NR 452 Capstone Simulation Paper

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Simulation Capstone: Prioritizing Patient Care

During this simulation, two clients, Maria Hernandez and Keola Akana, require care and assessment. Maria Hernandez is an 81-year-old female who presents with altered mental status and abnormal vital signs, potentially indicating a urinary tract infection. Her daughter reports decreased intake of food and fluids. On the other hand, Keola Akana, a 71-year-old male with acute left-sided heart failure, has gained seven pounds in the past two days. Determining the order of priority for assessing these patients is crucial.

Considering the presented cases, the first patient to be seen would be Maria Hernandez, with an altered mental status. This initial assessment serves as an introduction during the change of shift. Once this is completed, the nurse can prioritize Keola Akana’s evaluation due to his critical condition and the need to identify any additional indicators impacting his health.

NR 452 Capstone Simulation Paper

To assess Keola Akana’s left-sided heart failure, the nurse would introduce themselves to the patient, inform him about the shift change, and seek permission to conduct the assessment. Critical priority assessments for left-sided heart failure include observing increased heart rate, crackles indicating pulmonary edema, restlessness, confusion, abnormal heart sounds such as S3 and S4, alternating pulses, dyspnea, cough, and low saturation levels. If any of these indicators are present, they support the diagnosis of left-sided heart failure. Conversely, findings such as ascites, weight gain, hepatomegaly, jugular vein distention, or generalized edema suggest a right-sided heart failure episode (Lewis, Dirksen, Heitkemper & Bucher, 2014).

Once the assessment is complete, the nurse will document the findings and consult the doctor for medication orders. Two standard medications for left-sided heart failure are loop diuretics and ACE inhibitors. When administering medications from these classes, the nurse must monitor the patient’s sodium levels and fluid status due to the diuretic’s effect of flushing out sodium and fluids. Additionally, blood pressure should be closely monitored as a combination of loop diuretics and ACE inhibitors (Lewis, Dirksen, Heitkemper & Bucher, 2014).

NR 452 Capstone Simulation Paper

Overall, the prioritization of patient care in this simulation emphasizes the importance of promptly addressing the altered mental status of Maria Hernandez and conducting a comprehensive assessment for Keola Akana’s left-sided heart failure, enabling appropriate interventions and treatment decisions.

Cultural Differences Impact on Nursing

After administering medications to alleviate the symptoms of heart failure, the nurse should assess the patient’s readiness to consume food. However, before proceeding, the nurse must inquire about the patient’s dietary preferences and restrictions. These considerations may stem from the patient’s heart failure, prescribed medications, and cultural background. While there exists a general food pyramid outlining recommended dietary guidelines, cultural preferences often influence individuals’ ability to adhere to these recommendations. Recognizing this, the nurse should gather information about cultural factors impacting the patient’s dietary choices.

Understanding the patient’s cultural background will help the nurse tailor the nutritional plan. Certain cultures may have dietary staples or preparation methods that differ from the conventional food pyramid. This awareness enables the nurse to provide appropriate nutritional options that align with the patient’s cultural preferences while considering their health condition. Respecting and incorporating cultural values regarding food choices is essential to promote optimal nutrition and patient satisfaction.

In healthcare settings like hospitals or long-term care facilities, patients may face limited food choices that may not align with their cultural preferences. This can challenge ensuring adequate nutrition for individuals with specific cultural dietary requirements.


Considering these two clients’ unique needs and conditions, it is evident that their care requirements differ significantly. However, irrespective of their specific medical conditions, both patients can benefit from education and guidance on self-care practices to maintain their overall health. While it may initially appear challenging, patients can successfully engage in self-care routines with effort and support.

Ensure and support systems are crucial in helping them manage their health effectively. It is important to anticipate potential difficulties patients may face in adhering to their self-care regimens. If any indications suggest that patients struggle with maintaining their health, appropriate resources can be provided to assist them. These resources can offer guidance, answer questions, and address any concerns related to their health.


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