Cardiovascular, Respiratory, and Musculoskeletal

Purpose
To assess your ability to:

Identify anatomical, developmental, psychosocial, and cultural variations that guide assessment of the cardiovascular, respiratory, and musculoskeletal systems.
Describe the skills and techniques required to assess the cardiovascular system and document your findings.
Assess a client’s cardiovascular, respiratory, and musculoskeletal system as presented in a simulation.
Discuss the focus areas related to overall health of the cardiovascular, respiratory, and musculoskeletal systems in Healthy People 2030 initiatives.

Overview

This assignment requires you to assess a client’s cardiovascular, respiratory, and musculoskeletal system as presented in the following simulation.

Simulation:

Millie Larsen is an 84-year-old Caucasian female who lives alone in a small home. Her husband Harold passed away a year ago and she has a cat, Snuggles, who is very important to her. Millie has one daughter, Dina Olsen, who is 50, lives nearby, and is Millie’s major support system. Her current medical problems include: hypertension, glaucoma, osteoarthritis of the knee, stress incontinence, osteoporosis, and hypercholesterolemia

Part 1: As the simulation begins, Millie is at the clinic for routine examination and medication follow up. She is taking several anti-hypertensive medications, diuretics, and analgesics. Listen to Millie’s monologue which provides important details of how she views her current life situation. (You can access the text of Millie’s monologue by clicking the link to the PDF. It is also important to realize that the audio file is extremely large, and will take longer than usual to load).

Millie’s Audio File
PDF of Millie’s Monologue

Several weeks have passed since the clinic visit, and Millie is now in the hospital with a diagnosis of urinary tract infection and dehydration. Her presentation is atypical and she is confused.

Reflect on these questions:

What are Millie’s strengths?
What are your concerns about Millie?
What is the cause of the concern?
What information do you need?
What are you going to do about it?
What is Millie experiencing?

Part 2: This scene takes place at the 3:00 PM shift change. You are the nurse coming on at 3:00 PM. Millie has been in her room on the medical-surgical unit for about six hours. She was in the Emergency Department overnight because there were no available beds on the medical units. Due to her confusion, Millie did not take her medications properly in the days prior to admission and as a result, her blood pressure is very elevated. Millie’s daughter, Dina, is at the bedside and is quite concerned about the confusion and elevated blood pressure. You are expected to perform a general assessment of Millie.

Reflect on these questions:

Which assessment tools should you use to perform a general assessment of Millie?
What skills and techniques are required to assess the cardiovascular system?
What are the focus areas related to overall health of the cardiovascular, respiratory, and musculoskeletal systems in Healthy People 2030 (Links to an external site.) initiatives?
What are the anatomical, developmental, psychosocial, and cultural variations that guide assessment of the cardiovascular, respiratory, and musculoskeletal systems?
What might be some issues with multiple medications that she might be taking related to her elevated blood pressure, advanced age, current state of confusion, and her hospital stay?

Part 3: This scene occurs at 7:00 AM the following morning. You are now the nurse coming on at 7:00 AM. Millie has had a near fall while ambulating to the bathroom. Her confusion has begun to clear and her blood pressure is improving. During the handoff report, the nurse notices that the fall risk assessment has not been done, and discharge teaching should begin, since Millie is expected to be discharged tomorrow. Millie’s daughter has just arrived and is concerned about Millie going home alone when discharged. You are expected to perform a general assessment, fall risk assessment, and functional assessment (Katz ADL).

Two hours later, at 9:30 AM that morning, Millie’s primary care provider has written discharge orders and Millie is going home.

Reflect on these questions:

With the conflict that is developing between Millie and her daughter, is it safe for Millie to go home? On what do you base your decision?
If Millie does go home, what information/health promotion program would you recommend to Millie?

Action Items

Read the rubric for this assignment.
Complete your required reading before starting this assignment.
Read the scenario in the Overview of this assignment. Reflect on the questions provided in each part. You do not need to write answers about each question, but answering the questions as you read will assist you as you respond to the discussion question.
By the due date indicated, focus on Millie’s transition of care from the hospital back to the home setting and write a 250-400 word response to the following:

What are your concerns about Millie?
Describe the skills and techniques required to assess the cardiovascular system and document findings.
What medication teaching or other discharge teachings would you complete?
Discuss the focus areas related to the overall health of the cardiovascular, respiratory, and musculoskeletal systems in Healthy People 2030 (Links to an external site.) initiatives.
Identify anatomical, developmental, psychosocial, and cultural variations that guide assessment of the cardiovascular, respiratory, and musculoskeletal systems.

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