Discuss how you will manifest the Role

Discuss how you will manifest the Role of a Nurse Practitioner. (40 pts) Formulate Rehabilitation Plan following the correct format. (60pts) Problem Action/Strategies Person Responsible Resources Evaluation Indicators Case Scenario I Mrs. Ramirez is an 80 year old woman with Rheumatoid Arthritis. Her daughter, with whom she resides, drove her to the hospital due to dizziness, shortness of breath and chest pain. She is poor historian but her daughter relates that her symptoms have been occurring with increasing frequency over the past 2 weeks. Questioning reveals that Mrs. Ramirez has smoked 2 packs of cigarettes a day for the past 60 years, has a history of coronary disease and has been taking corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) for the management of her rheumatoid arthritis. Hospital records reveal that she was hospitalized 3 months ago for kidney infection. Her infection was treated with antibiotics and she was discharged to home without further complications. On physical examination, Mrs. Ramirez lungs are clear upon auscultation. Respiration is unlabored but rapid. No dysrhythmias are noted and her ECG is normal although her pulse is weak. Nail beds are pale and capillary refill is sluggish. Her skin is pale, cool and dry. Her heart sounds are audible and no murmurs or gallops are present. She is alert and cooperative. She states that her chest pain occurs with exertion which she describes as brisk walking and climbing stairs. Her abdomen is soft and non tender, bowel sounds are hyperactive and rectal examination reveals tarry-colored stool that has become black tarry stool after several weeks which she thought started after she began taking iron supplements. She also share that she has been having burning abdominal pain precipitated by eating food for the past 2 weeks. Blood work reveals the following: Complete Blood Count WBC 4500 uL Hgb 8.2 g/dL Hct 26.6% Plt 276,000 uL Coagulation studies are all within normal limits. Arterial Blood Gas pH 7.37 PaO2 70 PaCO2 43 O2 saturation 96 % on 4L of oxygen per nasal cannula Vital signs as follows Lying Sitting BP : 130/70 110/50 HR: 110 130 Respiration: 24 28 Temp: 98.5F 98.5F An upper endoscopy is performed on Mrs. Ramirez, which reveals a large gastric ulcer. The ulcer appears to be oozing blood. This finding is compatible with her reports of pain following eating, her tarry stools and her low hematocrit. She is diagnosed with Peptic Ulcer Disease and Gastric Ulcer. SCIENCE HEALTH SCIENCE NURSING CNM NCM

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