Student Name Chamberlain University NR-325 Adult Health II Prof. Name Date Introduction In the field of nursing education and clinical practice, delivering safe, effective, and patient-centered care is fundamental. The NCLEX-RN test plan serves as a crucial framework for ensuring that nurses are prepared to meet the diverse needs of patients across various healthcare settings. This paper explores the multiple dimensions of nursing care as outlined in the NCLEX-RN test plan, including the safe and effective care environment, management of care, safety and infection control, health promotion and maintenance, psychosocial integrity, physiological integrity, basic care and comfort, pharmacological and parenteral therapies, reduction of risk potential, and physiological adaptation. The NCLEX-RN test plan is more than an examination blueprint; it aligns nursing education with the competencies necessary for professional practice. Additionally, clinical self-assessment emerges as an essential tool for personal and professional growth, enabling nurses to identify strengths, recognize skill gaps, and pursue targeted improvement. Activity statements designed for each NCLEX-RN category serve as practical guides in preparing nursing students for the multifaceted responsibilities of clinical practice. The Dimensions of Nursing Care in the NCLEX-RN Test Plan Safe and Effective Care Environment This domain emphasizes creating a healthcare setting where patient safety and organizational efficiency coexist. It includes subcategories such as management of care and safety and infection control. Nurses are expected to coordinate care, delegate tasks appropriately, and implement infection prevention protocols to safeguard both patients and staff. Health Promotion and Maintenance Health promotion and maintenance focus on preventive care, patient education, and interventions that enhance long-term wellness. Nurses provide guidance on disease prevention, lifestyle modifications, immunizations, and developmental milestones. Psychosocial Integrity This category addresses the psychological, social, and emotional needs of patients. Nurses must deliver compassionate, culturally sensitive care, assess mental health, and foster therapeutic communication with patients and families. Physiological Integrity Physiological integrity encompasses the physical aspects of patient care, including basic comfort, pharmacologic therapies, monitoring of vital signs, reduction of risk potential, and adaptation to physiological changes. Clinical Experience Reflection During my medical-surgical clinical rotation, I encountered a patient who had sustained injuries from a motorcycle accident and required clavicle repair surgery. This case allowed me to refine skills in Physiological Integrity and Safety and Infection Control. I managed the patient’s post-operative pain, closely monitored vital signs, and adhered strictly to sterile procedures during dressing changes to prevent infection. However, I recognized areas for growth in Health Promotion and Maintenance and Psychosocial Integrity. Future clinical experiences will focus on patient education for injury prevention and lifestyle improvement, as well as on enhancing my ability to assess and support patients’ emotional well-being. Table 1 NCLEX-RN Categories Applied in My Clinical Experience NR 325 RUA NCLEX-RN Category Actions Performed Skills to Improve Physiological Integrity Managed pain, monitored vital signs, ensured post-surgical stability Continue refining assessment skills and intervention timing Safety and Infection Control Followed sterile techniques during dressing changes, monitored for infection signs Expand knowledge of infection prevention in specialized surgical care Health Promotion & Maintenance N/A in this case; identified as a future focus area Educating patients on injury prevention and healthy lifestyle changes Psychosocial Integrity Limited application in this case Strengthen emotional support strategies and therapeutic communication Professional Growth Plan To enhance competency in the areas identified, I will: By consistently applying these strategies, I aim to become a well-rounded nurse capable of addressing a full spectrum of patient needs in diverse clinical environments. Importance of the NCLEX-RN Test Plan for Nursing Practice The NCLEX-RN test plan ensures that nurses entering the workforce possess the competencies necessary for safe, effective, and holistic care. Mastery of each test plan category equips nurses with the skills to handle complex and varied patient conditions. Furthermore, integrating test plan guidelines into nursing curricula strengthens the alignment between academic preparation and real-world practice, ultimately safeguarding patient outcomes. References National Council of State Boards of Nursing. (n.d.). 2023 NCLEX-RN test plan. https://www.ncsbn.org/publications/2023-nclex-rn-test-plan NR 325 RUA UWorld. (n.d.). NCLEX-RN® Test Plan. UWorld Nursing. https://nursing.uworld.com/nclex-rn/test-plan/

Student Name Chamberlain University NR-325 Adult Health II Prof. Name Date Scenario Overview Carl Rogers is a 67-year-old African American man with a two-decade history of type II diabetes mellitus. On Tuesday at 1530, he was admitted directly from his primary care provider’s office to the hospital’s medical unit for management of a stage II, non-healing ulcer located on his right heel. Upon arrival, the admission assessment was completed, and pain management was initiated. Orders for a dressing change and insulin administration were documented but had not yet been carried out. The scenario unfolds later the same day at 1700. 1. Compare and contrast the onset, peak, and duration of long-acting and short-acting insulin. Long-Acting Insulin Long-acting insulin is primarily prescribed to maintain steady blood glucose control for individuals with type 1 or type 2 diabetes mellitus. Its role is to provide a consistent baseline level of insulin between meals and throughout the night. The onset of action typically occurs between 0.8 and 4 hours after administration. Unlike shorter-acting formulations, long-acting insulin has minimal to no pronounced peak, thereby reducing the likelihood of hypoglycemia due to fluctuations in serum insulin levels (Lewis et al., 2017). The duration of action ranges from 16 to 24 hours. Common examples include insulin glargine (Lantus), insulin detemir (Levemir), and insulin degludec (Tresiba). Short-Acting Insulin Short-acting insulin, often referred to as “regular insulin,” is used as a mealtime (bolus) insulin to control postprandial blood glucose spikes. Its relatively rapid onset of 30 minutes to 1 hour ensures synchronization with nutrient absorption during and after meals. The peak effect occurs approximately 2 to 5 hours post-injection, and its duration extends to about 5 to 8 hours. For optimal effect, short-acting insulin should be administered 30–45 minutes before eating. However, due to its longer duration compared to rapid-acting insulin, there is a slightly higher risk for hypoglycemia (Lewis et al., 2017). Comparison Table: Long-Acting vs. Short-Acting Insulin Feature Long-Acting Insulin Short-Acting Insulin Onset 0.8 – 4 hours 30 minutes – 1 hour Peak Minimal or no pronounced peak 2 – 5 hours Duration 16 – 24 hours 5 – 8 hours Primary Use Basal glucose control Mealtime glucose control Examples Glargine, Detemir, Degludec Regular insulin Hypoglycemia Risk Lower due to lack of peak Higher, especially if meals are delayed 2. What dietary teaching points can the nurse discuss with their patient with Type II Diabetes Mellitus? Dietary management is a cornerstone in the treatment of type II diabetes mellitus (DM). For individuals who are overweight or obese, gradual weight reduction is strongly recommended, as even modest weight loss can improve insulin sensitivity. An optimal diabetic diet should include balanced proportions of carbohydrates, proteins, and fats tailored to the individual’s metabolic needs. Carbohydrates provide essential energy, fiber, vitamins, and minerals, and intake should be customized based on blood glucose monitoring results and activity levels. The general recommendation for fiber is 25–30 grams per day, as this supports gastrointestinal health and glucose regulation. Fat consumption should be carefully managed, with minimal trans-fat intake and dietary cholesterol kept below 200 mg/day. Protein requirements should also be individualized; for overweight patients, excessively high-protein diets are generally discouraged to avoid undue strain on renal function. Collaborative meal planning between the patient, nurse, and dietitian enhances adherence by aligning dietary changes with personal preferences and cultural food practices. Incorporating education on portion control, glycemic index awareness, and meal timing further supports long-term glycemic stability (Lewis et al., 2017). 3. Describe best practices when providing wound care for diabetic foot ulcers. Effective wound care for diabetic foot ulcers aims to accelerate healing, prevent infection, and reduce the risk of amputation. Because individuals with diabetes are prone to delayed wound healing due to peripheral neuropathy and impaired circulation, meticulous wound care is critical. Best practices include: NR 325 Pre-Simulation – Carl Rogers Consistent monitoring and interdisciplinary collaboration between nurses, podiatrists, and endocrinologists improve healing outcomes and minimize complications such as necrosis or limb loss (Lewis et al., 2017). References Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. M. (2017). Medical-surgical nursing: Assessment and management of clinical problems (10th ed.). Elsevier. NR 325 Pre-Simulation – Carl Rogers Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2017). Davis’s drug guide for nurses (15th ed.). F.A. Davis.

Student Name Chamberlain University NR-325 Adult Health II Prof. Name Date Exam #2 – Comprehensive Study Guide Head Injury Anticipating Seizures in Brain Injuries Whenever a brain procedure or injury occurs, seizure risk must be anticipated. Patients should be placed on prophylactic anticonvulsant therapy during the acute recovery phase to prevent seizures and secondary neuronal damage. What are the signs and symptoms (S&S) of head injury? Increased Intracranial Pressure (ICP) What are the signs and symptoms? How do we manage it? How do we monitor them? How do we place the patient? Glasgow Coma Scale (GCS) A neurological assessment tool scoring eye opening (1–4), verbal response (1–5), and motor response (1–6). What are the abnormal postures? Stroke Know the Different Types Management Patent Airway – Primary priority; maintain oxygenation.Swallow Study/Test – Performed before oral intake to prevent aspiration.CT Scan Immediately – Differentiates between ischemic and hemorrhagic stroke; determines appropriate treatment. What are the signs and symptoms (S&S) of stroke? How do we manage those symptoms? Thrombolytic Therapy Treatments for Each Type of Stroke Stroke Type Primary Intervention Additional Measures Ischemic Thrombolytics, antiplatelet agents BP control, glucose management Hemorrhagic Surgery, BP reduction ICP management, seizure prevention Active Stroke – How do we manage them? NR 325 Exam 2 Left-Sided vs. Right-Sided Stroke Affected Hemisphere Common Deficits Left Aphasia, right-sided weakness, slow behavior Right Neglect of left side, impulsive behavior, poor spatial judgment Transient Ischemic Attack (TIA) Mini stroke — temporary blockage of cerebral blood flow with symptoms resolving within 24 hours. How do we manage them? Seizures Different Types The Precautions Status Epilepticus A neurological emergency — continuous seizure activity lasting >5 minutes or recurrent seizures without return to baseline. Requires immediate IV benzodiazepines. Seizure Medications Know the types: Phenytoin, valproic acid, carbamazepine, levetiracetam.Implications: Monitor drug levels, liver function, and watch for gingival hyperplasia (phenytoin). Meningitis S&S How do we manage the S&S and the patient with it? How do we test for it? Parkinson’s Disease S&S Alzheimer’s Disease How do we know? S&S How do we manage a patient with it? Increased Intracranial Pressure (ICP) Symptoms Normal Value Implications of Increased ICP Things to Avoid During Increased ICP Treatment Cranial Nerves Know names and functions — sensory, motor, or both. Parts of the Brain Myasthenia Gravis Paralysis & Priority Care Tensilon Test Amyotrophic Lateral Sclerosis (ALS) Progressive Weakness & Priority Care Guillain-Barré Syndrome Priority Care Multiple Sclerosis Presentation Treatment Delirium Acute Confusion Presentation Care Spinal Cord Injury Levels Complications Gallbladder Disease Inflammation & Stones Post-Surgery Care Pancreatitis Acute vs. Chronic Hepatitis Know all types (A–E) and modes of transmission. Cirrhosis of the Liver End Stage S&S Labs Complications Pancreatic Cancer Liver Cancer References American Heart Association. (2023). Guidelines for the management of stroke. https://www.heart.org Centers for Disease Control and Prevention. (2024). Meningitis. https://www.cdc.gov/meningitis National Institute of Neurological Disorders and Stroke. (2023). Brain injury and seizure prevention. https://www.ninds.nih.gov NR 325 Exam 2 National Multiple Sclerosis Society. (2024). Multiple sclerosis information. https://www.nationalmssociety.org World Health Organization. (2023). Neurological disorders. https://www.who.int

Student Name Chamberlain University NR-325 Adult Health II Prof. Name Date Clinical Review  1. Identify the appropriate technique/sequence used during a focused gastrointestinal physical assessment. A focused gastrointestinal (GI) physical assessment follows a deliberate sequence to ensure accurate findings. The patient should be positioned supine with knees slightly flexed and the head of the bed elevated slightly. The bladder should be emptied before the exam to avoid discomfort and interference with palpation. Steps of GI Physical Assessment 2. Describe the purpose, procedure, and nursing responsibility related to ERCP, Colonoscopy, and Liver Biopsy Procedure. Procedure Purpose Procedure Steps Nursing Responsibilities Endoscopic Retrograde Cholangiopancreatography (ERCP) Visualize biliary ducts, gallbladder, liver, and pancreas; detect obstructions or strictures Endoscope inserted through the mouth into duodenum; contrast injected into biliary tree; X-rays taken Pre: NPO 8 hrs, consent, sedation, antibiotics if ordered. Position: Semi-prone, reposition during procedure. Post: Monitor VS, gag reflex, and for perforation, infection, or pancreatitis Colonoscopy Inspect colon and rectum for polyps, tumors, inflammation Flexible scope inserted via anus into entire colon Pre: Bowel prep, clear liquid diet 24 hrs prior, NPO after midnight. Post: Monitor for bleeding, VS, encourage fluids, resume diet as tolerated Liver Biopsy Obtain tissue for diagnosis of liver disease or cancer Needle inserted between 6th–7th or 8th–9th intercostal spaces Pre: Check coagulation, crossmatch blood, teach breath-holding during insertion. Post: Flat position 12–14 hrs, frequent VS, monitor for internal bleeding 3. List the normal ranges, and purpose for these gastrointestinal-associated blood studies. Test Organ/System Normal Range Purpose Amylase Pancreas, small intestine 40–140 U/L Detects pancreatic inflammation Lipase Pancreas 0–160 U/L More specific for pancreatitis Total Bilirubin Liver, gallbladder 0.3–1.0 mg/dL Detects liver dysfunction or bile obstruction AST Liver 0–35 U/L Detects hepatocellular injury ALT Liver 4–36 U/L More liver-specific enzyme PT Coagulation (Warfarin) 11–13.5 sec Assesses clotting/liver function aPTT Coagulation (Heparin) 22–35 sec Monitors heparin therapy Cholesterol – Total Blood vessels <200 mg/dL Cardiovascular risk LDL Blood vessels <100 mg/dL “Bad” cholesterol HDL Blood vessels ≥40 mg/dL “Good” cholesterol Serum Ammonia Intestines, liver, muscles 6–47 mmol/L Detects hepatic encephalopathy 4. Explain the characteristics of hepatitis viruses (i.e., modes of transmissions, sources of infection, and infectivity). Type Mode of Transmission Source of Infection Infectivity HAV Fecal–oral Contaminated food/water, shellfish, infected stool High HBV Blood, body fluids Sexual contact, perinatal, contaminated needles Very high; survives outside body 7 days HCV Bloodborne IV drug use, blood products, unsafe tattoos High chronic rate HDV Bloodborne Co-infection with HBV Dependent on HBV HEV Fecal–oral Contaminated food/water High in developing countries; dangerous in pregnancy 5. Describe the clinical manifestations and nursing management of the patient with viral Hepatitis B. NR 325 Adult Health Final Exam Concept Reviews 6. Describe the clinical manifestations and nursing management of the patient with viral Hepatitis C (HCV). 7. Identify the etiology and clinical manifestations of cirrhosis of the liver. 8. What are the primary nursing responsibilities associated with cirrhosis of the liver? 9. What are the major complications of cirrhosis, and collaborative care for each? Complication Care Portal HTN & Varices Beta-blockers, endoscopic therapy, vasopressin Ascites Sodium restriction, diuretics, paracentesis Hepatic Encephalopathy Lactulose, rifaximin, protein control Edema Diuretics, skin protection 10. Describe the action and purpose for the following drugs in patients with liver problems. (See table from earlier section — maintained for accuracy.) 11. What is portal hypertension, and what are the associated complications? Portal hypertension is an abnormal increase in the blood pressure within the portal venous system, typically resulting from obstruction of blood flow through the liver due to cirrhosis. The condition leads to the development of collateral circulation, which has significant clinical consequences. Major Complications: 12. What are esophageal varices, and how are they managed? Esophageal varices are dilated veins in the lower esophagus, formed due to portal hypertension. They are fragile and prone to life-threatening hemorrhage. Management Approaches: 13. What is hepatic encephalopathy, and what are the treatment goals? Hepatic encephalopathy is a neuropsychiatric syndrome caused by accumulation of neurotoxins, particularly ammonia, due to liver failure. Goals of Treatment: 14. Describe the pathophysiology and clinical manifestations of acute pancreatitis. Acute pancreatitis results from premature activation of pancreatic enzymes within the pancreas, leading to autodigestion, inflammation, and varying degrees of necrosis. Common causes include gallstones, chronic alcohol use, hypertriglyceridemia, and certain medications. Clinical Manifestations: 15. What are the priority nursing interventions for acute pancreatitis? 16. Describe the pathophysiology, manifestations, and treatment of cholelithiasis. Cholelithiasis is the presence of gallstones within the gallbladder, often composed of cholesterol, bile salts, and calcium. Manifestations: Treatment: 17. What are the nursing responsibilities for a patient post-cholecystectomy? 18. Describe the etiology, pathophysiology, and manifestations of peptic ulcer disease (PUD). PUD involves erosion of the gastric or duodenal mucosa due to imbalance between mucosal defense mechanisms and acid-pepsin activity. Causes include H. pylori infection, chronic NSAID use, stress, smoking, and alcohol. Symptoms: 19. What are the complications of PUD, and how are they managed? Complication Management Hemorrhage Endoscopic hemostasis, PPI infusion, fluid/blood resuscitation Perforation Surgical repair, antibiotics, NG decompression Gastric outlet obstruction NG tube suction, endoscopic dilation, surgery 20. Identify the classes of drugs used to treat PUD and their actions. 21. Describe the nursing management of GI bleeding. 22. Explain the differences between ulcerative colitis (UC) and Crohn’s disease. Feature UC Crohn’s Location Colon only, continuous lesions Anywhere GI tract, skip lesions Depth Mucosa/submucosa Entire bowel wall Symptoms Bloody diarrhea, urgency Diarrhea, weight loss, abdominal pain Complications Toxic megacolon, perforation Fistulas, strictures 23. List nursing priorities for inflammatory bowel disease (IBD). 24. Describe the clinical picture of colorectal cancer. 25. Nursing care post-colorectal surgery. 26. Describe benign prostatic hyperplasia (BPH) and its management. BPH is a non-cancerous enlargement of the prostate gland causing urinary obstruction. Symptoms: Hesitancy, weak stream, nocturia, incomplete emptying. Management: 27. Post-TURP nursing responsibilities. 28. Describe testicular cancer risk factors and manifestations. 29. Nursing care post-orchiectomy. 30. Describe breast cancer risk factors and early detection. 31. Nursing management post-mastectomy. 32. Describe cervical cancer risk factors and prevention. 33. Endometrial cancer basics. 34. Ovarian cancer overview. 35. Nursing

Student Name Chamberlain University NR-325 Adult Health II Prof. Name Date Clinical iSBAR Introduce Yourself Your Name: GGYour Title: RNReason for Being Here: To provide a comprehensive clinical handoff report and ensure continuity of patient care using the iSBAR communication framework. S – Situation Patient: AEAge: 87Gender: FemaleHeight/Weight: Not documentedAllergies: No known drug allergies (NKDA)Code Status: Full CodeAttending Physician: Dr. LimperisPatient Chief Complaint: Right hip fracture due to a mechanical fall at home, accompanied by nasal bone fracture. B – Background The patient has a complex medical history that contributes to her current health status. She sustained injuries following a fall, which resulted in a right hip fracture and a nasal bone fracture. She has a documented history of multiple chronic conditions, including hypertension, hyperlipidemia, and anemia, with a current medication regimen that includes aspirin, cephalexin, Lipitor, and ferrous sulfate. Past Medical History: Not fully detailed in the chart but significant for cardiovascular disease and anemia.Social History: Unknown marital status, no documentation of tobacco, alcohol, or illicit drug use.Current Medications: Aspirin, Cephalexin, Lipitor, Ferrous Sulfate. A – Assessment Vital Signs BP HR RR Temp (°F) SpO₂ Pain (0–10) Reading 1 111/56 119 20 97.2 97% 6 Reading 2 151/80 105 18 96.9 96% 7 Falls Risk: Yes (high risk)IV Site: Saline lock in place; no fluids currently infusingAccu-Chek: Yes (daily monitoring)Isolation Precautions: None requiredRespiratory: Clear and equal bilateral breath sounds; patient encouraged to use incentive spirometer post-operativelyCardiovascular: Blood pressure fluctuations noted; requires close monitoringNeurological: Weakness in the right lower extremity secondary to fracture; alert and oriented ×3GI/GU: Constipation likely secondary to opioid use; urinary incontinence presentIntegumentary: Skin dry and pink; no open wounds observed except surgical incision sitePsychological: No documented family support; appears cooperative but fatigued R – Request/Recommendation Handoff report should be provided to the incoming nurse with emphasis on: Reason for Admission The patient was admitted following a fall at home resulting in a right hip fracture and nasal bone fracture. She is currently recovering post-operatively and undergoing physical rehabilitation to regain mobility. Medical Orders Summary Order Rationale Cardiac diet Reduces cardiovascular strain and manages hypertension risk Ambulate with assistance Minimizes fall risk while promoting recovery Monitor bowel movements Addresses constipation risk from Norco use Vital signs every 4 hours Detects blood pressure and heart rate fluctuations Daily blood glucose checks Monitors elevated glucose levels in diabetic patient CBC/BMP daily Tracks electrolytes, kidney function, and infection markers Physical therapy Restores strength and mobility following hip fracture Recent Lab Results Date Lab Test Result Normal Range Comment 7/3 Sodium (Na) 138 135–145 Normal 7/3 Potassium (K⁺) 3.6 3.5–5.0 Normal 7/3 Chloride (Cl) 110 (H) 97–107 Elevated, likely dehydration 7/3 CO₂ 22 (L) 23–29 Low due to dehydration 7/3 Glucose 139 (H) 70–99 Hyperglycemia, diabetic history 7/5 WBC 12.7 (H) 4.5–11.0 ×10³/µL Possible infection 7/5 Hemoglobin 10.2 (L) 12.0–15.5 Anemia present Medications (Example entry shown; all medications reformatted in similar table style for clarity) Generic / Brand Name Class Dose Ordered Indication Route / Frequency Adverse Effects Nursing Considerations Cephalexin / Keflex Anti-infective 500 mg Post-surgical infection prevention Oral q6h GI upset, rash, seizures Monitor for allergic reaction, assess wound site Nursing Care Plans 1. Acute Pain Related to: Hip fractureAs evidenced by: Patient reports pain, guards affected areaGoals: Patient will verbalize reduced pain within 24 hoursInterventions: 2. Impaired Skin Integrity Related to: Physical immobilizationAs evidenced by: Skin redness at pressure pointsGoals: Maintain intact skin throughout hospitalizationInterventions: 3. Impaired Physical Mobility Related to: Pain and weaknessAs evidenced by: Limited range of motion and decreased muscle strengthGoals: Patient will demonstrate improved mobility with assistance by dischargeInterventions: NR 325 Care Plan 2 Diagnosis References American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). ANA. Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier Health Sciences. NR 325 Care Plan 2 Diagnosis Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2020). Brunner & Suddarth’s textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.

Student Name Chamberlain University NR-325 Adult Health II Prof. Name Date NR 325 Adult Health II – Case Study #1 Patient Profile P.J. is a 74-year-old woman with a significant and complicated medical history. She has been hospitalized multiple times in the past, most recently discharged one month ago following a 14-day admission for a gangrenous open cholecystectomy. During that hospitalization, the gangrene extended into the common bile duct, resulting in a postoperative bile leak. This complication was further influenced by her history of diabetes mellitus. Currently, P.J. presents to the emergency department with a seven-day history of progressively worsening blurry vision in her left eye. She describes her vision as “fuzzy and distorted.” She reports feeling frustrated, noting that after surviving her gallbladder ordeal, she is now faced with new visual problems. P.J. has never been married but has strong social support through friends and caregivers. She is taking the following prescribed medications: Medication Dosage & Route Classification Indication Valsartan/Hydrochlorothiazide 160 mg/25 mg PO daily ARB + thiazide diuretic Hypertension Amitriptyline 25 mg PO daily Tricyclic antidepressant Depression Aspirin 81 mg PO daily NSAID/antiplatelet Cardiovascular prophylaxis Alprazolam 0.25 mg PO q6h PRN Benzodiazepine Anxiety Subjective Data Objective Data Discussion Question 1: Name six potential causes of P.J.’s blurry vision. Possible causes of blurry vision in this patient include: NR 325 Week 3 Case Study Potential Cause Mechanism/Notes Age-related macular degeneration Degeneration of central retina affecting sharp vision. Hypertensive retinopathy Chronic high BP causing retinal blood vessel damage. Diabetic retinopathy Microvascular retinal damage due to diabetes. Amitriptyline use Anticholinergic side effects causing blurred vision. Alprazolam use CNS depressant effects impacting visual processing. Acute eye inflammation or infection May cause swelling and blurred vision. Open-angle glaucoma Gradual loss of peripheral vision leading to blurry central vision. Ocular tumor Rare, but possible in elderly patients. Retinal detachment Sudden vision loss, medical emergency. Discussion Question 2: What will you include in P.J.’s focused assessment? A focused assessment should include: Case Study Progress An ophthalmology consult was obtained. Examination revealed scarring in the central macula, suggesting age-related macular degeneration (AMD). The ophthalmologist recommended treatment aimed at slowing disease progression and preventing further vision loss. Photodynamic therapy was scheduled. Discussion Question 3: What are the early signs of age-related macular degeneration (AMD)? Discussion Question 4: What tests can be done to determine if P.J. has AMD? Discussion Question 5: What risk factors are associated with macular degeneration? Discussion Question 6: What diet-related teaching will you provide P.J.? NR 325 Adult Health II – Case Study #2 Patient Profile S.H. is a 25-year-old male presenting to the emergency department with a one-day history of severe vertigo and vomiting. He has experienced several episodes of vertigo with right-sided tinnitus over the past month. The symptoms are worsened by head movement, and he reports crawling out of bed to prevent falls. Nausea is present at rest and aggravated by positional changes. Subjective Data Objective Data Diagnostic Studies Test Result Audiogram Severe sensorineural hearing loss (35 dB), predominantly low-frequency loss in right ear Weber test (tuning fork) Right sensorineural hearing loss Discussion Question 1: What is vertigo? How is it different from dizziness? Discussion Question 2: Based on the assessment, what do you think S.H. has and why? The presentation is consistent with Ménière’s disease, given the triad of vertigo, tinnitus, and hearing loss, with episodic worsening and audiogram-confirmed low-frequency hearing loss. Discussion Question 3: What other diagnostic tests may be ordered for S.H.? Discussion Question 4: The health care provider diagnoses S.H. with Ménière’s disease. What are the common causes of Ménière’s disease? Discussion Question 5: What are the priority nursing diagnoses for S.H.? Discussion Question 6: S.H. is being discharged with prescriptions for prochlorperazine and diazepam and recommendations to follow up with his primary care physician in 3–4 days. What should you teach him? References American Academy of Ophthalmology. (2023). Age-related macular degeneration. https://www.aao.org American Academy of Otolaryngology–Head and Neck Surgery. (2023). Ménière’s disease. https://www.entnet.org NR 325 Week 3 Case Study National Eye Institute. (2022). Macular degeneration: Facts and prevention. https://www.nei.nih.gov Mayo Clinic. (2024). Vertigo: Symptoms and causes. https://www.mayoclinic.org

Student Name Chamberlain University NR-325 Adult Health II Prof. Name Date Acute Kidney Injury – CAE PNCI Medical-Surgical Preparation Pathophysiology of Acute Kidney Injury Acute Kidney Injury (AKI) is characterized by a sudden decline in renal function, leading to reduced glomerular filtration rate (GFR), retention of nitrogenous waste products, fluid imbalance, and electrolyte disturbances. The pathophysiological changes depend on the underlying cause but often involve impaired renal perfusion, tubular injury, or urinary tract obstruction. In cases of urinary tract obstruction, urine flow is impeded, causing backward pressure (urinary reflux) into the renal pelvis. This increases hydrostatic pressure within the nephron and reduces GFR. Bilateral ureteral obstruction leads to hydronephrosis (dilation of the kidney), tubular blockage, and progressive loss of renal function. If obstruction is relieved within 48 hours, renal recovery is usually complete. However, prolonged obstruction results in tubular atrophy and irreversible interstitial fibrosis. In ischemic AKI, severe reduction in renal blood flow causes damage to the tubular basement membrane and patchy necrosis of the tubular epithelium, further impairing filtration and concentrating ability. Etiology, Clinical Features, and Diagnostic Patterns Causes of AKI AKI is classified into prerenal, intrarenal, and postrenal categories. Type of AKI Common Causes Signs and Symptoms Diagnostic Findings Prerenal Hypovolemia (dehydration, hemorrhage, diarrhea, vomiting, excessive diuresis, burns, hypoalbuminemia), decreased cardiac output (heart failure, MI, dysrhythmias, cardiogenic shock), decreased systemic vascular resistance (anaphylaxis, septic shock, neurological injury), decreased renal blood flow (bilateral renal vein thrombosis, renal artery thrombosis, hepatorenal syndrome). Oliguria, hypotension, tachycardia, dry mucous membranes, poor skin turgor, confusion. Urine sodium <20 mEq/L, high urine osmolality (>500 mOsm/kg), bland urinary sediment. Intrarenal Nephrotoxic agents (aminoglycosides, vancomycin, amphotericin B, contrast dye, hemolytic transfusion reactions, crush injury, ethylene glycol, lead, arsenic), interstitial nephritis (NSAIDs, ACE inhibitors, sulfonamides, rifampin, viral/fungal/bacterial infections), other (acute glomerulonephritis, malignant hypertension, lupus nephritis, thrombotic disorders). Edema, fatigue, flank pain, hematuria, oliguria. Urine sodium >40 mEq/L, muddy brown granular casts, low urine osmolality (<350 mOsm/kg). Postrenal Benign prostatic hyperplasia, bladder/prostate cancer, kidney stones, urethral strictures, neuromuscular bladder dysfunction, spinal cord injury, pelvic trauma. Lower abdominal discomfort, hesitancy, fluctuating urine output, anuria in complete obstruction. Imaging showing hydronephrosis or bladder distention; elevated post-void residual volume. Fluid and Electrolyte Imbalances in AKI Renal impairment affects electrolyte regulation, leading to potentially life-threatening abnormalities. Disturbance Causes Clinical Manifestations Hyperkalemia Reduced potassium excretion due to renal insufficiency; metabolic acidosis causing potassium shift from intracellular to extracellular space. Muscle weakness, paresthesias, bradycardia, irritability, leg cramps, dysrhythmias, abdominal cramps, diarrhea. Hyponatremia Dilution from fluid retention; sodium loss in hypo/hypervolemic states. Abdominal cramping, headache, confusion, dry mucous membranes. Hypocalcemia Hyperphosphatemia from reduced GFR; impaired vitamin D activation. Tetany, perioral/finger/toe tingling, positive Trousseau’s & Chvostek’s signs, irritability, bronchospasm. Management of Acute Kidney Injury Medical and Nursing Goals Key Interventions Sodium Polystyrene Sulfonate Sodium polystyrene sulfonate exchanges sodium ions for potassium in the colon, facilitating potassium excretion in stool. It is contraindicated in patients without bowel sounds due to the risk of bowel necrosis. Dialysis-Related Complications and Prevention Peritoneal Dialysis Complications: NR 325 Week 3 Acute Kidney Injury CAE PNCI Medical Surgical Prevention: Hemodialysis Complications: Prevention: Teaching Plan for AKI Patients MRSA Overview and Prevention MRSA (Methicillin-Resistant Staphylococcus aureus) is a resistant strain of staph bacteria that can cause difficult-to-treat infections, particularly in hospitalized or long-term care patients. It can spread to the community through direct contact. Prevention Measures: Peritoneal vs. Hemodialysis Feature Hemodialysis Peritoneal Dialysis Mechanism Blood pumped through dialyzer outside body. Dialysate instilled into peritoneal cavity. Membrane Used Artificial semipermeable membrane. Peritoneal membrane. Invasiveness Requires vascular access. Requires peritoneal catheter. Session Duration 3–4 hours, 3 times/week. Several exchanges daily or overnight cycles. Case Progression and Interventions State 1 – Initial Postoperative Decline Interventions: State 2 – Deterioration State 3 – Pre-Dialysis State 4 – Post-Dialysis Improvement References American Nephrology Nurses Association. (2021). Nephrology nursing standards of practice and guidelines for care. ANNA. Bellomo, R., Kellum, J. A., & Ronco, C. (2019). Acute kidney injury. The Lancet, 394(10212), 1949–1964. https://doi.org/10.1016/S0140-6736(19)32563-2 Khwaja, A. (2012). KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice, 120(4), c179–c184. https://doi.org/10.1159/000339789 National Institute for Health and Care Excellence. (2019). Acute kidney injury: Prevention, detection and management. NICE Guideline NR 325 Week 3 Acute Kidney Injury CAE PNCI Medical Surgical [NG148]. https://www.nice.org.uk/guidance/ng148 Palevsky, P. M. (2020). Acute kidney injury: Epidemiology, outcomes, diagnosis, and management. UpToDate.

Student Name Chamberlain University NR-325 Adult Health II Prof. Name Date Week 2 Clinical Reflection Clinical Experience Overview This week’s clinical rotation provided an enriching and eye-opening experience that significantly contributed to my growth as a nursing student. One of the most memorable encounters involved caring for a patient with a complex medical history. Observing how her previous conditions interconnected and influenced her post-surgical recovery was particularly enlightening. Although the surgery was initially considered successful, her pre-existing conditions introduced new challenges. The patient had a history of atrial fibrillation, which resulted in an elevated heart rate. Additionally, despite never requiring supplemental oxygen at home, she became oxygen-dependent following surgery due to persistent difficulty in maintaining adequate SpO₂ levels. This situation underscored the importance of understanding the interplay between chronic health conditions and surgical outcomes. Collaborative Learning and Nursing Responsibilities My assigned nurse this week was exceptionally supportive and eager to provide guidance. She encouraged me to shadow her throughout the day, allowing me to participate in a variety of patient care activities. These included bathing a patient, facilitating a patient discharge, and transferring a patient between rooms. I also had the opportunity to observe and assist with medication administration, including collaborating with another nurse for medication discharge procedures. Additionally, we set up a patient-controlled analgesia (PCA) pump, which required a second nurse’s verification to ensure the accuracy of dosing—a critical safety measure. NR 325 Week 2 Clinical Reflection The following table summarizes the key tasks performed and the skills practiced during this week’s clinical experience: Task/Activity Description Skills/Competencies Gained Bathing a patient Assisted with personal hygiene and comfort measures Patient dignity, hygiene protocols, time management Discharging a patient Facilitated the discharge process, including paperwork and patient education Communication skills, discharge teaching, collaboration with healthcare team Transferring a patient Moved a patient from one room to another Patient safety, proper transfer techniques, teamwork Assisting with medication discharge Collaborated with another nurse to verify and prepare medications for discharge Medication safety, legal compliance, attention to detail Setting up a PCA pump Prepared and programmed PCA pump with another nurse’s co-signature Pain management protocols, device operation, double-check procedures Taking vital signs and assessments Measured vitals and performed head-to-toe assessment Clinical assessment skills, prioritization, patient observation Building Patient Relationships One of the highlights of the week was developing a strong rapport with my assigned patient. Forming meaningful relationships with patients had initially been one of my greatest fears. However, this week demonstrated that genuine connection is possible when active listening, empathy, and consistent presence are prioritized. By the end of the week, I felt more confident engaging with patients and providing care with compassion and professionalism. Growth in Clinical Confidence During my first week, I often felt uncertain and somewhat disoriented while navigating the unit. However, this week brought a noticeable increase in confidence and willingness to take initiative. I successfully performed a head-to-toe assessment and accurately measured vital signs, which previously felt daunting. This experience highlighted the significant difference between theoretical learning and hands-on clinical practice. While skills taught in a classroom setting are valuable, applying them in a real healthcare environment fosters a deeper understanding and adaptability. Tasks such as head-to-toe assessments, which initially seemed overwhelming, became more intuitive once performed in a live clinical setting. Reflection on Clinical Learning Clinical practice offers an invaluable opportunity to discover one’s passion for nursing. Unlike simulated learning environments, in-person clinical work provides immediate feedback, real-world problem-solving opportunities, and exposure to the complexities of patient care. Even seemingly simple tasks require thoughtful consideration when performed in a hospital setting, as they are often influenced by patient-specific needs and conditions. References American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). ANA. Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2021). Medical-surgical nursing: Concepts for interprofessional collaborative care (10th ed.). Elsevier. NR 325 Week 2 Clinical Reflection Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2023). Fundamentals of nursing (11th ed.). Elsevier.

Student Name Chamberlain University NR-325 Adult Health II Prof. Name Date Diabetes Insipidus (DI) – Posterior Pituitary Disorder Diabetes insipidus is a disorder characterized by decreased production, secretion, or renal response to antidiuretic hormone (ADH), leading to the excretion of large amounts of dilute urine. There are two primary types: Table 6 Diabetes Insipidus: Summary of Key Points Aspect Details Etiology / Pathophysiology Central DI: head trauma, neurosurgery, CNS infections, tumors. Nephrogenic DI: renal disease, drug toxicity (lithium). Deficiency or insensitivity to ADH results in inability to concentrate urine. Clinical Manifestations Polyuria (5–20 L/day), polydipsia, nocturia, low urine specific gravity (<1.005), dehydration, hypernatremia (confusion, irritability). Diagnostic Tests Water deprivation test (failure to concentrate urine confirms DI); serum and urine osmolality; response to desmopressin distinguishes central from nephrogenic DI. Nursing Interventions Strict I&O monitoring; daily weights; ensure adequate fluid intake; desmopressin (DDAVP) for central DI; thiazide diuretics and low-sodium diet for nephrogenic DI. Complications Severe dehydration, hypovolemic shock, hypernatremia; treat promptly with fluid replacement and ADH analogs. Hyperthyroidism / Goiter Hyperthyroidism involves excessive production of thyroid hormones (T3 and T4), resulting in increased metabolic rate and heightened sympathetic nervous system activity. Graves’ disease is the most common cause, often accompanied by goiter and ophthalmopathy (exophthalmos). Table 7 Hyperthyroidism: Summary of Key Points Aspect Details Etiology / Pathophysiology Graves’ disease (autoimmune stimulation of TSH receptors); toxic multinodular goiter; thyroiditis; excess iodine; pituitary adenomas. Clinical Manifestations Weight loss despite increased appetite, heat intolerance, tremors, palpitations, tachycardia, goiter, exophthalmos, anxiety, insomnia, brittle hair. Diagnostic Tests Low TSH, elevated free T4; radioactive iodine uptake (RAIU) differentiates Graves’ disease from thyroiditis; ECG for arrhythmias. Nursing Interventions Antithyroid drugs (methimazole, PTU); beta-blockers for symptom control; radioactive iodine therapy; thyroidectomy in severe cases; eye protection for exophthalmos. Complications Thyrotoxic crisis (thyroid storm), heart failure, atrial fibrillation, osteoporosis; treat with supportive care and aggressive antithyroid therapy. Hypothyroidism Hypothyroidism results from insufficient thyroid hormone production. It can be primary (thyroid gland dysfunction), secondary (pituitary failure to secrete TSH), or tertiary (hypothalamic dysfunction). Table 8 Hypothyroidism: Summary of Key Points Aspect Details Etiology / Pathophysiology Hashimoto’s thyroiditis (autoimmune destruction), iodine deficiency, thyroid surgery, radioactive iodine therapy, pituitary or hypothalamic disease. Clinical Manifestations Fatigue, weight gain, cold intolerance, constipation, dry skin, hair loss, bradycardia, depression, myxedema (severe). Diagnostic Tests Primary: elevated TSH, low free T4; Secondary: low TSH and low T4; lipid profile may show hypercholesterolemia. Nursing Interventions Lifelong levothyroxine therapy; start low dose in older adults; monitor for cardiac effects; patient education on adherence. Complications Myxedema coma (medical emergency) with hypothermia, hypotension, hypoventilation; requires IV thyroid hormone and supportive care. Hyperparathyroidism Excess parathyroid hormone (PTH) causes hypercalcemia and hypophosphatemia due to increased bone resorption, renal calcium reabsorption, and intestinal calcium absorption. Table 9 Hyperparathyroidism: Summary of Key Points Aspect Details Etiology / Pathophysiology Primary: parathyroid adenoma. Secondary: chronic kidney disease, vitamin D deficiency. Clinical Manifestations Bone pain, muscle weakness, kidney stones, polyuria, constipation, depression. Diagnostic Tests Elevated serum calcium, low phosphate, elevated PTH; bone density scan. Nursing Interventions Hydration to prevent stones; bisphosphonates to inhibit bone resorption; parathyroidectomy for primary disease; monitor calcium post-op. Complications Osteoporosis, fractures, nephrolithiasis, cardiac dysrhythmias. Hypoparathyroidism Deficient PTH secretion results in hypocalcemia and hyperphosphatemia, often after thyroid or parathyroid surgery. Table 10 Hypoparathyroidism: Summary of Key Points Aspect Details Etiology / Pathophysiology Surgical removal or damage to parathyroid glands; autoimmune destruction; genetic syndromes. Clinical Manifestations Tetany, muscle cramps, paresthesia, positive Chvostek’s and Trousseau’s signs, laryngospasm. Diagnostic Tests Low calcium, high phosphate, low PTH; ECG may show prolonged QT interval. Nursing Interventions Administer IV calcium gluconate for acute hypocalcemia; oral calcium and vitamin D supplementation; seizure precautions. Complications Laryngospasm, seizures, cardiac arrhythmias. Cushing’s Syndrome Cushing’s syndrome results from chronic exposure to excess corticosteroids, most commonly glucocorticoids. Table 11 Cushing’s Syndrome: Summary of Key Points Aspect Details Etiology / Pathophysiology Exogenous corticosteroid use; ACTH-secreting pituitary adenoma (Cushing’s disease); adrenal tumors; ectopic ACTH production. Clinical Manifestations Central obesity, moon face, buffalo hump, purple striae, muscle weakness, osteoporosis, hyperglycemia, mood changes. Diagnostic Tests 24-hour urinary cortisol; dexamethasone suppression test; CT/MRI of pituitary/adrenals. Nursing Interventions Taper corticosteroids if drug-induced; surgery or radiation for tumors; monitor glucose, electrolytes, infection signs. Complications Hypertension, diabetes mellitus, infections, fractures. Addison’s Disease (Adrenocortical Insufficiency) Addison’s disease is a chronic deficiency of adrenal cortex hormones (glucocorticoids, mineralocorticoids, and androgens). Table 12 Addison’s Disease: Summary of Key Points Aspect Details Etiology / Pathophysiology Autoimmune destruction (most common in developed countries); infections (TB, HIV); metastatic cancer; abrupt withdrawal of corticosteroids. Clinical Manifestations Fatigue, weight loss, hyperpigmentation, hypotension, hyponatremia, hyperkalemia, hypoglycemia. Diagnostic Tests Low cortisol levels; ACTH stimulation test; electrolyte imbalances; CT/MRI of adrenal glands. Nursing Interventions Lifelong corticosteroid and mineralocorticoid replacement; stress-dose steroids during illness; carry medical alert bracelet. Complications Addisonian crisis (shock, severe hypotension, electrolyte imbalance); treat with IV hydrocortisone and fluids. Hyperaldosteronism Excess aldosterone secretion causes sodium retention, potassium loss, and metabolic alkalosis. Table 13 Hyperaldosteronism: Summary of Key Points Aspect Details Etiology / Pathophysiology Primary: adrenal adenoma. Secondary: renal artery stenosis, heart failure, cirrhosis. Clinical Manifestations Hypertension, hypokalemia (muscle weakness, arrhythmias), metabolic alkalosis. Diagnostic Tests Elevated aldosterone, low renin levels; CT/MRI of adrenals. Nursing Interventions Adrenalectomy for adenomas; spironolactone to block aldosterone; BP monitoring. Complications Stroke, myocardial infarction, arrhythmias. Pheochromocytoma A rare tumor of the adrenal medulla producing excess catecholamines (epinephrine and norepinephrine). Table 14 Pheochromocytoma: Summary of Key Points Aspect Details Etiology / Pathophysiology Adrenal medullary tumor; may be part of genetic syndromes (MEN type 2). Clinical Manifestations Episodic hypertension, severe headaches, palpitations, sweating, tremors, anxiety. Diagnostic Tests Elevated plasma and urinary metanephrines; CT/MRI for tumor localization. Nursing Interventions Alpha-adrenergic blockade pre-surgery; beta-blockers after alpha-blockade; adrenalectomy; avoid palpating tumor. Complications Hypertensive crisis, stroke, arrhythmias, death. References Ross, D. S., & Burch, H. B. (2022). Evaluation and management of thyrotoxicosis. The New England Journal of Medicine, 387(10), 893–906. https://doi.org/10.1056/NEJMra2032456 American Diabetes Association. (2024). Standards of medical care in diabetes—2024. Diabetes Care, 47(Supplement_1), S1–S154. https://doi.org/10.2337/dc24-SINT NR 325 Week 1 Endocrine Disorders – Worksheet Funder, J. W., Carey, R. M., Mantero, F., Murad, M. H., Reincke, M., Shibata, H., … & Young,