N512-19A Module Three: Respiratory Disease Across the Life Span

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Assignment 2

Emil Mowry is a 62 y.o., single, Latino rancher who did not complete high school. He remembers rolling his first cigarette when he was 11 years old. He does not remember ever wanting to quit smoking. For the last five years he has had increasing difficulty breathing. Emil was diagnosed by his Family Nurse Practitioner as having emphysema. He was told that he has Chronic Obstructive Pulmonary Disease (COPD). He did not ask his Nurse Practitioner what this means, but he plans to look it up on the Internet. N512-19A Module Three: Respiratory Disease Across the Life Span

The purpose of this assignment is to create an evidence-based patient-centered educational brochure on the pathophysiology and clinical manifestations of, and common treatment options for, COPD that could be used by Nurse Practitioners or Nurse Educators with their patients newly-diagnosed with this disorder. The proposed brochure should include graphics and citations from your textbook and the external, scholarly-practice literature.

You may present the content in the electronic format of your choice: single sheet, folded, tri-fold. In other words, you may use MS Word Document, MS Publisher, or any other software to develop your educational brochure. Since your audience are patients, please keep in mind the literacy and numeracy level (some literature suggests no more than 8^th grade level literacy and numeracy). Also, please refer to the Assignment Rubric below for grading criteria and to help you complete this assignment.

In regards to APA format, please use the following as a guide:

Include transitions in your brochure, if needed (i.e. headings or subheadings)
Use in-text references throughout the brochure
Spelling, grammar, and organization are appropriate
Include a reference list (this could be at the end of the brochure or you may submit a separate document listing your references)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA)

Assignment 2 Rubric

Criteria	60 Points	55 Points	50 Points	40 Points	Earned Points
Content: Application & Analysis	Responds correctly and/or appropriately to all questions and criteria. Content is excellent. Demonstrates a high level of critical thinking, shows significant insight or creative thought about the topic, and does not merely recite the text/resources. Uses concepts and terminology correctly. Detail rich and specific. N512-19A Module Three: Respiratory Disease Across the Life Span	Responds correctly and/or appropriately to all questions and criteria. Content is good. Demonstrates some critical thinking throughout the paper and may also show some insight or creative thinking about the topic. Mostly uses concepts and terminology correctly (1-2 issues). Minor detail inconsistencies (1-2).	Responds correctly and/or appropriately to at least one question OR if only one question, partially responds to question. Does not address all criteria. Content is minimal. Demonstrates at least one critical thinking skill in the paper. Attempts to use concepts and terminology correctly. Several detail inconsistencies (3-5).	Paper is unclear and does not address the questions and/or criteria. Content does not meet requirements. Many inconsistencies and conflicting information (6+).	/60
Criteria	20 Points	16 Points	14 Points	12 Points	Earned Points
Quality: Supporting Research & Sources	All work is accurately cited (where applicable) and appropriately supports content with research, text, multimedia, and/or other resources. References are relevant and enhance the topic.	Most of the work is accurately cited (where applicable) and adequately supports content with research, text, and/or resources. One issue with reference or use of one inappropriate reference. References are relevant to the topic.	2-3 issues with references, including the use of inappropriate references to support content. May fail to provide references to support content. 1-2 references are not relevant to the topic and/or distract from the topic at hand.	4 or more issues with references, including the use of inappropriate references to support content OR failure to include references (where applicable). No supporting references are used OR they are used but 3+ references are not relevant to the topic.	/20
Criteria	10 Points	8 Points	7 Points	6 Points	Earned Points
Organization	Paper is well-organized. Ideas are clear and arranged logically. Transitions are smooth, no flaws in logic.	Paper is organized. Ideas are usually clear and arranged in an acceptable sequence (1-2 issues). Transitions are usually smooth (1-2 issues), good support.	Paper lacks organization. There are many problems with the approach (3-5 issues with organization). Some difficulty understanding ideas. Issues with support and transitions (3-5).	Paper is poorly organized and difficult to understand. Many issues with support and transitions (6+). Ideas are arranged illogically and do not make sense.	/10
Accuracy & Basic Writing Mechanics	Error-free, including APA formatting, reflecting clear understanding of various forms of expression and careful editing.	Very few (less than 3) errors in spelling, grammar, syntax, and/or punctuation. Very few (less than 3) issues with APA formatting. Occasional poor choice of word.	4-5 errors in spelling, grammar, syntax, and/or punctuation. 4-5 issues with APA Formatting. Writing may be difficult to understand at times.	More than 5 errors in spelling, grammar, syntax, and/or punctuation. Many (6+ issues with APA formatting. Writing is difficult to understand in many instances.	/10

Assignment 2 Rubric

Criteria

60 Points

55 Points

50 Points

40 Points

Earned Points

Content: Application & Analysis

Responds correctly and/or appropriately to all questions and criteria. Content is excellent.

Demonstrates a high level of critical thinking, shows significant insight or creative thought about the topic, and does not merely recite the text/resources. Uses concepts and terminology correctly. Detail rich and specific.

Responds correctly and/or appropriately to all questions and criteria. Content is good.

Demonstrates some critical thinking throughout the paper and may also show some insight or creative thinking about the topic. Mostly uses concepts and terminology correctly (1-2 issues). Minor detail inconsistencies (1-2).

Responds correctly and/or appropriately to at least one question OR if only one question, partially responds to question. Does not address all criteria. Content is minimal.

Demonstrates at least one critical thinking skill in the paper. Attempts to use concepts and terminology correctly. Several detail inconsistencies (3-5).

Paper is unclear and does not address the questions and/or criteria. Content does not meet requirements. Many inconsistencies and conflicting information (6+).

N512-19A Module Three: Respiratory Disease Across the Life Span

/60

Criteria

20 Points

16 Points

14 Points

12 Points

Earned Points

Quality: Supporting Research & Sources

All work is accurately cited (where applicable) and appropriately supports content with research, text, multimedia, and/or other resources. References are relevant and enhance the topic.

Most of the work is accurately cited (where applicable) and adequately supports content with research, text, and/or resources. One issue with reference or use of one inappropriate reference. References are relevant to the topic.

2-3 issues with references, including the use of inappropriate references to support content. May fail to provide references to support content. 1-2 references are not relevant to the topic and/or distract from the topic at hand.

4 or more issues with references, including the use of inappropriate references to support content OR failure to include references (where applicable). No supporting references are used OR they are used but 3+ references are not relevant to the topic.

/20

Criteria

10 Points

8 Points

7 Points

6 Points

Earned Points

Organization

Paper is well-organized. Ideas are clear and arranged logically. Transitions are smooth, no flaws in logic.

Paper is organized. Ideas are usually clear and arranged in an acceptable sequence (1-2 issues). Transitions are usually smooth (1-2 issues), good support.

Paper lacks organization. There are many problems with the approach (3-5 issues with organization). Some difficulty understanding ideas. Issues with support and transitions (3-5).

Paper is poorly organized and difficult to understand. Many issues with support and transitions (6+). Ideas are arranged illogically and do not make sense.

/10

Accuracy & Basic Writing Mechanics

Error-free, including APA formatting, reflecting clear understanding of various forms of expression and careful editing.

Very few (less than 3) errors in spelling, grammar, syntax, and/or punctuation. Very few (less than 3) issues with APA formatting. Occasional poor choice of word.

4-5 errors in spelling, grammar, syntax, and/or punctuation. 4-5 issues with APA Formatting. Writing may be difficult to understand at times.

More than 5 errors in spelling, grammar, syntax, and/or punctuation. Many (6+ issues with APA formatting. Writing is difficult to understand in many instances.

/10

Discussion 3 (N512-19A Module Three: Respiratory Disease Across the Life Span)

Darla Thomas, a 25 y.o. African-American previously well woman, presents to her primary care Nurse Practitioner’s office with complaints of episodic shortness of breath and chest tightness. She has had the symptoms on and off for about 2 years but states that they have worsened lately, occurring two or three times a month. She notes that the symptoms are worse during the spring months. She has no exercise-induced or nocturnal symptoms. The family history is notable for a father with asthma. She is single and works as a secretary in a high-tech firm. She lives with a roommate, who moved in approximately 2 months ago. The roommate has a cat. The patient smokes occasionally when out with friends, drinks socially, and has no history of drug use. Examination is notable for mild end-expiratory wheezing. Pulmonary function tests are ordered to confirm the diagnosis.

In this discussion:

Discuss what you think this patient’s likely diagnosis is. Why do you support this “likely” diagnosis?
Identify the pathogenetic mechanisms that are responsible for this patient’s symptoms of wheezing, shortness of breath, and chest tightness.
What might you expect the results of her pulmonary function tests to be? Why?
Provide and discuss a plan of care for her. What would be your priority patient education outcomes? How would you achieve these outcomes?

Include citations from the text or the external literature in your discussions.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Sample Approach to DQ3

Based on her medical and social history, Darla Thomas’s symptoms are most likely the result of asthma. Asthma is an inflammatory disease caused by airflow obstruction and has intermittent symptoms such as wheezing, chest tightness, shortness of breath and cough (Hammer and McPhee, 2019). Triggers of the inflammatory response could be caused by allergens, which in Darla’s case would be pet dander from her roommates cat as well as the occasional cigarette.

Asthmatic exacerbations are the result of the activation of inflammatory cells. As stated in out textbook, the strongest predisposing factor of the development of asthma is the production immunoglobulin E (IgE) antibodies in response to allergen exposure (Hammer and McPhee, 2019). As the epithelium of the airway plays a key role in preserving lung tissue through particle clearance and fluid balance, direct injury to these cells may be the triggering event in the development of asthma (Fehrenbach, Wagner & Wegman, 2017). As inflammatory cells invade the epithelium, the airway mucosa becomes thick and edematous. Mucus hypersecretion occurs, which then results in mucus plugging of the airways and smooth muscle hyperresponsiveness and bronchoconstriction (Hammer & McPhee, 2019).

Pulmonary function testing will be ordered in order to accurately diagnose Darla, however if she is not experiencing an exacerbation at the time of testing her results may be normal. Typically, in an asthmatic patient the studies will show reduced expiratory airflow as well as a reduced FVC (forced vital capacity) which is a result in air trapping. Air trapping occurs with premature closing of the airway before full expiration. The testing may also show an increase in total lung capacity (Hammer and McPhee, 2019).

The treatment plan for Darla will include education focused on triggers and early detection of an exacerbation to allow for prompt treatment. In terms of symptoms and prevention, the goal is to decrease the number of exacerbations and to maintain current lung function. The daily use of inhaled glucocorticoid can reduce the severity of of symptoms and prevent exacerbations. Use of a rescue inhaler such as albuterol will rapidly relieve the sypmtoms of an exacerbation (Lazarus, 2018). Regular follow up and repeat pulmonary function testing should be done after the initiation of treatment and yearly thereafter. N512-19A Module Three: Respiratory Disease Across the Life Span

Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed). McGraw-Hill

Fehrenbach, H., Wagner, C., & Wegmann, M. (2017). Airway remodeling in asthma: What really matters. Cell and Tissue Research, 367(3), 551-569. doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.1007/s00441-016-2566-8

Lazarus, S. C., M.D. (2018). On-demand versus maintenance inhaled treatment in mild asthma. The New England Journal of Medicine, 378(20), 1940-1942. doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.1056/NEJMe1802680

447 words

Michelle,
I like how you mentioned immunoglobulin E (IgE) antibodies being a predisposing factor, I hadn’t thought about mentioning that in my post. It seems Ms. Thomas’s symptoms are being triggered from allergens such as smoking, cat dander, and/or environmental (pollen, dust, mold, etc.). Ms. Thomas’s father has asthma; Asthma is also known to be an inheritable disease (Rebar, 2019) which could be a contributing factor to Ms. Thomas’s asthma. The best treatment for asthma is preventing and avoiding precipitating factors, such as environmental allergens or irritants (Rebar, 2019). Educating Ms. Thomas on avoiding tiggers such as smoking and talking to her roommate about removing the cat would be of priority. However, some triggers may be unavoidable such as pollen, dust, mold, etc. I would consider prescribing Ms. Thomas a short-acting beta-agonist such as Albuterol in which she can take during an asthma attack to relieve symptoms of wheezing and shortness of breath (U.S National Library of Medicine, 2020). I might also refer Ms. Thomas to a pulmonologist or (someone mentioned in my post) also referring to an allergy specialist for a better understanding on what triggers are causing Ms. Thomas’s attacks which could help her know what tiggers to avoid. For example, if pollen is contributing to Ms. Thomas’s asthma attacks, she may want to avoid going outdoors when pollen counts are high.Great Post
Amanda

Reference

Rebar, C., Heimgartner, N., & Gersch, C. (2019). Pathophysiology made incredibly easy (6th ed). Wolters Kluwer

U.S National Library of Medicine. (13 January 2020). Asthma quick relief drugs. Medline Plus. https://medlineplus.gov/ency/patientinstructions/000008.htm

267 words

Michetle,

It is true that asthma is the most likely condition for the patient based on the exhibited condition. They are also related to the family history and environmental conditions. The cat, spring relation, smoking and an asthmatic father indicate the probability of respiratory dell inflammation hence the need for management.

51 words N512-19A Module Three: Respiratory Disease Across the Life Span

N512-19A Module Three: Respiratory Disease Across the Life Span