IT companies. He appears to be living a fulfilled life and financially comfortable. Born into an active practicing Islam family, he claims to be spiritual but not religious. But is a family oriented person and being the only child of his parents; he grew up having a cordial relationship with his Grandpa who is the only surviving grandparent he grew up knowing while others were dead before he matured. He has been involved in three different sexual relationships after divorcing his wife of five years, but he maintains a relationship with his twin girls and is very much involved in the activities of their lives. He claims he is happy and content with his life.

Working long hours; five days a week and with the nature of his job which required sitting for long hours; it allows him less time for physical exercise, but he tries to make up for it by climbing the stairs at work instead of using the elevator. He enjoys time out with his family and friends, loves fishing and playing video games and has no history of drug use, smoking or excessive drinking of alcohol; he drinks wine occasionally. 6-8 hours is an average time he sleeps for, but he sometimes brings his work home and stays up for longer hours.

Mr. JU identifies his poor diet (choice of food and timing) and lack of physical activities as his health problem. His 24 hours’ recall is; Breakfast- Bagel, and Cheese. Lunch- Pasta and two boiled Eggs. Dinner- Burrito.


Based on the assessment data, he lives a normal lifestyle but needs to be cautious of the health aspect. The sharp chest pain and heartburn should be assessed by a medical professional to rule out the possibility of Myocardial injury. Living by himself most of the time may be the cause of his poor diet because he is not motivated to seek out healthy food; he makes do with what is fast and available. Controlled diet and reducing environmental distress can help maintain health and reduce his occasional anxiety issues. From a nursing perspective, the priority of diagnosis is Pain which can be due to many reasons. Sufficient rest, monitoring of vital signs complications, lab tests and imaging (X-ray or EKG) is advised. The second priority is anxiety which causes hyperventilation and alters the acid-base imbalance of the body system. The third priority is the sharp, squeezing sensation in the chest due to the heartburn; client self-medicate, but medical attention is needed to have an accurate diagnosis for the chest pain.

The client is conscious and oriented but shows signs of pain aggravated by movement. Respiratory pattern is normal; 18. Blood pressure 110/83. Pupil equal, round but reaction to light and accommodation in the left eye was slightly slow. Capillary refill is less than 3 seconds. The temperature of upper and lower extremities was normal. Clean appearance, pleasant and cooperative. Lung fields are clear; bowel sounds are present in all four quadrants; skin moisture looks healthy except the dark spots on the face and whiteheads around the nose.

Educated client about healthy eating, controlling cholesterol level and the different possibilities causing chest pain and the clients verbalized “I would check in with my doctor, I am too young to die.”

Damilola Mohammed

JU Student Nurse.


Jarvis, C. (2016). Physical examination and health assessment. (7th ed.). St. Louis, Mo: Saunders.

Ackley, B., & Ladwig, G. (2017). Nursing diagnosis handbook: An evidence-based guide to

planning care (11th Ed.). St. Louis, MO: Mosby Elsevier.

Artifact 2: Medical Surgical Care plan

Jacksonville University
School of Nursing

Adult Health II Nursing Practice

Care Plan and MapDamilola MohammedStudent Name_______________________Clinical Dates Wednesday (Memorial Hospital)Professor StoerFaculty Name________________________JACKSONVILLE UNIVERSITYSCHOOL OF NURSINGADULT HEALTH NURSING PRACTICEPatient Initials- Mr C.C Room #- **61 Date of Admission 01/08/18Attending Physician- ConsultationAge: 89 years Sex- M Weight- 31.5Kg Allergies- CliostazolAdmitting and Primary Diagnoses- Carotid Artery OcclusionReason for assignment selection of this client – Medical Surgical skills II practiceFOCUSED CLIENT ASSESSMENTPSYCHOSOCIAL HISTORY: Mr. C.C. is a 89 years old white male who has been married for 68 years; has a daughter and four grandchildren. He claims he smoked for 48years but quit 20 years ago and he only drinks alcohol during social gatherings stating, “I am a social drinker”. He identifies himself as a catholic, he is full code and he joined the navy after the second world war and retired after 30 years of service.Past and present medical historyChief Complaint and Reason for Admission: Shortness of Breath and Chest PainPatient’s belief about symptoms: He believes his symptoms is related to Heart Failure due to history of Cardiac problemPresent Medical History: Patient stated he felt out of breath before going to bed at 18:30 a day before his admission; and he tried to sleep. He was awakened by pain at around 22hrs and he called the EMS. He had bilateral ankle pitting edema and complained of chill but no fever.Past Medical History: Carotid disease, Coronary Artery Disease, Hypertension, Hyperlipidemia, Congenital absent right kidney, Phlebitis, cardiomyopathy, PVD.Surgical History: Right carotid atherectomy, Permanent pacemaker (05/29/2003, 11/2017), Left heart catheterization with successful revascularization of circumflex with TIMI-3 flow and stenting, Two stents in right leg, cardiac stent.Family Medical History: Mother died of cancer and father had an Heart attack.Personal History of Psychological Disorders: None was statedFamily History of Psychological Disorders: None was statedAdvance Directives: None in place at this time.Immunizations. Pneumonia/Influenza- Flu shot (October/2017). No pneumococcal or tetanus shot in recent years.Last Physical Examination: October 2017

(include onset, duration, location, severity, precipitating/aggravating/alleviating factors)


Patient claims he has limited balance and coordination and moves around with a Walker. He denies speech changes, loss of consciousness and syncope episodes. He states that he feels numbness in his toes and finger tips but no tremor. He claims he feels weak sometimes but denies seizure, stroke and paralysis. He states no memory issues, saying he remembers when he married his wife 68 years ago and also states he would be 90 years old next month.



Patient denies suicidal ideation in the past or recent. He claims he is not depressed or has mood changes. He states he feels nervous when out of breath and only has difficulty concentrating at that moment.


He denies use of sunscreen but claims he cleanse daily with soap and uses moisturizing lotion. He stated he got phlebitis from his Heparin treatment. He denies history of skin disease, Nevi, Acne and changes in nails.


Patient claims he experiences no frequent or severe headaches. He denies head injury, dizziness, vertigo and syncope


Patient claims he wears corrective lenses due to his short sightedness. He claims his eye itch but does not feel pain. He stated no double vision, cross eye or eye drainage. He has no history of eye injury or disorder except cataracts on both eyes. He was unable to recall the date of his last eye exam.


Patient claims he has difficulty hearing but no complete hearing loss. He denies ear aches, discharge, tinnitus, vertigo or exposure to environmental noise. He states that he wears no hearing aids and his last Ear exam was October 2017.


Patient expressed that he has no nasal obstruction, discharge, epitaxis, sinus pain, allergies, trauma, frequent cold/URI. He stated that his nasal nares are dry.

Mouth and Throat.

Patient states that he experiences no mouth pain, bleeding gum, and sore throat. He claims he has an upper and lower denture and he has no change in taste as of recent. He denies dysphagia, and history of tonsillectomy.

Neck/Lymph Nodes.

Patient claims he has full range of motion with no pain/tenderness. He denies swollen glands or feeling lumps in his neck area.


Patient stated that he feels sharp pain in the middle of his chest. He denies any lump, swelling, or trauma to the chest. He stated that he does not perfume Breast self-examination.


Patient claims he has no lung disease, but experiences shortness of breath accompanied with chest pain. He has unproductive cough sometimes and has no history of Respiratory infection, asthma and exposure to toxins. He is on 2L oxygen via nasal cannula


He denies palpitation, heart murmur, cyanosis but experience chest pain and fatigue. He has dyspnea with exertion but no orthopnea. He claims he has edema on both legs and has history of Hypertension.

Peripheral Vascular.

Patient claims he feels numbness in the finger tips and toes. He stated that his legs are swollen, inflamed veins on both hands but has no varicose veins, ulcer or infection.


Patient claims he was recently changed to a cardiac diet. He denies nausea, vomiting, abdominal pain and dysphagia. He stated that he most recent weight was 235 pounds two months ago.

History of:

He denies history of ulcer, liver disease, appendicitis, colitis and jaundice. He claims his last bowel movement was the morning before and he experiences no pain or bleeding. He takes multivitamins but not currently using laxatives, Antacids or herbal supplements


Patient denies urgency, frequency, dysuria, dribbling or incontinence. He states that nocturia is not more than 2 times at night. He claims he has no kidney disease, but he only has one right kidney from birth. No flank/suprapubic pain and no abnormal urine color.

Genitalia/Male Reproductive.

Patient claims his prostate exam was 5 years ago and denies genitalia dysfunction, lesion, discharge and itching.

Sexual Health.

Patient states he has been married to the same woman for 68 years and gets tested for HIV.


Patient claims he experiences sharp lower back pain and he does not exercise. He denies having Gout, Arthritis, muscle/joint pain but has history of broken leg bones and sprain. He has full range of motion.


Patient claims he is currently on blood thinner, but he has not does not experience excessive bleeding/bruising. His blood group is O+ and he denies Anemia, IV drug use and exposure to toxins.


Patient denies bulging eyes, neck swelling, change in appetite but he states that he sometimes feels nervous. He states that change in skin after he was placed on a blood thinner that caused Phlebitis.



B/P: 155/59 Temp: 97.3 (Oral)

Pulse: Rate: 59

Location: Radial (R)arm

Rhythm: Regular

Volume/Amplitude: 2+ (normal)

Respirations: Rate: 14

Depth: shallow

Effort: quiet

Expansion: symmetric

Locus: Chest

General Survey.

Patient is alert and oriented x 3, he is not under the influence of drugs/alcohol. He is cooperative, gentle and his speech, appearance, behavior is appropriate for the situation. He appeared his age; well-nourished and developed. His hygiene, grooming and posture is appropriate and his recent and remote memory is intact. He is unable to ambulate without assistance.


Patient skin temperature is warm to touch, texture is moist and has appropriate hair distribution. He had no lesion or abnormality with mucous membrane aside dry nasal nares. The skin of both of his arms were red – blanching.


Patient has grey hair with receding hair line and distribution was even.


There is no sign of clubbing or biting of nails, the color is translucent and no deformities. Capillary refill was less than 3 seconds.


Eye contact – Yes

Brows and lashes present – Yes

No Lesions/Acne present on the face

Face is symmetric with no involuntary movements

He has active ROM


No Nystagmus/ptosis/lid lag/discharge/crusting

Conjunctivae clear and pink

Sclera of the right eye was red and itching


Pupil size was deferred in order not to cause further irritation.


No Masses/lesions/scaling/discharge/tenderness on palpation on pinna, tragus, Auditory meatus was clear and no visible ear wax.

External canal has no discoloration or discharge

Tympanic membranes are pearly gray, intact and no perforation as assessment could permit.

Whispered words were difficult for patient to hear bilaterally

Nose and Sinuses.

Nose is symmetric with no deformities.

No tenderness to palpation

No bleeding, masses, lesions

Nares were patent and with no discharge

No septal deviation/perforation

Mucous membranes: red and dry

Mouth and Throat.

Patient can clinch teeth and has fresh breath

Lips are pink/without lesions

Mucosa and gingival: pink and moist

Tongue is midline/symmetric/without lesions, swelling or bleeding

Palates are both intact/without lesions

Gag reflex present

Uvula raises midline on phonation

Tonsils: in

Grade: 1+ (visible)


Symmetrical with no masses/tenderness/pain

Full ROM and good muscle strength present

Lymph nodes were non-palpable

Trachea is midline

Thyroid is non-tender with no enlargement, and no bruits

Carotid arteries = bilaterally; bruits present on the Left

Carotid pulse 97bpm/ bounding

Spine and Back.

Patient has normal spinal profile

No scoliosis/lordosis or tenderness over spine

Thorax and Lungs.

Respiratory rate:14, resting, regular/unlabored and on 2L oxygen via nasal cannula

Chest expansion and chest wall are symmetric

No bulging of ICS, retractions, or using accessory muscles

No discoloration of skin and hair is present with minimal distribution

No Nevi, bulging, masses, lesions, or tenderness to palpation

Lung fields resonant bilaterally and Tactile fremitus equal bilaterally

Costal angle <90 degrees

No Wheezing/crackles/stridor/rub but mild rhonchi is present.



No retractions, discharge, lesions, masses, edema, or tenderness

Color of breast, areola and nipples has no abnormal findings and no palpable lymph nodes.


Precordium is without pulsations/heaves on thrills

Apical pulse is palpable

Grade artery pressure: 2+ (Normal)

S1 and S2, (supine) not diminished or accentuated

ECG shows Atrial fibrillation and flutter


Rounded and soft

Symmetrical and uniform

No Scars/lesions/striae

Umbilicus is midline

Bowel sounds:

RUQ is present

LUQ is present

LLQ is present

RLQ is present

Vascular sounds: No bruits heard in aorta, iliac/renal

Tympany predominates all quadrants

Abdomen: No masses or tenderness to light palpation

No Organomegally or inguinal lymphadenopathy as assessment permits

Abdominal reflexes are normal

Femoral and inguinal pulses = bilaterally were deferred

Murphy’s sign (inspiratory test) is negative

Able to complete deep breath without pain


Symmetric bilaterally

Color of the both arms are red and blanching

No cyanosis and lesions

Temperature is warm to touch

Edema – Pitting edema – 4+ (indentation of >10mm)

No Varicosities, calf tenderness

Hair distribution is even bilaterally

Peripheral pulses (grade artery pressure:

Carotid – 2+ (Normal) Bilaterally

Brachial – 2+ (Normal) Bilaterally

Radial – 2+ (Normal) Bilaterally

Femoral – deferred

Popliteal – deferred

Dorsalis pedis – 1+ (Thready) Bilaterally

Posterior tibialis – 2+ (Normal) Bilaterally


No Muscle atrophy

Bilaterally equal muscle tone, size, and strength

All joints with full ROM (Grade 5) without swelling (except both ankles), crepitus, or tenderness

No Weakness, or tremors


Smooth and coordinated with some limitation

Unable to assess Tandem walk due to fall precaution

Unable to assess Romberg’s sign due to fall precaution but patient able to stretch out both arms in bed for 30 seconds.

Rapid alternating movements (RAM) – finger to nose smoothly intact but slow paced.

Muscle strength: Patient is able to maintain flexion against resistance and without tenderness


Patient mood, behavior, affect is appropriate

He is Alert and oriented to person, place and time

Thought coherent is normal

Remote and recent memories are intact

Genitalia and Rectum. Assessment was deferred.


Alcohol Use – Patient only drinks alcohol during social gathering which can be estimated as once in a month.

No history of Drug Use

Tobacco Use – Smoked for 48 years but quit 20 years ago.


· How illness may affect sexuality – Patient expresses no recent sexual activities.

· How hospitalization may affect sexuality – Patient expresses no effects on sexuality

· Any questions, needs, or additional concerns – None at this time

Travel History. Patient traveled to the Caribbean’s last year but no recent travel within the last 6 months.

Work Environment.

(Employed/unemployed, occupation, status) Patient retired from the Navy and currently unemployed.

Home Environment.

(Smoke and carbon monoxide detectors/fire extinguisher/animals/quiet/safe)

Patient lives with his wife and the home environment is safe and quiet. Smoke detectors and fire extinguisher are in place

Hobbies/Leisure Activities.

Patient reads novels during his leisure time, watch games on television and attends church services.

Stress. (moderate)

Economic Status.

Military Service. Patient was in the navy for 25 years


· Religious/cultural affiliation – Catholic

· Religious/cultural beliefs concerning health or illness- Patient expressed no relation between religious/cultural belief with his health.

· Holiday or food restrictions while hospitalized- None was mentioned

Ethnic Background.

Health Maintenance Activities

Health perception.

· General health (fair)

· Patients description: Patient claims he has had to undergo many surgical procedures including a pacemaker and his mobility is getting limited making it difficult for him to do what he previously was able to do.


· Energy level (/normal)

· Usual exercise/activity patterns (recent changes) Do not exercise

· Needs no assistance with eating, bathing and dressing

· Requirements (walker)


· Problems (falling asleep/early waking/hours per night/napping)

· Amount of sleep He sleeps for a maximum of 5 hours at night

· Type of sleep – REM and NREM

· Naps – 2 hours nap during the day

· Methods used to facilitate sleep – quiet room, closed blinds and lights off.

· Feelings on waking (fatigued, refreshed) – refreshed


· Type of diet (list) – Cardiac diet (Low fat, low sodium)

Low sugar

· 24 hour recall:

· Breakfast – Oat, French toast, scramble egg and diced pineapple

· Lunch – Salmon, mixed vegetable salad and milk

· Dinner – Vegetable soup and baked potatoe

· Snacks – unsalted cracker, fruits

· Enjoys snacks – Enjoys fruits

· Fluid intake at least 4 glasses a day

· Fluid restriction – None

· Weight (recent gain/loss) – Unable to determine


· Educational level – College

· Learning needs – List of foods included in Cardiac diet

· Communication barriers (list) – deficit in hearing

· Memory loss (Y/N) – No

· Primary language- English

· Reads English (Y/N) – Yes

· Other languages (list) – None stated


· How illness/wellness is affecting patient

Patient expresses despair having been told he might have to undergo another surgery and considers declining.

· Body image or self-esteem concerns – Positive outlook and self-esteem is intact and appropriate.


· Significant other or emergency contacts – Wife (present at bedside), Daughter and eldest granddaughter.

· Primary, secondary, or tertiary roles – Primary (Keeps company and loving relationship), Secondary (Provide needs, transportation and assistance with some ADLs)

· Role changes/conflicts caused by illness/wellness – Changes in family roles because the wife is presently making all the decision, and this might be the norm.

Coping and Stress Management.

· Needs (social services, financial counselor) – Cannot be determined at this time

· May need (home care, nursing home) – Home care for wound dressing if surgery is done. Monitoring of blood pressure and adhering to life style changes e.g. Diet

· Coping mechanisms used by client – Relaxing and reading

Use of Safety Devices.

(Seatbelt/safety precautions while operating dangerous tools/machines)

Patient is aware of seatbelt use and handling of machinery with precautions

Developmental stage:

Erickson Developmental Stage: Integrity vs Despair. At this stage, older adults reflect on past lives having a feeling of integrity and contentment based on their experience or fulfillment. While some will have feelings of despair when they reflect on their past experiences; fear of death and struggling with chronic disease.

After assessing Mr. C who is 89 years old, although his health is declining, and his quality of life is diminished, he appears to have feeling of contentment, portrays positive energy but remaining socially active. He believed his greatest achievements are his family and his service to the Navy.

Medications, IV’s and Nutritional Supplements

Classification and ActionAspirin Children’sNonopioid analgesicsInhibits the production of prostaglandins which leads to a reduction of inflammation and also decreases platelet aggregation.Coreg (Carvedilol)AntihypertensiveIt blocks stimulation of Beta 1 and Beta 2 adrenergic receptor sites.Plavix (Clopidogrel Bisulfate)Antiplatelet agentIt inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors.Lovenox (Enoparin Sodium)Anticoagulantprevents thrombus formation by potentiating the inhibitory effect of antithrombin on factor Xa and thrombin.Lasix (Furosemide)Loop DiureticIt inhibits the reabsorption of Sodium Chloride and promotes excretion of water, sodium, chloride, magnesium in the ascending loop of Henle.Humalog (Insulin Lispro)AntidiabeticsIt lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat, inhibiting glucose production.Nitostat(Nitroglycerin)AntianginalIt increases coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions.ULTRAMTramadol HCLAnalgesicsIt binds to mu-opioid receptors and inhibits reuptake of serotonin and norepinephrine in the CNS.2L Nasal cannulaDose, Range Route and Time Schedule81mg (1 CHWT)6.25mg (1Tab) Oral/Twice Daily75mg (1TAB)/Oral/Daily40mg – 0.4Ml SBQ/Daily80mg – 8ml IV/Twice dailyRegimen 2 SBQ/Before meal and bedtime0.4mg (1TAB. SL)/ Sublingual/AS DIRECTED25mg – 0.5 TAB/ Oral/Q6H as neededOxygen therapySide Effects and ContradictionsS.E: Bleeding, Tinnitus, Abdominal pain, Hepatotoxicity, GI UpsetContraindication:Hypersensitivity to aspirin, other NSAIDs, Bleeding disorder, Chronic alcohol useS.E: Dizziness, fatigue, memory loss, blurred vision, bronchospasm, GI upset, erectile dysfunction.Contraindication: Hypertensives reaction, Pulmonary edema, Bradycardia, Severe hepatic impairment, AsthmaS.E: Bleeding, Hypersensitivity reaction, dizziness, fatigue, headache.Contraindication: Bleeding disorderS.E: Bleeding, anemia, dizziness, headache, injection site irritation and pain.Contraindication: Hypersensitivity to pork products, History of heparin induced thrombocytopenia.S.E: Tinnitus, orthostatic hypotension, dry mouth, Ototoxicity, hypokalemia, hyponatremia, hyperglycemia, hyperlipidemia.Contraindication:Liver Disease, chronic kidney disease, pregnancy, aminoglycosides can cause ototoxicity.S.E: Pruritis, Hypoglycemia, hypokalemia.Contraindication:Hypoglycemia, Pregnancy.S.E: Dizziness, Headache, blurred vision, syncope, GI upset, hypotension, tachycardia, increased ICP. Contraindication: Severe anemia, pericardial tamponade.S.E: Dizziness, somnolence, malaise, constipation, GI upset.Contraindication: Hypersensitivity, Opioid dependency, pregnancy.Headaches, fatigue, nose/skin irritation.Nursing Implications1.Use caution in bleeding disorders, chronic alcohol use.2. Monitor liver function tests.3. Increases risk for bleeding with warfarin, heparin, and clopidogrel.4. Increased risk for GI bleeding with NSAID use.5. Monitor for toxicity or overdose: onset tinnitus,headache sweating.1.Monitor vital signs: BP & pulse2. Monitor for orthostatic hypotension and dizziness and consider patient rising slowly.3.Monitor daily input, output and weight.4. Monitor for difficulty breathing, wheezing and dizziness.1.Monitor patient for signs of bleeding and neutropenia.2. Drug may increase risk for bleeding when using warfarin, aspirin, heparin and other herbal supplements.3. monitor CBC and platelet count4.Discontinue use 5-7 days before surgery.1.monitor for signs of bleeding and hemorrhage.2. DO NOT eject air bubble prior to injection and DO NOT aspirate or massage site.3. Observe injection site.4. Monitor CBC, platelet count and stools for occult blood.1.Adjust dose and use caution with liver or kidney disease.2. Change patient position slowly.3. Drug may cause excessive urination; observe for dehydration, electrolyte imbalance and metabolic alkalosis.4. Monitor for increased risk of digoxin toxicity5. Monitor renal panel1.Assess for symptom of hypoglycemia (anxiety, restlessness, chills)2.Monitor weight periodically.3. Monitor glucose every 6hr during therapy.1.Assess location, duration and precipating factors of patients anginal pain.2. Monitor blood pressure and pulsebefore and after administration.3. Assess for and report blurred vision or dry mouth.4. Be alert for overdose symptoms: Hypotension, tachycardia; warm, flushed skin headache, palpitations, confusion, nausea, vomiting, moderate fever, and paralysis. Death can occur from asphyxia.1.Assess type, location and intensity of pain2. Assess bowel function routinely to prevent constipation3. Monitor patient for seizures4. Monitor for toxicity (respiratory depression and seizures).Nurse will take precaution avoid risk of fire.Nurse will ensure the cannula is properly in place.Assess nasal nares for infection, dryness and bleeding.Rationale for Drug Therapy for this ClientBaby aspirin is quarter of the 325-milligram dose in an adult aspirin pill which is good for the heart. Patient is on this dose to reduce risk of stroke and heart attack.It is used to control patient hypertension, reduce angina and risk for MI.It is a treatment for PVC and CAD by reducing plaque buildup and risk for MI and stroke.Enoxaparin is a low molecular weight heparin. It will prevent complication of DVT, PE in the patientDrug therapy is used to control patient Blood pressure and fluid volume related to his pitting edema.Decreases patient blood glucose even though he denies diabetes, but his glucose level is 190It is a Prophylaxis, treatment, and management of angina pectoris.Drug Therapy is used to relieve patient’s moderate – severe pain.Oxygen will be deliver via nasal cannula to administer low-flow oxygen to the pt. to prevent hypoxia.


Include: Summary of all reports from laboratory, radiology, imaging,

pathology, surgical, EKG, EEG, etc

TestRange / Units01/08/2018DateDateSignificance
WBC4.50-11.00 K/ul5.9This monitors the immune system. Elevated when there is an infection present.
RBC4.30-5.90 mil/ul4.93The number of RBC count determines oxygen, nutrients transport in the body system.Anemia is an indication for Insufficient.
Hemoglobin13.5-17.5 g/dl11.6 This is the protein in RBC that contain oxygen. Used to check for Anemia or excessive fluid or blood loss.
Hematocrit41.0-53.0%36.4This is the total percentage of RBC in the blood cell.
MCV80.0-100.0 fl100Average red blood cell size
MCH25.0-35.0 pgHemoglobin amount per red blood cell
MCHC30.0-37.0 g/dlA type of WBC that destroys invaders(infection).
RDW11.5-15.5%A type of antibody that produces Antibodies and Plasma cell in response to an Antigen
Platelet Count150-450 K/ul150This is the clotting factors that is examined for potential bleeding disorder
MPV7.0-11.0 flThe volume of the platelets in the body. Having a Low MPV indicates that the platelet count in your blood is lower than normal and that you are in danger of suffering more blood loss in case you get injured.
Neutrophil40-75%A type of WBC that destroys invaders(infection).
Lymphocyte15-45%A type of antibody that produces Antibodies and Plasma cell in response to an Antigen
Monocyte3-13%Turns to Macrophage and eat the invader(infection) and also get rids of dead cells
Eosinophil0-7%Control inflammation and active during parasite infections and allergic reactions.
Urine Macroscopic
ColorNormal is yellow to Amber
Sp Gravity1.005-1.0351.08Low indicates dilute and high indicates concentrated urine
ProteinNeg+ might be sue to stress, pregnancy, fever, exercise,diabetes
GlucoseNegPregnancy, endocrine & renal problem can make renal threshold (160-180) low.
KetonesNegNot found in urine
BilirubinNegBilirubin is a breakdown product of hemoglobin which produces an extremely yellow to amber color in urine and may be an indication of liver disease, hepatitis or bile duct obstruction.
Urine BloodNegNot found in urine
NitriteNegNot found in urine
Urobilinogen≤ 0.2Not found in urine
Leuko EsteraseNegEnzyme that breaks down WBC. + is an indication of infection.
H = High * = Abnormal
Urine Microscopic
TestRange/ UnitsDateDateDateDateSignificance
WBC< 2 / HPF37elevated WBCs in urine signifies inflammation or infection, called pyuria or pus in urine.
RBC< 2 / HPFModeratePresence of blood is called hematuria. If they are present in sufficient amounts, the urine may be pinkish, red or brown urine indicates Bleeding in the urinary tract)
Bacteria+ indicates UTI
H = High * = Abnormal
Electrolytes & Comprehensive Metabolic Studies
Sodium135-145 mEq/L143Within Normal range. It controls osmotic pressure and acid- base balance
Potassium3.5-5.1 mEq/L4.1Within normal range. It regulates muscle contraction & nerve excitability. Elevated K+ can cause cardia arrhythmias
Chloride98-110 mEq/L109Normal. Regulates acid base balance in the body.
Carbon Dioxide22-32 mEq/L27Respiratory exchange of carbon dioxide in the lungs and serves as the body buffering system.
Glucose70-110 mg/dl
A1C4-6 %
BUN7-23 mg/dl25 H35 HWaste product of protein metabolism. Elevation can be due to severe HTN, decrease renal perfusion or an obstruction in the urinary tract
BNP0-99 pg/ml
Creatinine0.7-1.5 mg/dl1.212.3 HThe by-product of muscle metabolism. Elevation might be due to nephrotoxicity due to drugs administered or dehydration.
Anion Gap9-22 mEq/L7Indication for electrolyte ibalance.
Osmolality Calculated280-300mOs/kg294To determine hypernatremia, hypokalemia. May be associated with overhydration
Bilirubin, Total0.3-1.8 mg/dl
Bilirubin, Conjugated.0-.4 mg/dl
Protein, Total6.0-8.5 g/dl
Albumin3.4-5.1 g/dl
Calcium8.5-10.5 mg/dlIt is involved in bone and tooth metabolism, blood coagulation and endocrine function
Alkaline Phosphatase38-126 IU/L70diagnosis of bone fracture
AST/GOT15-41 IU/L10Indicates cellular damage in heart problem patients.
ALT/GPT17-63 IU/L13Indicates mount of enzymes in the blood.
H = High * = Abnormal L = Low
Routine Chemistry
TestRange / UnitsDateDateDateSignificance
Amylase36-128 IU/LEvaluates and diagnose the treatment of modalities used for pancreatitis
Lipase22-51 IU/LAssess for pancreatic disease related to inflammation, cyst specific to the diagnosis of pancreatitis
H = High * = Abnormal L = Low
Cardiac Studies
TestRange / UnitsDateDateDateSignificance
Creatinine Kinase49-397 IU/LMonitors MI and some disorders of the musculoskeletal systems
Creatinine Kinase MB0.0-4.9 ng/mlAssess cardiac ischemia
Troponin I0.00-1.00 ng/ml0.026Evaluates muscle damage related to MI
H = High * = Abnormal L = Low
TestRange/ UnitsDateDateDateDateSignificance
Cholesterol36-128 Mg/dl
Triglycerides< 150 mg/dl
HDL40-65 mg/dl
LDL90-185 Mg/dl
H = High * = Abnormal L = Low

Tests/Procedures (including pre and post procedure teaching)

Cardiac Catheterization


1. Nurse will assess patient’s readiness for procedure

2. Inform patient about sensation he might experience during the procedure such as palpitation, feeling of heat when the dye is injected.

3. Inform about risks of the procedure

4. Inform patient to be NPO 8 hours before, discontinue antiplatelet and NSAIDs

5. Assess allergies to Dye


1. Teach patient to keep insertion site extremity straight.

2. Patient should remain in bed 2-6 hours after

3. Teach patient how to recognize symptoms of infection and bleeding and should report it.

4. Nurse will monitor vital signs every 15mins for 1 hour.

5. Encourage fluid intake.

Electrocardiogram – Interpret in simple terms; readings from the ECG Strip or monitor to the patient

Carotid Artery Ultrasound

Carotid endarterectomy


1. Nurse will assess patient medication history and inform patient on the drugs to hold pre-op.

2. Nurse will do physical, neurological and baseline vitals assessment.

3. Explain procedure to client including complications.


1. Teach patient to support head with hand when changing position.

2. Teach patient symptoms of complications and should report immediately

3. Nurse will monitor cranial nerves impairment



1. Risk for decreased cardiac output related to Inadequate blood pumped by the heart to meet metabolic demands of the body AEB patient reports of chest pain and shortness of breath.

2. Acute Pain r/t heart tissue ischemia, or blockages in the coronary arteries AEB patient report pain of 7/10 and grimacing.

3. Risk for ineffective Cerebral tissue perfusion r/t blockage of carotid artery AEB patient report of weakness and history of CAD

4. Risk for Impaired Tissue Perfusion related to obstruction in vessels, AEB bruits in left carotid artery.

5. Activity Intolerance related to imbalance between oxygen supply and demand AEB advanced age and patient report of diminished strength.

6. Fear related to surgery in vital area as evidence by patient self-report that he might not follow through with surgery plan


NURSING DIAGNOSIS & RELATED CAUSERisk for decreased cardiac output related to Inadequate blood pumped by the heart to meet metabolic demands of the body.VALIDATED BY DEFINING CHARACTERISTICS OF THE CLIENT (AEB)Subjective Data:Patient self-reports of –chest painshortness of breathFatigueObjective Data:Advanced ageEKG changes (Atrial fibrillation and flutter).Thready Dorsalis pedis pulsePitting Edema +4Medical history of Hypertension and cardiomyopathyMEASURABLE CLIENTOUTCOMES(Match each AEB)Short term:Patient will report and display reduced episode of dyspnea, chest pain and normal EKG reading by the end of shift.Long term:Patient will reduce activities that induces fatigue and increase cardiac workload after discharge home.NURSING INTERVENTIONS(Match each outcome)Short term:1.Nurse will administer supplemental oxygen as ordered and needed.R: oxygen helps improve myocardial contractility, reduce ischemia, and reduce lactic acid levels.2.Nurse will monitor vital signs and cardiac rhythm.R: Pain can elevate vital signs causing, Bradycardia, hypoxemia, hypertension or hypotension, and reduced cardiac output. ECG changes reflecting dysrhythmias indicate need for additional evaluation and therapeutic intervention.3. Nurse will administer nitroglycerin tablets sublingually as ordered, (every 5 minutes) until chest pain is resolved.R: Nitroglycerin causes coronary artery and veins to dilate and this helps to reduce preload and afterload and decrease myocardial oxygen demand.Long term:1.Nurse will ensure patient recognize precipating factors and remains on short-term bed rest or maintains activity level that does not compromise cardiac output.R: Conserved energy, reduces cardiac workload.2.Nurse will assess home environment and provide home care services necessary for cardiac disease.R: Establishing a system that that promotes care coordination is important for successful care of the patient.3. Nurse will refer patient to a cardiac rehabilitation program for education, monitored exercise and rebuild quality of life.R: The program promotes positive outcome based on health and self-concept.(Ladwig, et al. 2017, Pg. 187)EVALUATION OF CLIENT OUTCOMES(Describe the Outcome, not the intervention)Short term:Outcome met.Patient was on 2L oxygen and medication was administer. ECG result showed stabilization and patient was no longer short of breath.Long term:Outcome met.Patient verbalized understanding of reducing stress and necessary arrangement is been done by family members to assist with ADLs.
#2 NURSING DIAGNOSIS & RELATED CAUSEAcute Pain r/t heart tissue ischemia, or blockages in the coronary arteries.VALIDATED BY DEFINING CHARACTERISTICS OF THE CLIENT (AEB)Subjective:Patient reports:Pain level of 7 (0-10)Chest pain that hurts at nightBackpainObjective:GrimacingGuarding behaviorMEASURABLE CLIENTOUTCOMES(Match each AEB)Short term:Patient will verbalize relief in pain and with a pain scale of 2/10 within 30 minutes of Nursing intervention.Long term:Patient will describe how unrelieved pain will be managed during discharge educationNURSING INTERVENTIONS(Match each outcome)Short term:1.assess if patient is able to provide a self- report of pain intensity during subsequent assessment.R: Self-report is considered the single most reliable indicator of pain presence and intensity.2. Nurse should assume that pain is present if patient is unable to provide a self-report and provide options of intervention for patient.R: In absence of self-report nurse can use clinical judgement and implement care accordingly.3. Administer supplemental analgesic doses as ordered to keep the patient’s pain level at or below the comfort-function goal.R: PRN order can be used between regular does to help provide comprehensive pain management.Long term:1.Nurse will educate and evaluate patient’s understanding of pharmacology and nonpharmacologic treatment.R: This promotes accuracy, safety and adherence to medical interventions.2. Teach basic principles of pain management using variety of educational strategies, and evaluate learning.R: Educational strategy increases knowledge and decrease anxiety.3.Nurse will encourage patient to plan activities around periods of greatest comfort whenever possible.R: An active self-management strategy facilitates learning to balance activity and rest for the purpose of increasing function(Ladwig, et al. 2017, Pg. 641)EVALUATION OF CLIENT OUTCOMES(Describe the Outcome, not the intervention)Short term:Goal was met after 3 hours of nursing intervention.Long term:Goal was not met because of the inability to evaluate during discharge education.
NURSING DIAGNOSIS & RELATED CAUSEActivity intolerance r/t imbalance between oxygen supply and demandVALIDATED BY DEFINING CHARACTERISTICS OF THE CLIENT (AEB)Subjective data:Patient reportsSOBdiminished strengthfatigueNo exerciseObjective data:Advanced ageBed restLack of motivationMEASURABLE CLIENTOUTCOMES(Match each AEB)Short term:Patient will demonstrate increased tolerance to activity by end of shift.Long term:Patient will verbalize symptoms of adverse effects of exercise and report onset of symptoms immediately before discharge.NURSING INTERVENTIONS(Match each outcome)1.When appropriate, gradually increase activity, allowing the patient to assist with positioning, transferring, and self-care as able.R: Carefully balance provision of assistance; facilitating progressive endurance will ultimately enhance the patient’s activity tolerance and self-esteem.2. Gradually increase activity with active range-of-motion exercises in bed, increasing to sitting and then standing.R: Gradual progression of the activity prevents overexertion.3. Active ROM exercises should be encouraged and involve patient in planning activities that gradually build endurance.R: Exercise maintains muscle strength, joint ROM, and exercise tolerance.Long term:1. Teach energy conservation techniquesR: Energy conservation techniques reduces oxygen consumption, allowing a more prolonged activity.2. Provide emotional support and positive attitude regarding abilities.R: Appropriate supervision during early efforts can enhance confidence.3. Teach the patient how to recognize signs of physical overactivity or overexertion.R: Knowledge promotes awareness to prevent the complication of overexertion.(Ladwig, et al. 2017, Pg. 123)EVALUATION OF CLIENT OUTCOMES(Describe the Outcome, not the intervention)Short term:Outcome not met.Patient reports weakness and was also on fall precaution.Long term:Outcome was met.Patient was able to identify symptoms like SOB, extreme fatigue and pain.


1. State anticipated date of discharge – Unknown

2. List specific client needs for teaching, equipment, referrals, and for home care, etc.


1. Patient will need Incentive spirometer to encourage deep breathing

2. Oxygen therapy at home


1. Life style changes: reduce or stop intake of alcohol, low fat and sodium diet, safe physical activity

2. Daily Blood pressure monitoring

3. Weight management and should report sudden increase in weight

4. Adherence to medication and inform about signs and symptoms, when to present to the hospital or call 911.

5. Patient will have to report sign of bruising or bleeding due to antiplatelet regimen.

6. Teach patient to rise slowly in order to prevent orthostatic hypotension.

Home Care

Physical therapist for monitored exercise

Wound care nurse for post operation care and monitoring of vital signs

3. In addition, attach one completed discharge form (a copy) per semester


Mr. C needs more teaching about life style changes especially diet and physical activities. The patient needs to understand the benefits these changes have in influencing his current diagnosis and this will also promote adherence. Patient needs the list of foods that are beneficial to health and the teaching about DASH diet is recommended.

DASH diet (Dietary Approaches to Stop Hypertension) provides approximately 2,100 calories a day, as well as 4,700 mg of potassium, 500 mg of magnesium, and 1,250 mg of calcium (Nathenson, 2017). The DASH diet also encourages a lower consumption of sodium which helps in in controlling Hypertension. The DASH diet is rich in fruits, vegetables, and low fat or nonfat dairy. It also includes mostly whole grains; lean meats, fish, and poultry; and nuts and beans. It is high in fiber and low to moderate in fat. Nathenson (2017) is his article stated that, obesity epidemic in the US has increased in rate, especially in relation to diet related disease like Heart disease, Hypertension and Diabetes. It is important to teach patients about benefits of physical activities and dietary intake.


Ackley, B.J., Ladwig, G.B., Flynn, M.B., (2017) Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care. (11th Ed.) Elsevier, Inc.

Deglin, J.H., Vallerand, A.H., Sanoski,C., (2017) Davis’s drug guide for nurses. (15th Ed.) Philadelphia: F.A. Davis

Learning theories: Erikson Stages of development. https://www.learning-theories.com/eriksons-stages-of-development.html

Nathenson, Paul., (2017) The DASH diet: A cultural adaptation. Nursing. 47(4):57-59, doi:10.1097/01.NURSE.0000512500.35560.b7

Ackley, B.J., Ladwig, G.B., Flynn, M.B., (2017) Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care. (11th Ed.) Elsevier, Inc.

Difference between the two Artifact.

The first was done during my first semester of nursing school. It included basic knowledge about patient assessment. There was few error of me providing subjective information rather than objective. There was APA mistakes. The second Artifact included comprehensive Nursing process. Illustrating patient assessment, nursing diagnosis, plan of care, implementation and evaluation. The data collection was more structured and APA was improved

3. Demonstrate clinical excellence to provide caring, compassionate, and culturally appropriate patient-centered care to people in a variety of settings. E.g Presentation, evaluations,

ARTIFACT 1: 1st Semester Clinical Evaluation



NUR 221: Essentials of Nursing Practice

Course/Semester: Summer(Sophomore)

Student: Damilola Mohammed Faculty: Professor Carrier

Directions: The following evaluation criteria are used to determine individual student performance. These criteria should be evaluated based the expected level of clinical practice as outlined in the Jacksonville University School of Nursing Pre-licensure Undergraduate Competencies. The clinical evaluation criteria are meant to be used as guidelines and do not supersede the clinical instructor’s judgment. Items located in the shaded boxes are essential to safe nursing practice for a first semester sophomore clinical student. Students must receive a score of at least 8 points on all items in the shaded boxes to successfully complete this course. Justification must be clearly stated for each of the criteria that are scored above or below an 8. *Points for criteria on psychomotor performance will be doubled. Students will complete this form and submit it to their clinical instructor prior to the formal clinical evaluation appointment.

Point allotment criteria:

10 = Clinical performance reflects excellent delivery of safe nursing care with minimal guidance to multiple clients or one complex client for the expected level of clinical practice. Solidly demonstrates accurate and appropriate knowledge and usually integrates knowledge with skills. Consistently engages in self-direction in relation to learning.

9 = Clinical performance reflects above average delivery of safe nursing care with minimal guidance in the usual clinical situation for the expected level of clinical practice. Demonstrates adequate knowledge and requires minimal assistance in integrating knowledge with skills. Recognized learning opportunities but may require assistance in utilizing them.

8 = Clinical performance reflects average delivery of safe nursing care with moderate amount of guidance for the expected level of clinical practice. Demonstrates adequate knowledge and requires moderate assistance in integrating knowledge and skills. Requires some direction in recognizing and utilizing learning opportunities.

7 = Clinical performance reflects difficulty in the provision of safe nursing care requiring significant guidance for the expected level of clinical practice. Demonstrates gaps in necessary knowledge and requires frequent or almost constant assistance in integrating knowledge and skills.

6 = Clinical performance is unsafe without constant, intense supervision and guidance at the expected level of clinical practice. Frequently lacks necessary knowledge and skills and is unable to integrate these into practice. Requires constant, detailed instruction regarding learning opportunities.

8Critical Thinking and Evidence-Based Practice1,7 (i.e. recognizes risk for injury {falls, aspiration, skin breakdown}; recognizes impact of evidence based-practice, theoretical models of nursing, scholarly inquiry, and the need for life-long learning. All written work completed to reflect specific patient.)Justification:
10Makes Sound Decisions2,3,9 (i.e. recognizes culturally-appropriate personal care needs; demonstrates basic decision-making; manages time/resources effectively; recognizes the need for expert assistance)Justification:I made sound decisions during my clinical rotation and one of them was assisting not only the Nurse I was assigned to but offered help to other Nurses when I was not actively doing a task. I also decided to always ask the Assistive Personnel to be allowed to take the Vital signs of Patients assigned to her. This boosted my confidence level in communicating with patients and I learned the proper use of the Electronic Devices.
7Patient Education6 (i.e. promotes healthy lifestyles through health promotion and risk reduction; recognize appropriate patient education needs)Justification:
8Communication4 (demonstrates appropriate verbal, nonverbal, and written communication with other members of the healthcare team, patients and their families, peers, and clinical instructor)Justification:
8Accountability5 (i.e. exhibits professional values and behaviors; abiding by the ANA code of ethics and legal statutes including confidentiality; appropriate follow-up in patient care; responsible for actions; mature and dependable following SON guidelines as demonstrated by being punctual in attendance and assignments and being appropriately dressed and with clinical tools)Justification:
8Nursing Standards of Care 2,3,5 (i.e. applies standards of care as defined by professional nursing practice; provides compassionate care)Justification:
10Motivation/Initiative10 (i.e. engages in professional conversations, demonstrates eagerness to learn, and seeks additional opportunities for self-improvement)Justification:I demonstrated eagerness to learn from the Nurses and other Medical Personnel at the Hospital. I ask questions about medications and their interaction with the diagnosis. Another instance, is when the Monitor Technician took time to explain the Cardiac monitor tracing; I was able to distinguish the Normal Sinus Rhythm and some abnormal tracing. Also, I always asked the Nurses to allow me to do some task that were within the scope of my training while she supervised.
7Leadership8 (i.e. recognizes the need for expert assistance and limited scope of practice)Justification:
10Psychomotor Performance1 (i.e. demonstrates technical competence, with the assistance of the RN or clinical instructor, in bedside assessment, sterile and aseptic technique, and basic personal care needs including, but not limited to, administering oral and enteral feedings, monitoring O2 therapy, assisting with mobility, and managing bowel and bladder elimination) *Points for this criterion will be doubled.Justification:I learned and also operated the IV Pump, the Blood Glucose Meter and Vital Signs Device. I assisted in feeding a Patient her breakfast, provided Bed pan for bowel elimination, emptied a Foley Catheter Bag and helped in Repositioning other Patients.

1,2,3,4,5,6,7,8,9,10 correspond with School of Nursing Program Outcomes.

Additional Comments:

______%_ X 80_pts = __________points for clinical performance

(total from (points for

tool expressed clinical performance

as percentage) from syllabus)

________________ + _____________ = _________ points for final grade

Clinical Performance Paperwork

Student Signature: _____________________________________


ARTIFACT 2: Community Nursing Evaluation



NUR 437: Community Health Nursing Clinical

Due July 17, 2018

Course/Semester: Damilola Mohammed

Student: Damilola Mohammed Faculty: Professor O’Rourke

Directions: The following evaluation criteria are used to determine individual student performance. These criteria should be evaluated based the expected level of clinical practice as outlined in the Jacksonville University School of Nursing Pre-licensure Undergraduate Competencies. The clinical evaluation criteria are meant to be used as guidelines and do not supersede the clinical instructor’s judgment. Items located in the shaded boxes are essential to safe nursing practice for a fifth semester clinical student. Students must receive a score of at least 8 points on all items in the shaded boxes to successfully complete this course. Justification must be clearly stated for each of the criteria that are scored above or below an 8. *Patient Education and Communication points will be doubled.Students will complete this form and submit it to their clinical instructor prior to the formal clinical evaluation appointment.

Point allotment criteria:

10 = Clinical performance reflects excellent delivery of safe nursing care with minimal guidance to multiple clients or one complex client for the expected level of clinical practice. Solidly demonstrates accurate and appropriate knowledge and usually integrates knowledge with skills. Consistently engages in self-direction in relation to learning.

9 = Clinical performance reflects above average delivery of safe nursing care with minimal guidance in the usual clinical situation for the expected level of clinical practice. Demonstrates adequate knowledge and requires minimal assistance in integrating knowledge with skills. Recognized learning opportunities but may require assistance in utilizing them.

8 = Clinical performance reflects average delivery of safe nursing care with moderate amount of guidance for the expected level of clinical practice. Demonstrates adequate knowledge and requires moderate assistance in integrating knowledge and skills. Requires some direction in recognizing and utilizing learning opportunities.

7 = Clinical performance reflects difficulty in the provision of safe nursing care requiring significant guidance for the expected level of clinical practice. Demonstrates gaps in necessary knowledge and requires frequent or almost constant assistance in integrating knowledge and skills.

6 = Clinical performance is unsafe without constant, intense supervision and guidance at the expected level of clinical practice. Frequently lacks necessary knowledge and skills and is unable to integrate these into practice. Requires constant, detailed instruction regarding learning opportunities.

9Critical Thinking and Evidence-Based Practice1,7 (i.e. synthesizes concepts from the liberal arts and sciences, nursing, and community health; applies this knowledge to the development and health of individuals, aggregates and communities, locally, nationally and globally).Justification:The clinical rotation at Job Corp helped improved my cognitive skills required in analyzing, solving problems and making efficient decisions. Combining critical thinking with creativity and flexibility, I worked independently to make decisions and use current evidence-based information to formulate teaching planning on Smoking Cessation. I applied critical skills in gathering and analyzing the information.I believe I still have more room for improvement to become a proficient nurse.
10Makes Sound Decisions2,3,9 (i.e. uses community information, current research , and technology to design, coordinate and manage nursing care of the health of individuals, aggregates and communities.)Justification:Using sound decision making I explored good judgement during my rotation at Job Corp and also the community assessment project. I assisted in developing, planning and communicating proficient information about the assigned Zip code.
10Patient Education6 (i.e. facilitates education to promote healthy lifestyles through health promotion, risk reduction, and disease prevention education for individuals, aggregates and communities). *Points will be doubled.(Points are doubled for this section.)Justification:For efficient education my goal to learn about Job Corp and the services they offer was achieved and at the same time; orienting to the environment and the daily activities of the students. I went ahead to assess teaching and learning needs of the students and implemented a health teaching plan that is appropriate for them.I used evidence-based research to guide practice in health teaching about Smoking Cessation and provided them with important information which included the Toxic substances in tobacco, the side effects, resources available to quit and also provided them better understanding about Vaping and Hookah.The feedback from the student revealed that some of the information was new to them and very effected.
10Communication4 (demonstrates effective communication, collaboration and negotiation with clients and other healthcare professionals, student peers, and supervising instructor to improve health outcomes. (Points are doubled for this section.) *Points will be doubled.Justification:I made tremendous improvement in my communication skills which was explored when educating the students at Job Corp and during my group project. I was able to collaborate with my group to come up with the best outcome and also to my clinical instruction when professional expert intervention is needed.
10Accountability5 (i.e. exhibits professional values and behaviors as affirmed by a code of ethics, ANA standards of practice for community and public health nursing, and legal statutes in the delivery of health care to aggregates and communities; is responsible for actions; is mature and dependable following SON guidelines as demonstrated by being punctual in attendance and assignments and being appropriately dressed.)Justification:I took responsible and was accountable to the care and services provided during my clinical rotation; using evidence-based practice and the nursing process to complete tasks assigned. I submitted my clinical assignments within the required time frame. I asked for clarification from the instructor when needed and I also demonstrateed personal responsibility by arriving on time
10Nursing Standards of Care 2,3,5 (i.e. applies standards of care as defined by the profession and community and public nursing practice; provides compassionate, culturally sensitive, direct and indirect nursing care to clients in aggregates and communities.)Justification:Using the Nursing standards of care as a yardstick, I provided therapeutic and culturally congruent care to the students and providing services that is within the expected scope of professional nursing standards.
10Motivation/Initiative10 (i.e. engages in professional conversation; demonstrates eagerness to learn; seeks opportunities for learning and self-improvement; explores advocacy opportunities for vulnerable populations.)Justification:I was eager to learn about the services about Job Corp from the staffs. I also had the opportunity learn from the student during HEALS teaching session. The Zip code assessment provided me with the opportunity to learn about other community during the class presentation and also information concerning health and living conditions of the communities.
9Leadership8 (i.e. demonstrates leadership and collaboration with interdisciplinary health care partners and professional, political, and/or regulatory organizations to support positive changes in health of aggregates and communities.)Justification:I exhibited leadership abilities in my accountability to my colleagues, instructors and the students. As a leader I provided knowledge, career advice and empowerment for the students. I shared ideas, my experience as a student and answer questions that will add positive impact in the students’ career goals.I also played significant roles as a team player during my community assessment project.The skills I have learned during my clinical rotation will help improve my skills in becoming a proficient leader in my career as a Nurse.

Additional Comments:

__________% X 100_pts = __________points for clinical performance

(total points (points for

from tool x .01) clinical performance

from syllabus)

________________ + _____________ = _________ points for final grade

Clinical Performance Paperwork

Student Signature: _____________________________________


4. Communicate, collaborate, and negotiate effectively to improve patient healthcare outcomes.

5. Exhibit professional values and behaviors as outlined by a professional code of ethics, professional standards, and legal statutes. Professional feedback (critical care), email from prof, clinical evaluation. FSCJ leter of recommendation



6. Promote healthy lifestyles through health promotion, risk reduction, and disease prevention education for individuals and populations. E.g Job Corp HEALS teaching

Artifact I: Breast Self-Exam Teaching in Med Surg1

Patient Breast-Self Examination Teaching Plan

Damilola Mohammed

Jacksonville University

February 7th, 2018

Patient’s Initial: Ms. T.G. Sex: Female

Admitting Diagnosis: Epigastric pain radiating to right side

Patient’s Health History: Patient claims she has been feeling severe abdominal pain for the past 10 days; aggravated with eating and accompanied by nausea, vomiting and diarrhea.

She has history of Hypertension, Dyslipidemia, Pancreatitis, Ovarian cyst, Irregular Heartbeat, CVA. Surgical history includes: cholecystectomy, oophorectomy, tumor removal left ovary, nose repair secondary to fracture.


Rationale for Topic:

Breast cancer is the second most frequent cancer and 5th cause of cancer-related mortality. Breast self-examination plays an important role in the early detection of breast cancer. This teaching is important for the patient because her health history, Age, Race and Gender contributes to the risk factors of breast cancer. Women need to be aware of changes with their breast and how to identify the risk factors and symptoms of breast cancer.

Content of Teaching:

Teaching will include steps for BSE:

a. Select a date for BSE every month and it should be 7 days after menstrual cycle.

b. Stand in front of mirror and examine size, shape, discoloration and swelling.

c. Raise arms up and examine for any changes discussed in previous step

d. Press the nipples and assess for yellow or bloody discharge

e. Lay on the back and feel the breast with the pads of the finger using a circular motion. This step can also be done standing in the bathroom. Wet and slippery skin makes it easy to feel for lump.

Objectives for teaching plan:

a. Short-term: Patient will be able to identify abnormal sign and symptoms of breast abnormalities: inverted nipple, redness, rash, swelling, discharge from nipples.

b. Long-term: Patient will be able to follow and demonstrate the steps for BSE.

Evaluation of Patient’s Learning: Patient was cooperative, attentive and participated in the discussion. Using the Teach Back Technique, patient demonstrated and explained the BSE steps.

Evaluation of Student’s Teaching: Teaching was held in the patient’s room. Demonstration was done with cloths on and URL of a BSE video was provided on the patient’s cell phone. Yearly clinical examination and Mammogram was also recommended.


The Five Steps of a Breast Self-Exam. (n.d.). Retrieved January 24, 2018, from


Breast Self-Examination. (n.d.). Retrieved January 24, 2018,

Artifact 2: Smoking Cessation teaching at Jacksonville Job Corp (Community Nursing)


Teaching Objectives:

Identify health promotion, risk management, and disease prevention protocols for commonly

encountered problems associated with smoking.

Teaching strategies you intend to use: Verbal communication, group discussion, activity.

According to CDC smoking is the most preventable cause of death in the United States.

A. Substances in Cigarette

1. Substances in Tobacco

a. Formaldehyde: rat poison

b. Carbon monoxide: dangerous gas that is toxic for the body. When it binds with hemoglobin it reduces the oxygen supplied to body tissues.

c. Tar: commonly used for road construction

d. Nicotine: Addictive Effects & Withdrawal. Nicotine raises the blood pressure and spikes up the adrenaline which can lead to a Heart attack.

e. Ammonia

B. Types of Tobacco Products

1. Chewing Tobacco

2. Cigarette

3. Hookah

4. Cigar

C. Effects of Tobacco substances in the body:

1. Cardiovascular (Hypertension, Stroke)

2. Respiratory (Asthma, COPD, Emphysema, URI)

3. Integumentary (Buerger’s Disease, Raynaud’s Syndrome, Wrinkles, Dehydration)

4. Circulation (Deep vein thrombosis, Hypoxia)

5. Oral (dental decay & Abrasion, Periodontitis bacterial and viral infection)

6. Cancer (Oral, Lungs Cancer)

D. E-Cigarette: also known as “Vaping” is commonly used as a smoking cessation device and young individuals also use it because of the flavoring. E-cigarette also contains Nicotine but without the smoke and Tar. E-Cigarette includes other chemicals that create water vapor that is inhaled into the lungs and toxic for the body.


Straw Activity

The objective – To understand the physical limitations that people experience from the use of tobacco products

Materials Needed – Straws or coffee stirrers

Contraindication: If you have asthma, please don’t participate in this activity; also, if you feel lightheaded or dizzy, please stop the activity.

Directions – To demonstrate the health effects of tobacco use, have student volunteers stand and run in place for thirty seconds. When they stop, ask students how they feel after running.

Then, have each volunteer take a straw, place it in his/her mouth, and pinch his/her nose. Have the volunteers run in place again, but with the straw and the pinched nose. After students have finished running, ask them how they feel after running with the straws.

Discussion: Explore the differences between running with and without the straw. This is how people with severe airway and lung disease, like emphysema, feel when they try to breathe through their mouth and nose. It is difficult to exhale and to catch your breath. They often need to use oxygen at all times to stay alive.

E. Resources and Alternatives to Promote Cessation of Tobacco Use.

1.Prescribed products (Nicotine Inhaler) and nonprescribed product (Transdermal patch & Nicotine gum)

2. Florida Phone quit 18778226669

3. Group quit class – Florida A.H.E.C. Network

4. Web Quit www.tobaccofreeflorida.com.quityourway


Janet Konefal. (n.d). Retrieved Alternative and Complementary Treatments in Tobacco

Cessation. Retrieved November 4, 2017, http://www.aheceducation.com/userfiles/File/Alternative%20Treatments/COMPLEMENTARY%20MEDICINE%20%20SMOKING%20CESSATION%20%5BC.pdf

Why should I quit. (n.d.). Retrieved November 4, 2017,



The first BSE teaching was during my medical Surgical rotation and it was spontaneous in the hospital setting while the second was an organized program by The Jacksonville Job Corp. As a senior student more experience and knowledge is expected to teach to community.

7. Incorporate evidence-based knowledge and theory into nursing practice.


Damilola Mohammed

Maternal Newborn Case Study

Jacksonville University

May 22nd, 2018

1. How common is cord prolapse? What patients are at higher risk for cord prolapse?

Cord prolapse is an obstetric medical emergency which occurs when the umbilical cord which connects the baby to the placenta exits from the uterus and precedes the fetus presenting part in the pelvis. It is a dangerous and uncommon complication which occurs between 0.14% and 0.62% of all births with perinatal mortality ranging between 36 -345 per 1,000 births. The Patients who are at risk for Cord Prolapse includes:

· Multiparous women

· Multiple Gestation

· Women with Polyhydramnios or Hydramnios

· Women with cephalopelvic disproportion

· Low birth weight infant (less than 2.5kg)

· Prematurity Fetal congenital anomalies

· Breech presentation (Footling, Transverse lie)

2. Describe the three classifications of cord prolapse?

· Occult Prolapse: This is when the umbilical cord descends alongside the presenting fetal part but has not advanced past the presenting fetal part. Occult umbilical prolapse can occur with both intact or ruptured membranes and the cord might not be felt during vaginal examination.

· Cord Presentation – This is when the cord precedes the presenting part and the cord has not passed the opening of the cervix; it is held in an intact membrane and can be palpated through the membrane.

· Complete Cord (Overt) Prolapse: This is when the cord descends past ruptured membranes and can be felt in the vagina or seen outside of the vulva.

3. What signs and symptoms presented in this scenario would indicate that you are dealing with a cord prolapse? What is usually the first indication of a cord prolapse?

The first indication of a Cord prolapse will be Deceleration of fetal Heart rate; because pressure on the cord decreases oxygen blood supply to the fetus. The signs and symptoms in the scenario that indicated that the patient has a cord prolapse includes:

· Spontaneous rupture of membrane

· Unreassuringly fetal heart rate (decrease in fetal baseline)

· Deceleration of fetal Heart rate which did not improve after repositioning.

· Loop of the Cord is felt during vaginal examination

4. How does the underlying pathology in cord prolapse relate to its signs and symptoms?

Cord Prolapse is preceded by Spontaneous or artificial rupture of membranes and as labor advances with each contraction; the compression of cord results in decreased flow and leads to non-reassuring fetal status.

The umbilical cord consists of an umbilical vein which carries oxygenated blood, and 2 umbilical arteries that return deoxygenated blood. The umbilical vein has a thin wall which is susceptible to compression and at higher pressures the arteries will also be compressed. The decreased in blood flow triggers baroreceptors causing vagal stimulation which causes decelerations. chemoreceptors can sense hypoxemia, and this may raise the baseline heart rate to a tachycardic range. if the presenting part does not fill the entire cervix there is room for the cord to descend, hence the highest risk of cord prolapse. Cord prolapse should be suspected when there is a non-reassuring fetal heart rate pattern (bradycardia, variable decelerations etc.), particularly if such changes commence soon after membrane rupture spontaneously and it should be confirmed via Ultrasound or vaginal examination.

5. What are the intervention priorities of the bedside nurse in the event of a cord prolapse? Why might a tocolytic drug be administered in a cord prolapse emergency?

· The initial intervention is to call for help and prepare prompt delivery of the fetus via immediate vaginal birth if cervix is fully dilated or emergent cesarean section if it is not; to prevent neurologic consequences or fetal death

· Provide the mother with oxygen mask

· Minimize compression of the Cord by:

· Repositioning: Knee to chest, Sim’s Position or adjusting bed to Trendelenburg

· Push up the presenting part by applying pressure vaginally. The nurse’s gloved finger should remain in the vagina to provide firm pressure on the fetal head (to relieve compression) until the physician arrives and until the baby is born.

· If cord is protruding from the vagina, wrap cord loosely in sterile towel saturated with warm, sterile normal saline.

· Filling the Bladder by Inserting a Foley’s catheter and instilling 500 to 750ml of normal saline. Bladder distension helps elevate the presenting part.

· Monitor Fetal Heart Rate to determine whether the cord compression is adequately relieved.

· Tocolytic Drug: Terbutaline 250mcg Subcutaneous injection can be administered and this will help reduce uterine contraction and improves circulation to the placenta bed.

6. How should a patient be positioned in the event of a cord prolapse? How would a patient feel when positioned in this manner?

Patient should be placed in knee to chest or Sim’s position because it allows for the fundus of the uterus to lie at a lower level than the cervix and this promotes return of the loop of the cord into the uterine cavity. The bed can also be adjusted to the Trendelenburg position when preparing to be transported to the operating room. This position helps the force of gravity to relieve umbilical cord compression, but this position is uncomfortable for the mother if the period from the diagnosis to delivery interval is prolonged and cannot be maintained for more than 10 minutes.

7. What should other caregivers do to assist in a cord prolapse emergency?

Other care givers can help in alleviating stress and reducing the patient’s anxiety by reassuring, providing support and concise information/plan about the situation while medical intervention is ongoing. They can collaborate with other staffs to make swift and firm life saving measures and decisions. They can also help in reassessing and reevaluating the fetus and maternal well-being.

8. How quickly could a C/S be performed in your clinical setting?

Cesarean Section should be performed per hospital protocol. It is recommended immediately if the patient is not completely dilated; to help prevent cord compression which can lead to death of the fetus.

9. How can a patient be supported emotionally through a cord prolapse emergency?

Patient can be supported emotionally and keep her calm by talking to her and her husband about the situation and plan of intervention. The Nurse can also assign another staff member to talk and answer their questions while intervention is ongoing.

10. What newborn assessment priorities would you anticipate in the event of a cord prolapse?

· Frequent monitoring of Fetal Heart Rate

· Assessment of Umbilical cord. It should be kept moist and uncompressed. Absence of pulsation of the cord is an indication that the fetus is dead

11. Assume regional anesthesia was not possible and general anesthesia was necessary. What changes would this cause in the scenario as described?

The General Anesthesia can further cause hypotension and compromise utero-placental perfusion of an already hypoxic fetus. The mother will also be deprived of seeing her baby and have assurance of well-being until she is stabilized.


Barnett WM (1989). Umbilical cord prolapse: a true obstetrical emergency. J Emerg Med

[online]7(2):149-52. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/2661671

Ladewig. P. A., London, M. L., & Davidson, M. R. (2017). Contemporary maternal-newborn

nursing care (9th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.


Alzheimer’s Case Study

Damilola Mohammed

Jacksonville University

June 18th , 2018

Alzheimer’s Case Study

1. What is the pathophysiology of Alzheimer’s disease (AD)?

Alzheimer’s disease (AD) is the most common kind of dementia affecting millions of people across the world. This disease is a progressive neurodegenerative disorder that leads to gradual loss of cognitive function and memory. Several brain imaging techniques have been used to investigate the changes in the brain, which cause the development and progression of Alzheimer’s disease. The main neuropathological findings have shown that AD develops when amyloid plaques build up outside the neurons or nerve cells, affecting the brain’s function. Amyloid is a type of protein that is found in all parts of the body (Kumar & Singh, 2015). For reasons that have not yet been determined, AD is caused by the improper division of the amyloids that caused a beta-amyloid that is toxic to the brain’s neurons. However, some evidence suggests that amyloid plaques are not the primary causes of AD because they have been found in cognitively normal adults and their amount does not correlate with the degree of cognitive impairment in patients with Alzheimer’s disease (Kumar & Singh, 2015). Neurofibrillary Tangles (NFT), have also been found to play an important role in the pathophysiology of AD. NFTs are aggregates of hyperphosphorylated tau protein (Reitz & Mayeux, 2014). Tau protein is involved in the normal neuronal development and axonal growth in the brain. The hyperphosphorylated tau protein aggregates into NFT, which is deposited preferentially in various neurons in the mesial temporal lobe, the frontal association cortices, and temporal parietotemporal region (Kumar & Singh, 2015). The correlation between the density of tau NFT and location is what causes the symptoms of Alzheimer’s and dementia. Moreover, some studies have shown that the amyloid beta is not toxic unless the tau protein is also available (Kumar & Singh, 2015). AD is also associated with neuron and synapse loss. Synapse loss and neuron cell death distribution, which similar to that of NFT, leads to acetylcholine deficit. Acetylcholine is the transmitter involved with memory (Reitz & Mayeux, 2014). Therefore, its deficit causes memory loss on AD patients.

2. What risk factors does RM possess for developing AD?

One of the risk factors that RM possesses is her age. Old age is the most common risk factor for AD. As one gets older, their chances for having AD also increase. There are approximately 5.5 people in the United States living with AD. At 60 years, the prevalence is 1%. With every 5 years increase, the prevalence of AD approximately doubles. People above the age of 85 have the highest risk with the prevalence being between 30% and 50% (Reitz & Mayeux, 2014). Since RM is 85, she has a very high chance of having AD. Another risk factor for RM is that she is a woman. AD affects women at a much higher rate compared to the men. In the United States, the ratio of prevalence of AD for men to women is 1:2. The higher rate of AD in women has been associated with their higher chance of living past 70 years but even after the exclusion of the longevity argument, the prevalence is still higher in women (Reitz & Mayeux, 2014). Lastly, RM has a family history of Dementia with a sister who does with AD at 75 years and her mother at 80 years. 70% risk of AD is connected to a person’s genetics. Having a family history of AD increased chances that she has the genetic risk factor for AD (Reitz & Mayeux, 2014).

3. Describe the MMSE, the categories and how each are tested. What does the score of 18 / 30 indicate?

The mini-mental state examination (MMSE), also known as the Folstein test, is a 30-question questionnaire that is extensively used in measuring cognitive impairments. This test is used for clinical screening of dementia and testing of the progression of cognitive impairment. The test consists of problems and simple questions testing a number of areas (Stein, et al., 2015). There are eight main categories examined by the MMSE. The first two are orientation of time and orientation of place, for which the patient can score a maximum of five points for each. The orientation of time category measures the future decline of the patient’s cognitive function. The orientation of place measures their understanding of places as broad as streets and as narrow as a floor. Another measured category is registration, for which one can get a maximum of three points. This category repeats prompts to investigate the patient’s ability to register information in the brain. The test also measures attention and calculation with a total score of 5. It also measures recall and repetition with scores of 3 and 1 respectively. Lastly, the test examines language and complex commands (Stein, et al., 2015). A score of 10-18 indicates that MS has moderate cognitive impairment.

4. Describe the mechanism of action of each of the above medications, and why RM is taking them.

Aricept (donepezil): This medication is used in the treatment of dementia associated with AD. This medication increases cortical acetylcholine by inhibiting acetylcholinesterase, the enzyme that destroys acetylcholine (Brooker et al., 2016). This, in turn, improves the patient’s concentration and memory. RM is taking this medication because of her decline in cognitive function caused by her dementia.

Avapro (irbesartan): this a medication used to treat hypertension. Irbesartan blocks the angiotensin receptor leading to the dilation of blood vessels and thus, reduced blood pressure (Gülbahar et al., 2017). RM has had hypertension for 30 years, so this medication helps to lower her blood pressure.

Crestor (rosuvastatin): This a medication used to treat high cholesterol and related issues. This medication is a selective inhibitor of HMG-CoA reductase, the enzyme that converts 3-hydroxy3methylglutaryl coenzyme A to the precursor of cholesterol, mevalonate (Gülbahar et al., 2017). RM takes this medication because she has had hypercholesterolemia for 25 years.

One baby aspirin daily: Daily aspirin therapy reduces the risk of a heart attack. It works by interfering with blood clotting action, which can cause clots in the vessels leading to a stroke or heart attack (Gülbahar et al., 2017). With anemia, hypercholesterolemia, and hypertension, RM has an increased risk of heart attack; hence the necessity for the daily aspirin treatment.

5. What diagnostics tests would you anticipate being ordered to evaluate RM’s health status and why?

Ferritin Test: This is a test that measures the amount of ferritin, the iron-storing protein in the blood. This test is likely to be done to measure her iron levels because she has been diagnosed with iron deficiency anemia. The test will measure the progress of treatments.

Blood pressure: She will consistently be tested for the changes in blood pressure because she has hypertension which causes abnormal changes in the blood pressure.

Lipoprotein panel: this is a tool used to measure the levels and types of cholesterol available in the blood. This patient has hypercholesterolemia. Hence, it is important to monitor her cholesterol levels.

6. Vascular dementia must be considered as a possible cause of RM’s increasing cognitive dysfunction. Explain the pathophysiology of vascular dementia and the risk factors associated with it.

Vascular dementia is the impairment of cognitive functioning such as reasoning, memory, and judgment that is caused by impaired blood flow to the brain. This is the second most common type of dementia after AD (T O’Brien & Thomas, 2015). The pathophysiology of vascular dementia can be in the line hypoperfusion or hemorrhagic/ischemic brain damage. When the cardiovascular system does not function effectively, the blood may fail to get enough oxygen to the brain. Various brain responses are dependent on oxygen. With inadequate oxygen, the brain gets into a state of oxidative stress, causing the cognitive dysfunction, which is irreversible (T O’Brien & Thomas, 2015).

One of the main risk factors for vascular dementia is hypertension. Hypertension has been found to change the structure and function of the blood vessels. In the long-term, the changes in the blood vessels affect the flow of nutrients to the brain, causing dementia (T O’Brien & Thomas, 2015). Old age is also a risk factor for vascular dementia just like in AD. The effects of the cardiovascular dysfunction on the brain takes a long time. Therefore, older people have a higher risk of having cardiovascular dementia. Patients who have had a stroke are twice more likely to develop this form of dementia than those who do not (T O’Brien & Thomas, 2015).

7. Depression in an elderly patient is often mistaken for AD. What are several ways to distinguish depression from dementia?

Depression and dementia may express themselves in elderly patients in similar ways because they share some characteristics. In fact, some studies have suggested that there may be a connection between the two (Lugtenburg et al., 2016). There are no assessments that can be used to certainly differentiate a depressed and demented elderly patient but there are some behavioral assessments that can be used to tell the difference. In assessing memory, the depressed patients may have trouble concentrating and have minor memory lapses that can affect their moods. On the other hand demented patients tend to have consistent trouble storing new information and remembering major things such as whether they have eaten (Lugtenburg et al., 2016). When using language, depressed patients may speak slowly but they use language correctly. Demented patients, on the other hand, may have significant problems in the use of language. Depression does not affect the use of familiar objects. Demented patients can forget how to do familiar activities such as wearing a shirt. Lastly, depressed patients have better orientation than demented patients. Elderly patients with depression can tell who they are talking to or where they are. Patients with dementia can forget the identity of people and places (Lugtenburg et al., 2016).

8. Discuss the 3 stages of AD with the common symptoms associated with each stage.

The three stages in the progression of AD include the mild stage, moderate, and severe stage also known as the early, middle, and late stages respectively. In the early stage of the illness, a person can function independently because the symptoms of cognitive impairment are still mild (Reitz & Mayeux, 2014). Common symptoms on this stage include problems determining the right label of names for people or objects, misplacing objects, trouble planning, and problems doing tasks in a social or work setting.

On the moderate stage of AD, a person starts having symptoms that are noticeable to others and may require a greater level of care (Reitz & Mayeux, 2014). The symptoms can include, but not limited to, the following; forgetfulness of events that have occurred, forgetfulness of a person’s history, increased incidences of getting lost, inability to recall phone numbers and addresses, and personality and behavioral changes such as repetitive and compulsive behaviors, delusions, and suspiciousness.

On the sever stage the person completely loses the ability to control their environment; hence, they need to be restricted (Reitz & Mayeux, 2014). At this stage, a person needs round-the-clock help to perform daily activities, they have increased difficulty communicating, and changes in physical abilities such as walking.

9. What needs do you anticipate for the family? What are some key teaching points for the family regarding RM’s care?

RM’s family will require round-the-clock assistance to maintain her health in the future. Once her dementia progresses, it will be hard for her to do the simplest tasks and she might develop health conditions associated with the medication for dementia. Some key teaching points that they need is to keep things simple, to make it easier for RM to remember things. They should not show frustration or anger when the symptoms get worse. Instead, they should pay attention to RM’s feelings rather than her words so that they can always get her what she needs regardless of her ability to express herself. Lastly, it is important that they hire a caregiver always to watch her because she might be a danger to herself or others.


Brooker, D. J., Latham, I., Evans, S. C., Jacobson, N., Perry, W., Bray, J., … & Pickett, J. (2016). FITS into practice: translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes. Aging & mental health20(7), 709-718.

Gülbahar, Ö. S. B., Mahmood, A., Zsoldos, E., Allan, C. L., Topiwala, A., & Ebmeier, K. P. (2017). The Effects of Cardiovascular Diseases and Medications on Structural Brain Outcomes. Klinik Psikofarmakoloji Bulteni27, 191.

Kumar, A., & Singh, A. (2015). A review on Alzheimer’s disease pathophysiology and its management: an update. Pharmacological Reports67(2), 195-203.

Lugtenburg, A., Zuidersma, M., Voshaar, R. C. O., & Schoevers, R. A. (2016). Symptom dimensions of depression and 3-year incidence of dementia: results from the Amsterdam study of the elderly. Journal of geriatric psychiatry and neurology29(2), 99-107.

Reitz, C., & Mayeux, R. (2014). Alzheimer disease: epidemiology, diagnostic criteria, risk factors and biomarkers. Biochemical pharmacology88(4), 640-651.

Stein, J., Luppa, M., Kaduszkiewicz, H., Eisele, M., Weyerer, S., Werle, J., … & Pentzek, M. (2015). Is the Short Form of the Mini-Mental State Examination (MMSE) a better screening instrument for dementia in older primary care patients than the original MMSE? Results of the German study on ageing, cognition, and dementia in primary care patients (AgeCoDe). Psychological assessment27(3), 895.

T O’Brien, J., & Thomas, A. (2015). Vascular dementia. The Lancet386(10004), 1698-1706.

8. Demonstrate leadership and collaboration within interdisciplinary health care partners and professional, political, and/or regulatory organizations to support change in health care.

Artifact I: My leadership experience at Memorial Hospital

Leadership Paper

Damilola Mohammed

Jacksonville University

February 22nd, 2018

Leadership is a broad concept that involves an individual influence on other individuals in a group; working together to achieve established goals. Nursing leadership is essential in advancing nursing practice and ensure patients are being cared for and their needs are adequately advocated. The presence of active leadership is important in the Nursing profession as it is in other industries and the role differs from a manager of the unit. The nurse leader works closely with the staffs and ensures patients care meets the standard set.

I had the opportunity to work with and observed the Nurse leader of Memorial Hospital and I had a pleasant experience in learning about decision making, effective communication, collaboration of patients care and coordination of the unit. I believe that she implemented the Democratic type of leadership and; this style of leadership encourage input from team members before making a final decision. This process allows the staffs and the patients have a voice in decision making as well as patient care. Communication is an active component or a significant factor on how she coordinates the unit. Democratic leadership makes room for fairness, competence, creativity, courage, intelligence and honesty. Nurse Gale has an open-door policy, she is hands-on with the patients; which helps lessen the nurse’s workload and she also does rounding to each patient’s room to have effective communication and building rapport with the patients and also getting feedback on how to make them more comfortable.

My overall experience during my day as a student nurse leader was pleasant and educative. I intend to use some of the strategies I have learned to make sound decisions in my future career.

Artifact 2: MY Philosophy of Nursing and Transformation leadership role

Transformational Leadership in Nursing

Damilola Mohammed

Jacksonville University

July 11th, 2018

Transformational Leadership in Nursing


In many developed countries, modern healthcare is facing workforce challenges, financial constraints, the demand for improved patient-centered care, rising demand for access to health care and issues related to quality as well as the safety of healthcare. Therefore, effective governance is crucial for the effective maximization of healthcare management in a healthcare environment. Emerging from this issue is the role of nursing leadership in a clinical setting (Daly et al., 2014). Various literature has reiterated the significance of effective nursing leadership in ensuring delivery of high-quality healthcare system that provides safe as well as effective healthcare. In healthcare settings, effective nursing leadership has gained popularity as an essential component for ensuring quality care as well as a healthy working environment. As such, the importance of good nursing leadership is becoming more apparent in the healthcare environment (Yukl, 2012). This paper aims to explain how I will, as a nurse leader, use transformational leadership theory to impact nursing practice.

An Overview of Transformational Leadership Theory

Leadership, at its core, is the process of influencing other people to not only understand but also support what needs to be done as well as how to do it; it is the process of facilitating both the individual and collective efforts with the aim of accomplishing shared objectives (Daly et al., 2014). This implies that leadership plays a major role in maximizing efficiency as well as achieving organizational goals. Amongst the various theories of leadership, transformational leadership theory has attracted a lot of attention among managers and leadership experts. According to Xu (2017), James MacGregor Burns first coined the concept of transformational leadership, which he defined as the relationship between a leader and his or her followers in which both parties motivate each other leading to value system congruence a leader and his or her followers. Bernard Bass extended Burn’s thoughts by including strong vision as well as personality as some of the common traits of a transformational leader. Also, they transformational leaders motivate their followers to change or adjust their expectations, inspirations as well as opinions to work toward shared goals. Moreover, he mentioned four crucial elements of transformational leadership: strong motivation, personal consideration, intellectual stimulation as well as ideal impact.

Rationale for Transformational Leadership

Studies show that transformational leaders impact their followers’ satisfaction as well as a commitment to an organization (Xu, 2017). Given that it can impact both institutional as well as individual outcomes this style of leadership can be applied in all organization. Hence, transformational leadership is of absolute importance in nursing leadership. Most specifically, transformational leadership focuses on change. Daly et al. (2014) assert that leaders who use transformational leadership style are considered as a change agent who utilizes the personalities as well as qualities to motivate others to achieve shared goals and visions as well as to empower them.

Most importantly, transformational leaders influence their followers by not only inspiring but also motivating them to attain organizational objectives. Leaders must strive at building trustful connections with their followers by embracing open, honest as well as fair in their interaction and motivate them to be independent decision makers. Also, leaders must embrace effective communication strategies in leading employees toward achieving the ultimate goals. Moreover, leaders must firmly believe in their vision, have the courage to attain their goals and portray a great sense of self-confidence (Xu, 2017).

With regards to nursing practice, transformational leaders do not only schedule appropriate time but also practice one on one interaction with nurses to reassure them of the leader’s respect plus trust. Secondly, a transformational nurse leader always listens carefully to a nurse’s thoughts because he or she understands the importance of recognizing a nurse’s needs plus concerns. Also, a transformational leader analyzes the severity of a problem and presents his or her expectations to the followers which could motivate nurses toward career development and promotion. Through transformational leadership, a leader can influence nurses’ behaviors and enhance their commitment leading to achievement of organizational goals (Xu, 2017).

The Impact of Nursing Leadership in Community

With the increasing need for quality care, highly qualified employees and promotion of patient care needs, nursing leadership is playing a major role in local, regional and national healthcare settings. Effective nurse leaders strive for appropriate manpower as well as resources for the attainment of optimal care quality as well as patient outcomes. At the institutional level, whether in local, regional or national setting, nurse leaders play a significant role in strategy formulation and implementation through their participation in senior management decision making. Also, they influence how an organization’s perception of nursing practices. Various studies find a clear relationship between rational styles of leadership and lower mortality rates, reduced medication errors as well as hospital-acquired infections. Specifically, some studies show that employees whose leaders demonstrate higher relational leadership report positive patient safety outcome. A leader’s ability to promote safe working environment depends on his or her knowledge of patient care, his or her level of relational skills as well as the leader’s ability to not only recognize, but also implement effective patient safety practices (Wong, Cummings & Ducharme, 2013).

Application of Transformational Theory to Personal growth in Leadership

Growth is always associated with an increase in quality, development, and quantity over time. People can grow individually by increasing their skills and understanding or as a team by increasing their ambition and ability to serve others (Neck & Manz, 2010). Personally, I have always strived for continuous improvement. To do so, I have always shared my development opportunities as well as receptive to other people’s feedback. Neck and Manz (2010) assert that transformation or a breakthrough change characterize growth. More often, personal growth is more about incremental improvement over some time. I believe that by striving for continuous improvement and encouraging as well as helping my teammates to do so, I can make a positive impact on an organization as a leader. This is the culture that leaders should strive for- a culture of teamwork, where members help each other, share with one another, collaborate, have positive energy and work towards the shared vision.

Self-Reflection as a Leader Today and in the Future

There are many qualities of great leadership: confidence, transparency, the ability to execute ideas, perseverance, passion, vision, and perseverance. Nonetheless, I believe that there is one leadership quality that is crucial for effective leadership- self-reflection. It is one leadership quality that I can guarantee will remain constant in my journey as a leader. This is because everything starts with an individual knowing what he or she is doing, why he or she is doing it and how he or she is doing it. I believe that a leader who does not take enough time to conduct self-reflection is headed into avoidable failure every time. Self-reflection is a powerful technique that leaders can use to improve their performance. It is an honest means of assessing one’s strengths, weaknesses as well as areas that need improvement.

Relating Transformational Leadership Theory in Future Practice

Effective leadership in nursing is an important pathway through which nurses can realize healthcare delivery and patient demands. With today’s ever-changing business environment organizations require adaptive and flexible leadership, which is transformational leadership. From a personal perspective, I will apply the four elements of transformational leadership as a nurse leader. They include idealized influence, intellectual stimulation, individual consideration as well as inspirational motivation.

According to Northouse (2010), idealized influence builds admiration, trust, confidence as well as respect providing followers with a sense of mission. For this to happen, I will, as a nurse leader, need to be a role model that employees would seek to emulate. Wang et al. (2011) suggests that a leader, as a role model, is less likely to face resistance whenever he or she strives to implement new initiatives. Most importantly, I will involve employees in decision-making processes. Inspirational motivation revolves around encouraging followers to achieve an organization’s goals, objectives, and aspirations while at the same time achieving their individual goals and aspirations (Northouse, 2010). Motivation is, inarguably, an important component of healthcare as it affects care and performance. As a leader, I will communicate high expectations to workers and inspire them through motivate to share in the organization’s vision.

Intellectual stimulation encourages employee motivation, challenging employee and leader’s beliefs (Northouse, 2010). With this in mind, I will encourage employees to propose new ideas and empower them to use evidence-based practice to approach challenges in new ways. In particular, they will ensure that workers are provided with information technology facilities which will enhance continuing learning for the promotion of quality care and best practices. With regards to individualized consideration, Northouse (2010) indicates that transformational leaders do not only encourage, but also support their followers to achieve higher achievement levels. They also assist workers in realizing full actualization by acting in an advisory capacity. As a leader, I will support and care for nurses in times of need. The support can happen through positive feedback as well as staff appraisals.

9. Allocate and manage resources to ensure patient safety and high quality health care.

Artifact ! Community Resources (Make a Wish Organization)

Artifact 2: Windshield Survey 32206


10. Engage in life-long learning and scholarly inquiry to continue professional career development. ACLS, BLS, CEUS



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