DIAGNOSIS LIST: Chronic renal failure with dialysis via av fistula Diabetes Type II Dementia (MMSE 19/30) Peripheral edema Chronic ulcers lower extremities Hypertension MEDICATION LIST: Zofran prn Sliding scale Humalog prior to meals Lantus 10units bid Namenda 10mg qd Renavite qd Lasix 40mg bid BACKGROUND INFORMATION: Patient is a 68 year old, Hispanic, female

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DIAGNOSIS LIST:

• Chronic renal failure with dialysis via av fistula
• Diabetes Type II
• Dementia (MMSE 19/30)
• Peripheral edema
• Chronic ulcers lower extremities
• Hypertension

MEDICATION LIST:

• Zofran prn
• Sliding scale Humalog prior to meals
• Lantus 10units bid
• Namenda 10mg qd
• Renavite qd
• Lasix 40mg bid

BACKGROUND INFORMATION:

Patient is a 68 year old, Hispanic, female. Speaks primarily Spanish, knows only broken English.  She has been a dialysis patient for over 10 years.  Most recently it has been more difficult for dialysis to maintain proper fluid status post dialysis.  She has also been experiencing severe nausea upon return which affects her eating habits for the day.  She has been sent out to the hospital from the nursing home where she lives three times in the last month upon return from dialysis due to being unresponsive, hypotensive, and once for hypoglycemia.  She has had a progressive decline in mobility and at this time does not even like to get out of bed, sleeping most of the day.  Today upon return from dialysis it was noted that the nephrologist is recommending a discontinuation of dialysis treatments.  Her daughter is very involved in her care and visits daily.  Labs:  CBG range: 34-280 prior to meals, k+ 2.8, BUN 58, creat 1.8.  She remains a full code at this time.  

Paragraph form #1:

Complete research on the role of the nurse in this case. Provide the findings of your research: educational requirements of this role, complete job description, their specific role in patient-centered care (Holistic Care). 

Paragraph form #2:

Include a paragraph on the role of the patient's NURSE, followed by the initial presentation of the plan of care (include assessment data, Goals/Outcomes, Interventions, Rationale, Evaluation & replanning process), questions for two other interprofessional team members:  PCP, Social Worker, Dietitian and family from the perspective of the NURSE.  These questions are case-specific for social, legal, ethical, or economic elements that need addressed. Two questions posed to team (one for each of two other roles above) clearly asking a question to improve the inter-professional team collaborative effort.  You are presenting the plan from the perspective of the nurse, but in the paragraph, it should be clear that you know the roles of others and that you know how to utilize the members of the team for the best outcomes for your patient.

Think critically about this patient's situation and all parties that should be involved from the mindset of the role of the nurse. Please look at this holistically and patient-centered, within the role of the nurse. Present questions to the other interprofessional team members and present interventions, support, actions, suggestions, ideas, etc. to the team. Are there other disciplines that should be involved in this case? How can this team proceed to optimize positive patient outcomes?