Assignent Solutionnurs

Assignment Description #2 Upload complete assignment to folder, turnitin will be activated. Ensure you include a title, and a reference page (if required). This assignment involves creating a concept map to answer the assigned questions. A brief (250 word) document may be included to support the work (not required). This is a creative assignment to provide a visual representation of case. Scenario Overview/history Mr. S. is a 50-year-old man. He is the CEO of a large real estate company. He lives with his wife in an upscale suburban neighborhood outside of Toronto. His job is very stressful and he deals with this by drinking 2 or 3 bottles of beer, and several glasses of wine each evening. Frequently, he has business lunches where several alcoholic drinks may be consumed, however he never appears to be impaired during business hours. He states he feels he has balanced his responsibilities quite well, but his lifestyle does not allow him to fully abstain from drinking. Unfortunately, his cirrhotic liver has never fully recovered from 25 years of heavy drinking. Although he has been diagnosed with cirrhosis, he has not been compliant with follow-up visits to his health care provider. Past Medical History: Admitted to the hospital four times in the past 24 months, with a diagnosis of G.I. bleed. He has a 30-year history of smoking. Current/present situation He states he has been coughing on and off for the past several days. His wife informs that this morning he coughed up “bright red blood” but he was quite irritable and refused to come to the hospital. His wife did call 911 earlier this evening when he began vomiting large amounts of bright red blood. He is admitted to your medical floor. On initial assessment you note that he is awake, alert, and answers questions appropriately. His vital signs are 114/66, 84, 97 R/A and remain within normal range from those recorded earlier in emergency. You observe that he is jaundiced, has gynecomastia, and multiple ecchymotic areas on his body. The site for the maintenance IV has fresh bloodstains noted on the dressing. Later in the same shift, as you are doing rounds, his wife comes out of the room distraught. You quickly enter his room and observe a large amount of blood all over his gown and bed linen. He looks terrified, appears confused and states I feel nauseated and dizzy. Vital signs at this time are: B/P 86/54, HR 122, SpO2 95 room air. Physical Exam Findings at this time: Neurological: awake, alert, orientated to time, but not to place, irritable and confused. HEENT: Epistaxis noted; Yellow sclera Respiratory: lung lobes clear bilaterally, breath sounds diminished to bases, complaining of shortness of breath Cardiac: normal S1 S2, no S3 or S4. Heart rhythm regular, Pulse weak HR 122. BP 86/54 mmHg, feels fatigued & lethargic Abdomen: abdomen firm and distended, bowel sounds hyperactive to 4 quadrants, abdominal discomfort, vomiting large amounts of bright red blood GU: normal urinary output, gynecomastia MSK: some mild tremors in both hands Skin: pale, jaundiced, multiple ecchymotic areas on his body Lab values: • Hemoglobin 70 mmol/L (normal for males: 140 – 180 mmol/L) • Hematocrit 0.27 • AST 260 u/L (normal: 0 – 35 u/L) • Ammonia level of 117 mcmol/L, (normal: 6 – 47 mcmol/L) • INR 3 (INR 0.81- 1.2) Treatment / Interventions ordered • Packed RBCs to be infused 2Units over 2 hours each • Second PIV insertion • Octreotide • IV fluid 0.9 Nacl at 25mls/hr • Albumin 25% 5g to be infused after RBCs completed • ?eta adrenergic blocker • Spironolactone • Lactulose • Sclerotherapy for bleeding varices Questions: answers to be adapted to a concept map: 1) List the subjective and objective nursing assessment data? 2) Cluster the relevant cues (data). Identify the inter-relationships between/among them. Explain what each cluster infer/suggest. (3 clusters) 3) Identify one data gap for each cluster and explain how this data would further inform the cluster or nursing diagnosis. (support your work) 4) Formulate 3 Potential Nursing Diagnosis from the data (cue) clusters, and from those identify what one is the Priority Nursing Diagnosis. Briefly explain why this is the priority for Mr. S. 5) Identify SMART goal for the Priority Nursing Diagnosis? Ensure that the goal aligns with the Priority Nursing Diagnosis and follows the SMART format. 6) Apply the four metaparadigm to this case study. Describe how you would consider Mr. S in relation to the 4 metaparadigm. 7) Choose 1 Pattern of Knowing (Except Empirical). Briefly but concisely explain how you anticipate this Way of Knowing will guide your care? What will be included in your nursing management that demonstrates/supports this Way of Knowing?