Widespread crepitations on chest auscultation

Part B GuidelineCase based written assignment: 50% consisting of 2 componentsPart A due 11/3/18 midnight 10%- I have completed it and submitted.Part B due 18/4/18 midnight 40%I have done part A already and explained clinical reasoning cycle first three steps.In part B need to explain other all parts of the clinical reason cycle and care plan for presenting case situation of the patient see below. I will attach part A tomorrow for guide.
Just for clarification of PART B assignment.No introduction or conclusion required.Pathophysiology in paragraphs and need referencing.Care plan should be in template/table with headings ofNursing diagnosis 5- goal (short term and long term)-interventions-rationales and evaluation.
Reflection is to be done in a paragraph at the end
M.G, a 68 year old female with frequent hospital presentations is admitted from the emergency department (ED) with a diagnosis of congestive heart failure (CCF). She was discharged from the hospital 11 days ago (March 12th 2018) and comes in today stating, “I just had to come to the hospital today because I can’t catch my breath, my legs are as big as tree trunks and I am having difficulty walking.” After further questioning, you learn she has not been strictly following the fluid and salt restriction ordered during her last hospital admission and has not been compliant with her medication. You note that she has gained 5 kgs since her discharge.Past medical history:HTAMI 4 years agoChronic renal failureType 2 Diabetes MellitusHyperlipidaemiaFamily HistoryMother, died at age 65 years of CVAFather, died at age 67 years of acute myocardial infarction (AMI)Sister, alive and well, age 62 yearsBrother, alive, age 70 years, has coronary artery disease, HTN, type II diabetes mellitus (DM)Patient Past HistoryMarried for 45 years, two children, alive and well, six grandchildrenCholecystectomy, age 42 years Hysterectomy, age 48 yearsRecent Blood Pressure Assessments:January 2: 150/92January 31: 156/94 (commenced on hydrochlorothiazide [HCTZ] 25 mg PO daily)February 28: 140/90Current observations: P 122 irregular, BP 160/100, RR 26, T 37.3 C O2 Sats 93% on room air.Widespread crepitations on chest auscultation. Sweaty. Chest X Ray shows widespread consolidation and cardiomegaly.Atrial Fibrillation on ECG newly diagnosed. Apical pulse is fast and thready.Skin colour is pink. Oedema present ++Nursing Assessment:Prescribed Medications:Captopril 25mg PO dailyHydrochlorothiazide [HCTZ] 25 mg PO every morning)Enalapril (Vasotec) 5 mg PO BDFurosemide (Lasix) 40 mg/ twice daily POPotassium chloride 20 mEq/day POLaboratory Test Results (Fasting)Potassium 5.3 mEq/LSodium 145 mEq/LChloride 100 mEq/LBicarbonate 27 mEq/LGlucose 11.2 mmolCreatinine 4.5 mg/dLBUN 43 mg/dLMagnesium 1.9 mEq/Radiology ResultsCXR shows cardiomegaly and pulmonary congestion ++
This assignment consists of two parts.Please read the following instructions carefully.
NSG2101:   Case based written Assignment
Part A: Due end week 4 – Sunday 2330- March 11th 2018Assignment weighting: 10%Word limit: unspecifiedFor the given case study, design a concept map and work through EACH of steps 1-3 of the clinical reasoning cycle to demonstrate an understanding for the physiology presented in the case study.Part B: Due end week 8 -Sunday 2330- April 18th 2018Assignment weighting: 40%Word limit: 1500 words- its included part A as wellUsing your work from Part A, DISCUSS the comprehensive care of this patient incorporating each of the above learning outcomes. Identify three (5) PRIORITISED nursing problems. For EACH nursing problem, DESCRIBE the specific nursing activities, goals, rationales, and evaluations that you would incorporate when caring for this patient. Using evidence-based practice, research your interventions to ensure best practice in your nursing care.

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