Question

Below is my case study, I have already answered the first two questions but need help with the last two.

Denzel Armstrong Case Study

Welcome to Dr. Jones’s busy general practice clinic where he sees patients of varying ages. You are one of three RNs in the clinic and your general duties include assessment, patient education, assistance with minor dressing changes, obtaining routine labs (i.e. urine, blood etc.) to name just a few. You have been a nurse for five years and feel very comfortable in this environment. On this day, you have a student nurse, Mary, assigned to work along with you. Mary is a second-year nursing student in a local university where she is working towards her BSN degree. Let’s help Mary get started with her first patient, Denzel Armstrong!

Denzel Armstrong is an obese 65-year-old African American male who is new to the clinic. His previous physician retired 1 year ago and he is now seeking care for his hypertension. He also has complaints of urinary frequency and nocturia three to four times/night for 2 weeks. He denies dysuria or fever, but admits to urgency and mildly decreased force of stream. Denzel reports 8 – 12 bathroom visits per day. He denied previous problems with urination and states that his only medical problem is high blood pressure, for which he takes hydrochlorthiazide 25 mg/day.

QUESTION-

1. Mary is almost ready to provide care for Denzel. Great job! Your final task is to work with her to develop a thorough assessment plan for your identified top priority. Provide clear rationale for each aspect of the plan. Include references as needed.

rubric-

Lesson 4 Assessment Plan Rubric

Lesson 4 Assessment Plan Rubric
Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeIdentification of abnormalities	5.0 pts Clearly identified all abnormal data with appropriate rationale for each; at least one citation for each rationale. 4.0 pts Clearly identified most abnormal data with appropriate rationale for each; at least one citation for each rationale. 3.0 pts Clearly identified some abnormal data with appropriate rationale for each; at least one citation for each rationale. 2.0 pts Clearly identified few abnormal data with appropriate rationale for each; some citations missing. 1.0 pts Vaguely identified abnormal data with appropriate rationale for each; no citations noted. 0.0 pts No answer noted	5.0 pts
This criterion is linked to a Learning OutcomeIdentification of other areas of assessment	5.0 pts Clearly identified 5 other assessment areas with appropriate rationale for each. 4.0 pts Clearly identified 4 other assessment areas with appropriate rationale for each. 3.0 pts Clearly identified 3 other assessment areas with appropriate rationale for each. 2.0 pts Clearly identified 2 other assessment areas with appropriate rationale for each. 1.0 pts Clearly identified 1 other assessment areas with appropriate rationale for each. 0.0 pts No answer noted	5.0 pts
This criterion is linked to a Learning OutcomePrioritization of care	6.0 pts Prioritization of the top three assessment areas with clear rationale. 3.0 pts Prioritization of the top two assessment areas with clear rationale. 2.0 pts Prioritization of the top one assessment area with clear rationale. 0.0 pts No prioritization noted.	6.0 pts
This criterion is linked to a Learning OutcomeDevelopment of assessment plan	10.0 pts Thorough assessment plan provided for top priority with clear rationale. 9.0 pts Strong assessment plan provided for top priority with clear rationale. 8.0 pts Assessment plan missing some vital components provided for top priority with clear rationale. 7.0 pts Minimal assessment plan provided for top priority with clear rationale. 4.0 pts Vague assessment plan noted or rationale omitted. 0.0 pts No assessment plan noted.	10.0 pts
This criterion is linked to a Learning OutcomeMechanics (sentence structure is clear; grammar, punctuation and spelling are correct; proofreading is evident etc.)	2.0 pts No spelling/grammatical errors noted 1.0 pts Few spelling/grammatical errors noted 0.0 pts Multiple spelling/grammatical errors noted.	2.0 pts
This criterion is linked to a Learning OutcomeAPA	2.0 pts No APA errors noted 1.0 pts Few APA errors noted 0.0 pts Multiple errors noted	2.0 pts
Total Points: 30.0

Answer 1

As Denzel Armstrong is suffering from hypertension he is on hydrochlorthiazide. His nocturia and urinary frequency are purely drug related. His age is also one of the concern where he is unable to tolerate frequency and is physically tierd.

Main Priority Point of concern is:

Nocturia, frequency, Impaired urinary elimination

Following are the things should be assessed.

1. Voiding patterns should be assessed.

Rationale : To find out the urinary abnormalities, to know the intake and out put fluid amounts

2. Reports should be maintained on force of urinary stream as Denzel is already having problem of decreased force stream.

Rationale : Decreased force definitely leads to the sensation of fullness over the bladder. This indicates inadequate emptying and also retention.

3. Denzel is on hydrochlorthiazide which is a diuretic. So all the drug regimens should be reviewed.

Rationale : Many drugs interfere with bladder emptying as this is the one Denzel is administered with.

4. Patients usual pattern of urination must be assessed.

Rationale: This helps to find out the pattern whether it's normal to the person or drug related or age related

Plans :

1. Encourage adequate fluid intake and limit fluid intake in the evening as Denzel is having nocturia which makes even worse

Rationale ;:Good amount of fluid intake maintains balance which further preventing infection and lesser during evening reduces nocturia

2. Provide catheter if necessary.

Rationale : Reduces frequent moving to bathroom during nights and also Denzel is moving almost 8 to 12 times which make his physical strength go down. Also reduces ascending infection.

3. Administer anti spasmodics. Also drugs such as Pro banthine etc.

Rationale : This reduces the symptoms of frequency and nocturia.

4. Monitor lab reports clinically especially for creatinine and Blood Urea nitrogen levels.

Rationale : Creatinine and Blood Urea nitrogen levels helps in determining the stages of renal diseases if any. Creatinine levels greater than the base value of patients needs to be definitely monitored.

5. Also needs to check whether Denzel is having a habit of taking alcohol. If so need to educate the limiting intake of alcohol.

Rationale: Alcohol and caffeine are considered to be bladder irritants and increase urinary frequency.

6. Encourage Denzel to do exercises.

Rationale : Exercises especially pelvic floor exercises improves sphincter tone.

7. Administer antibiotics if necessary .

Rationale : As Denzel is hospitalized with frequency there is a chance of getting further ascending nosocomial infection such as UTI.

8. Skin care is also one of the major concern. Skin hygiene must be maintained.

Rationale: Frequent urination leads to moistened skin which further is a source of developing multiple infections. So always area must be patted dry to prevent excoriation and dermatitis.

9.Frequent mobility should be provided by ambulation devices.

Rationale : This reduces infections and also reduces the risk of nosocomial infections.

10. Bladder training can be provided.

Rationale : Helps to cope up with the frequencies and urgencies reducing the stress urge.

Hope this assessments plans and rationales better will help you.