NRS 455 Benchmark – Case Study: Mr. D. Assessment

Directions: Read the case study below. Evaluate the information and formulate a conclusion based on your evaluation. Complete the critical thinking table and submit this completed template to the assignment dropbox.

Case Study: Mr. D.

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It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. D., presented below.

Health History and Medical Information

Mr. D. is a 65-year-old male nonadherence diabetic with end-stage renal disease receiving dialysis. He is a retired certified public accountant in the last 5years and practices the Muslim faith. He reports that he avoids all pork products. His complaints included decreased balance, loss of sensation, fear of falling, and decreased endurance during activities of daily living due to the effects of dialysis treatment. Patient’s previous medical evaluation includes end stage renal disease (ESRD) on dialysis and referral for recommendations for initiating exercise program. Patient comorbidities include obesity with a body mass index (BMI) of 45, type II diabetes mellitus with long-term insulin use, hypertension, sleep apnea, depression with lack of family support and understanding, and diabetic neuropathy. Patient denies suicidal ideation but does report feelings of loneliness and helplessness. Mr. D. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.

Objective Data:

Height: 68 inches; weight 134.5 kg
BP: 140/94, HR 84, RR 22
2+ pitting edema bilateral feet and ankles
Fasting blood glucose: 146 mg/dL
Total cholesterol: 250 mg/dL
Triglycerides: 312 mg/dL
HDL: 30 mg/dL
Serum creatinine 1.8 mg/dL
BUN 32 mg/dl
GRF (glomerular filtration rate)-13mL/min

Clinical Manifestations

Describe the clinical manifestations present in Mr. D., focusing on the normal and abnormal findings and how this relates to his current condition.

Subjective

Mr. D has the following subjective findings:

Decreased balance

Loss of sensation

Decreased activity endurance

Feelings of loneliness and helplessness

Exertional dyspnea

Sleep apnea

Ankle edema

Pruritus

Objective

Mr. D has the following objective findings

Risk of fall

Morbid Obesity:BMI-46.4

Tachypnea

High blood pressure-140/94

Bilateral 2+ pitting ankle and feet edema

Hyperlipidemia

Hyperglycemia

Elevated creatinine and BUN levels

Decreased glomerular filtration rate (GFR)

Potential Health Risks for Diabetes WithEnd-Stage Renal Disease

Identify the potential health risks for a diabetic with ESRD and the impacts of nonadherence.

Identify the potential health risks for a diabetic with end-stage renal disease (ESRD) that are of concern for Mr. D.

Mr. D has a medical history of Type II Diabetes and ESRD, which puts him at risk of various health risks.

Coronary heart disease: This is a significant health risk of ESRD and diabetes. Mr. D has obesity, hyperlipidemia, and HTN, which further increases the risk for Coronary heart disease.

Metabolic Acidosis: Mr. D is at risk of developing Metabolic Acidosis caused by the accumulation of phosphates, sulfates, and other organic anions that cause an increase in the anion gap (Zheng et al., 2020).

Hyperkalemia: Mr. D is at risk of hyperkalemia, which develops when GFR falls below 20-25 mL/min, as the kidneys’ ability to excrete potassium decreases (Zheng et al., 2020).

How does Mr. D.’s nonadherence to his diabetes self-management plan for DM Type II contribute to ESRD?

Non-adherence to diabetic medication contributes to impaired blood glucose control, which leads to long-term hyperglycemia. Mr. D’s failure to adhere to his medications led to impaired glucose metabolism with constant hyperglycemia, resulting in insulin resistance (Zheng et al., 2020). Insulin resistance is linked with abnormal insulin sensitivity, which contributes to kidney failure.

Describe the common considerations with insulin use for practicing Muslims.

The primary care provider (PCP) of a practicing Muslim patient should consider the ritual fasting that Muslims observe during Ramadan. The PCPC should plan for the patient’s care to establish if one can fast and how the blood glucose levels can be managed during the fasting period (Ahmed et al., 2020).

For the practicing Muslim, the PCP should consider the following when planning for the patient’s care: Glycemic status; Complications and other comorbidities that may be worsened by prolonged fasting like CKD and Heart conditions; The patient’s diet and meal plan; Possible risks of dehydration and electrolyte imbalance (Ahmed et al., 2020).

Furthermore, the PCP should plan whether the patient can fast by assessing renal and hepatic functions, electrolyte imbalance, and infections.

Pathophysiology of Renal Dialysis

Explain the pathophysiology of renal dialysis.

Explain the pathophysiology of renal dialysis.Compare peritonealdialysis and hemodialysis.

Renal dialysis replaces the non-endocrine function of the kidney in patients with renal failure. The modalities used in renal dialysis are continuous hemofiltration and hemodialysis, intermittent hemodialysis, and peritoneal dialysis. These modalities exchange serum solutes and remove fluid from the blood through dialysis and filtration across a permeable membrane (Thajudeen et al., 2023).

During renal dialysis, the serum solute diffuses passively between fluid compartments down a concentration gradient, which is termed diffusive transport. During filtration, the serum water passes between compartments down a hydrostatic pressure gradient, drawing solute with it through convective transport. The two processes are usually used together in a process called hemodiafiltration (Thajudeen et al., 2023).

Hemodialysis entails passing a patient’s blood through an artificial semi-permeable membrane, which takes over the kidney’s filtering and excretion functions.

On the other hand, peritoneal dialysis uses the peritoneum as a natural permeable membrane through which water and solutes can equilibrate (Thajudeen et al., 2023). Unlike hemodialysis, peritoneal dialysis is less physiologically stressful and does not need vascular access.

Describe in detail the pathophysiological explanation and stages of renal disease that leads to ESRD.

ESRD is a terminal disease state characterized by a GFR below 15 mL/min. Patients with chronic renal failure undergo five stages that lead to ESRD.

Stage 1- Kidney damage with normal GFR > 90 ml/min.

Stage 2- Mild reduction in GFR 60-89 ml/min.

Stage 3a- Moderate reduction in GFR 45-59 ml/min

Stage 3b- Decreased GFR 30-44 ml/min

Stage 4- Severe reduction in GFR, 15-29 ml/min.

Stage 5 –Renal failure with GFR < 15 ml/min.

Explain the potential factors that contributed to Mr. D.’s ESRD.

The factors that may have contributed to ESRD in Mr. D include:
Age (65 years): Advanced age is a risk factor for ESRD.

Obesity

Hyperlipidemia

Systemic hypertension

Uncontrolled diabetes

Elevated serum creatinine level

Functional Health Problems

Evaluate of Mr. D.’s functional health patterns.

Evaluate each of Mr. D.’s functional health patterns using the information given.

Value/Belief Pattern: Mr. D observed Islamic religious beliefs and practices.

Health Perception/Management: The patient ineffectively manages diabetes and fails to adhere to medication.

Nutrition/Metabolic: The patient has morbid obesity, hyperlipidemia, and pruritus.

Elimination: Impaired kidney function with ESRD and a GFR of 13mL/min.

Activity/Exercise: Reports reduced tolerance to activity and exertional dyspnea.

Sleep/Rest: Reports of sleep apnea affecting the quality of sleep.

Cognitive/Perceptual: Reports impaired balance and loss of sensation.

Self-Perception/Self-Concept: Positive feelings of loneliness and helplessness.

Role/Relationship: Lack of family support and understanding.

Sexuality/Reproductive: Reduced tolerance to activity intolerance may affect the patient’s sexual activity and quality of sex.

Coping/Stress: Lack of family support could be contributing to stress and depression.

Discuss at least five actual or potential problems you can identify from the “Functional Health Patterns Assessment Guide,” located in the Topic 3 Resources. Provide a rationale for each.

Activity-Exercise Pattern: The patient has reduced activity tolerance attributed to a reduced blood supply to the myocardium, as evidenced by reports of increased shortness of breath with activity and decreased activity endurance

Nutritional-metabolic Pattern: Altered nutrition, more than body requirements related to a mismatch between energy intake and energy expenditure, as evidenced by morbid obesity.

Sleep-Rest Pattern: Disturbed sleep pattern related to reduced lung capacity secondary to obesity, as evidenced by sleep apnea.

Coping/Stress Pattern: Suicidal risk related to a history of depression. The patient reports feelings of loneliness, helplessness, and lack of family support, which put him at risk of suicide.

Elimination Pattern: The patient has impaired urinary elimination related to impaired kidney function. The patient has elevated BUN and creatinine levels, which indicate kidney failure.

Nursing Health Management and Health Promotion

Provide ESRD nursing management and health promotion opportunities.

Nursing management for Mr. D will include

Fluid restriction is to attain fluid balance and prevent fluid overload complications. The nurse should monitor the patient’s intake and output and hydration status and assess for signs of fluid overload. Besides, the nurse should assess the patient’s fluid status by obtaining daily weights (Elendu et al., 2023).

The nurse should administer the prescribed medications for this patient.

Patients with kidney impairment are often prescribed diuretics to manage fluid retention and control blood pressure.

Monitoring vital signs, including BP, respirations, heart rate, and temperature. Systolic and diastolic BP and peripheral pulses can be used to assess cardiac output (Elendu et al., 2023).

The nurse should teach the patient to measure his BP daily and identify abnormal findings.

The nurse should collaborate with a dietitian to assess Mr. D’s nutritional needs. This includes teaching the patient and evaluating his understanding of and adherence to dietary plans (Elendu et al., 2023).

Develop a patient education plan for ESRD that could be offered to Mr. D. for prevention of future events, health restoration, and maintaining renal status.

The patient education plan for Mr. D, with regard to the ESRD condition, will include the following:

Lifestyle modification includes increasing physical activity and decreasing caloric intake to promote weight loss, lower cholesterol levels, and attain optimal blood pressure and blood glucose levels (Chen et al., 2023).

Moderate aerobic and muscle-strengthening exercises should be recommended to improve cardiovascular health, lower blood pressure, and promote weight loss.

Dietary restrictions include adopting a low-sodium diet to lower BP. The patient should be instructed to limit daily protein intake to slow the GFR decline and improve proteinuria (Kim & Jung, 2020).

Education on a renal diet. Mr. D should be educated about the renal diet by avoiding foods high in phosphorus (Kim & Jung, 2020).

Education on avoiding nephrotoxic medications like NSAIDs and aminoglycosides (Chen et al., 2023).

Assume Mr. D. lives in your community. Include community resources and supportive care available for Mr. D. for ESRD care and management at home.

The community resources and supportive care available in my community for Mr. D include

Dialysis locator services

Transplant resources

Community education programs on ESRD, hypertension management, and kidney transplantation

Discuss the nurse’s role in using the holistic multidisciplinary care approach that would be safe and effective for patients like Mr. D., including aspects such as devices, transportation, eligibility for transplant, living conditions, promotion of resiliency, and independence.

As a member of the multidisciplinary team, the nurse has the role of planning, coordinating, and evaluating the patient’s care. The nurse collaborates with the dietitian and social worker to evaluate the patient’s home environment and determine equipment needs before discharge (Ng et al., 2023).

The nurse should provide psychological support for the patient and family and refer them to a psychologist for psychological counseling.

Mr. D may require social services due to the complex process of applying for financial aid to pay for ESRD medical care. Thus, the nurse should collaborate with the social worker to identify these social services and refer the patient (Ng et al., 2023).

References

Ahmed, S. H., Chowdhury, T. A., Hussain, S., Syed, A., Karamat, A., Helmy, A., Waqar, S., Ali, S., Dabhad, A., Seal, S. T., Hodgkinson, A., Azmi, S., & Ghouri, N. (2020). Ramadan and diabetes: A narrative review and practice update. Diabetes Therapy, 11(11), 2477-2520. https://doi.org/10.1007/s13300-020-00886-y

Chen, T. K., Hoenig, M. P., Nitsch, D., & Grams, M. E. (2023). Advances in the management of chronic kidney disease. BMJ (Clinical Research ed.), 383, e074216. https://doi.org/10.1136/bmj-2022-074216

Elendu, C., Elendu, R. C., Enyong, J. M., Ibhiedu, J. O., Ishola, I. V., Egbunu, E. O., Meribole, E. S., Lawal, S. O., Okenwa, C. J., Okafor, G. C., Umeh, E. D., Mutalib, O. O., Opashola, K. A., Fatoye, J. O., Awotoye, T. I., Tobih-Ojeanelo, J. I., Ramon-Yusuf, H. I., Olanrewaju, A., Afuh, R. N., Adenikinju, J., … Yusuf, A. (2023). Comprehensive review of current management guidelines of chronic kidney disease. Medicine, 102(23), e33984. https://doi.org/10.1097/MD.0000000000033984

Kim, S. M., & Jung, J. Y. (2020). Nutritional management in patients with chronic kidney disease. The Korean Journal of Internal Medicine, 35(6), 1279–1290. https://doi.org/10.3904/kjim.2020.408

Ng, M. S. N., Brown, E. A., Cheung, M., Figueiredo, A. E., Hurst, H., King, J. M., Mehrotra, R., Pryor, L., Walker, R. C., Wasylynuk, B. A., & Bennett, P. N. (2023). The Role of Nephrology Nurses in Symptom Management – Reflections on the Kidney Disease: Improving Global Outcomes Controversies Conference on Symptom-Based Complications in Dialysis Care. Kidney International Reports, 8(10), 1903–1906. https://doi.org/10.1016/j.ekir.2023.08.025

Thajudeen, B., Issa, D., & Roy-Chaudhury, P. (2023). Advances in hemodialysis therapy. Faculty Reviews, 12, 12. https://doi.org/10.12703/r/12-12

Zheng, L., Chen, X., Luo, T., Ran, X., Hu, J., Cheng, Q., Yang, S., Wu, J., Li, Q., & Wang, Z. (2020). Early-onset type 2 diabetes as a risk factor for end-stage renal disease in patients with diabetic kidney disease. Preventing Chronic Disease, 17. https://doi.org/10.5888/pcd17.200076

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Assessment Description

Use the “Case Study: Mr. D.” template and the “Functional Health Patterns Assessment Guide”, located in the topic Resources, to complete the assignment.

Case Study: Mr. D. has indirect care experience requirements. The “NRS-455 – Case Studies: Indirect Care Experience Hours” form, found in the Topic 1 Resources, will be used to document the indirect care experience hours completed in the case study. As progress is made on the case study, update this form indicating the date(s) each section is completed. This form will be submitted in Topic 3.

You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies and professional standards:

RN-BSN

2.4: Diagnose actual or potential health problems and needs.

2.8: Promote self-care management.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 2.3, 2.4, 2.8, 3.1, and 3.3.

Benchmark – Case Study: Mr. D. – Rubric

Rubric Criteria

Total130 points

Criterion	1. Unsatisfactory	2. Insufficient	3. Approaching	4. Acceptable	5. Target
Clinical Manifestations in Mr. D.	0 points Subjective and objective clinical manifestations are not present.	4.88 points Subjective and objective clinical manifestations are incomplete or incorrect.	5.14 points Subjective and objective clinical manifestations are present but lack detail.	5.79 points Subjective and objective clinical manifestations are detailed.	6.5 points Subjective and objective clinical manifestations are thorough.
Potential Health Risks (B) (C2.4)	0 points Discussion of the potential health risks for a diabetic with end-stage renal disease that are of concern to the patient is not present.	14.63 points Discussion of the potential health risks for a diabetic with end stage renal disease that are of concern to the patient is incomplete or incorrect.	15.41 points Discussion of the potential health risks for a diabetic with end stage renal disease that are of concern to the patient is present but lacks detail.	17.36 points Discussion of the potential health risks for a diabetic with end stage renal disease that are of concern to the patient is detailed.	19.5 points Discussion of the potential health risks for a diabetic with end stage renal disease that are of concern to the patient is thorough.
Nonadherence to Diabetes Self-Management Plan (B) (C2.8)	0 points Explanation of how nonadherence to the diabetes self-management plan contributes to end-stage renal disease is not present.	9.75 points Explanation of how nonadherence to the diabetes self-management plan contributes to end-stage renal disease is incomplete or incorrect.	10.27 points Explanation of how nonadherence to the diabetes self-management plan contributes to end-stage renal disease is present but lacks detail.	11.57 points Explanation of how nonadherence to the diabetes self-management plan contributes to end-stage renal disease is detailed.	13 points Explanation of how nonadherence to the diabetes self-management plan contributes to end-stage renal disease is thorough.
Pathophysiology of Renal Dialysis and ESRD	0 points Explanation of the pathophysiology of renal dialysis, stages of renal disease that lead to ESRD, and potential factors that contributed to the patient’s ESRD is not present.	14.63 points Explanation of the pathophysiology of renal dialysis, stages of renal disease that lead to ESRD, and potential factors that contributed to the patient’s ESRD is incomplete or incorrect.	15.41 points Explanation of the pathophysiology of renal dialysis, stages of renal disease that lead to ESRD, and potential factors that contributed to the patient’s ESRD is present but lacks detail.	17.36 points Explanation of the pathophysiology of renal dialysis, stages of renal disease that lead to ESRD, and potential factors that contributed to the patient’s ESRD is detailed.	19.5 points Explanation of the pathophysiology of renal dialysis, stages of renal disease that lead to ESRD, and potential factors that contributed to the patient’s ESRD is thorough.
Functional Health Patterns	0 points Evaluation of the functional health patterns, including a discussion of at least five actual or potential health problems identified from the Functional Health Patterns Assessment Guide, is not present.	9.75 points Evaluation of the functional health patterns, including a discussion of at least five actual or potential health problems identified from the Functional Health Patterns Assessment Guide, is incomplete or incorrect.	10.27 points Evaluation of the functional health patterns, including a discussion of at least five actual or potential health problems identified from the Functional Health Patterns Assessment Guide, is present but lacks detail.	11.57 points Evaluation of the functional health patterns, including a discussion of at least five actual or potential health problems identified from the Functional Health Patterns Assessment Guide, is detailed.	13 points Evaluation of the functional health patterns, including a discussion of at least five actual or potential health problems identified from the Functional Health Patterns Assessment Guide, is thorough.
Nursing Management and Health Promotion	0 points Description of nursing management and health promotion opportunities for patients with ESRD is not present.	9.75 points Description of nursing management and health promotion opportunities for patients with ESRD is incomplete or incorrect.	10.27 points Description of nursing management and health promotion opportunities for patients with ESRD is present but lacks detail.	11.57 points Description of nursing management and health promotion opportunities for patients with ESRD is detailed.	13 points Description of nursing management and health promotion opportunities for patients with ESRD is thorough.
Patient Education Plan	0 points Development of patient education plan that could be offered to the patient for prevention of future events, health restoration, and maintaining renal status is not present.	9.75 points Development of patient education plan that could be offered to the patient for prevention of future events, health restoration, and maintaining renal status is incomplete or incorrect.	10.27 points Development of patient education plan that could be offered to the patient for prevention of future events, health restoration, and maintaining renal status is present but lacks detail.	11.57 points Development of patient education plan that could be offered to the patient for prevention of future events, health restoration, and maintaining renal status is detailed.	13 points Development of patient education plan that could be offered to the patient for prevention of future events, health restoration, and maintaining renal status is thorough.
Community Resources	0 points Explanation of the community resources and supportive care available for ESRD patient management at home is not present.	4.88 points Explanation of the community resources and supportive care available for ESRD patient management at home is incomplete or incorrect.	5.14 points Explanation of the community resources and supportive care available for ESRD patient management at home is present but lacks detail.	5.79 points Explanation of the community resources and supportive care available for ESRD patient management at home is detailed.	6.5 points Explanation of the community resources and supportive care available for ESRD patient management at home is thorough.
Multidisciplinary Care Approach	0 points Discussion of the role of the nurse in using the multidisciplinary approach that would be safe and effective for patients like Mr. D., including aspects such as devices, transportation, eligibility for transplant, living conditions, promotion of resiliency, and independence, is not present.	9.75 points Discussion of the role of the nurse in using the multidisciplinary approach that would be safe and effective for patients like Mr. D., including aspects such as devices, transportation, eligibility for transplant, living conditions, promotion of resiliency, and independence, is incomplete or incorrect.	10.27 points Discussion of the role of the nurse in using the multidisciplinary approach that would be safe and effective for patients like Mr. D., including aspects such as devices, transportation, eligibility for transplant, living conditions, promotion of resiliency, and independence, is present but lacks detail.	11.57 points Discussion of the role of the nurse in using the multidisciplinary approach that would be safe and effective for patients like Mr. D., including aspects such as devices, transportation, eligibility for transplant, living conditions, promotion of resiliency, and independence, is detailed.	13 points Discussion of the role of the nurse in using the multidisciplinary approach that would be safe and effective for patients like Mr. D., including aspects such as devices, transportation, eligibility for transplant, living conditions, promotion of resiliency, and independence, is thorough.
Mechanics of Writing Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.	0 points Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.	5.85 points Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.	6.16 points Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.	6.94 points Few mechanical errors are present. Suitable language choice and sentence structure are used.	7.8 points No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.
Format/Documentation Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.	0 points Appropriate format is not used. No documentation of sources is provided.	3.9 points Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.	4.11 points Appropriate format and documentation are used, although there are some obvious errors.	4.63 points Appropriate format and documentation are used with only minor errors.	5.2 points No errors in formatting or documentation are present.

Criterion

1. Unsatisfactory

2. Insufficient

3. Approaching

4. Acceptable

5. Target

Clinical Manifestations in Mr. D.

0 points

Subjective and objective clinical manifestations are not present.

4.88 points

Subjective and objective clinical manifestations are incomplete or incorrect.

5.14 points

Subjective and objective clinical manifestations are present but lack detail.

5.79 points

Subjective and objective clinical manifestations are detailed.

6.5 points

Subjective and objective clinical manifestations are thorough.

Potential Health Risks (B)

(C2.4)

0 points

Discussion of the potential health risks for a diabetic with end-stage renal disease that are of concern to the patient is not present.

14.63 points

Discussion of the potential health risks for a diabetic with end stage renal disease that are of concern to the patient is incomplete or incorrect.

15.41 points

Discussion of the potential health risks for a diabetic with end stage renal disease that are of concern to the patient is present but lacks detail.

17.36 points

Discussion of the potential health risks for a diabetic with end stage renal disease that are of concern to the patient is detailed.

19.5 points

Discussion of the potential health risks for a diabetic with end stage renal disease that are of concern to the patient is thorough.

Nonadherence to Diabetes Self-Management Plan (B)

(C2.8)

0 points

Explanation of how nonadherence to the diabetes self-management plan contributes to end-stage renal disease is not present.

9.75 points

Explanation of how nonadherence to the diabetes self-management plan contributes to end-stage renal disease is incomplete or incorrect.

10.27 points

Explanation of how nonadherence to the diabetes self-management plan contributes to end-stage renal disease is present but lacks detail.

11.57 points

Explanation of how nonadherence to the diabetes self-management plan contributes to end-stage renal disease is detailed.

13 points

Explanation of how nonadherence to the diabetes self-management plan contributes to end-stage renal disease is thorough.

Pathophysiology of Renal Dialysis and ESRD

0 points

Explanation of the pathophysiology of renal dialysis, stages of renal disease that lead to ESRD, and potential factors that contributed to the patient’s ESRD is not present.

14.63 points

Explanation of the pathophysiology of renal dialysis, stages of renal disease that lead to ESRD, and potential factors that contributed to the patient’s ESRD is incomplete or incorrect.

15.41 points

Explanation of the pathophysiology of renal dialysis, stages of renal disease that lead to ESRD, and potential factors that contributed to the patient’s ESRD is present but lacks detail.

17.36 points

Explanation of the pathophysiology of renal dialysis, stages of renal disease that lead to ESRD, and potential factors that contributed to the patient’s ESRD is detailed.

19.5 points

Explanation of the pathophysiology of renal dialysis, stages of renal disease that lead to ESRD, and potential factors that contributed to the patient’s ESRD is thorough.

Functional Health Patterns

0 points

Evaluation of the functional health patterns, including a discussion of at least five actual or potential health problems identified from the Functional Health Patterns Assessment Guide, is not present.

9.75 points

10.27 points

11.57 points

Evaluation of the functional health patterns, including a discussion of at least five actual or potential health problems identified from the Functional Health Patterns Assessment Guide, is detailed.

13 points

Evaluation of the functional health patterns, including a discussion of at least five actual or potential health problems identified from the Functional Health Patterns Assessment Guide, is thorough.

Nursing Management and Health Promotion

0 points

Description of nursing management and health promotion opportunities for patients with ESRD is not present.

9.75 points

Description of nursing management and health promotion opportunities for patients with ESRD is incomplete or incorrect.

10.27 points

Description of nursing management and health promotion opportunities for patients with ESRD is present but lacks detail.

11.57 points

Description of nursing management and health promotion opportunities for patients with ESRD is detailed.

13 points

Description of nursing management and health promotion opportunities for patients with ESRD is thorough.

Patient Education Plan

0 points

Development of patient education plan that could be offered to the patient for prevention of future events, health restoration, and maintaining renal status is not present.

9.75 points

Development of patient education plan that could be offered to the patient for prevention of future events, health restoration, and maintaining renal status is incomplete or incorrect.

10.27 points

Development of patient education plan that could be offered to the patient for prevention of future events, health restoration, and maintaining renal status is present but lacks detail.

11.57 points

Development of patient education plan that could be offered to the patient for prevention of future events, health restoration, and maintaining renal status is detailed.

13 points

Development of patient education plan that could be offered to the patient for prevention of future events, health restoration, and maintaining renal status is thorough.

Community Resources

0 points

Explanation of the community resources and supportive care available for ESRD patient management at home is not present.

4.88 points

Explanation of the community resources and supportive care available for ESRD patient management at home is incomplete or incorrect.

5.14 points

Explanation of the community resources and supportive care available for ESRD patient management at home is present but lacks detail.

5.79 points

Explanation of the community resources and supportive care available for ESRD patient management at home is detailed.

6.5 points

Explanation of the community resources and supportive care available for ESRD patient management at home is thorough.

Multidisciplinary Care Approach

0 points

Discussion of the role of the nurse in using the multidisciplinary approach that would be safe and effective for patients like Mr. D., including aspects such as devices, transportation, eligibility for transplant, living conditions, promotion of resiliency, and independence, is not present.

9.75 points

10.27 points

11.57 points

13 points

Mechanics of Writing

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.

0 points

Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.

5.85 points

Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.

6.16 points

Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.

6.94 points

Few mechanical errors are present. Suitable language choice and sentence structure are used.

7.8 points

No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.

Format/Documentation

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.

0 points

Appropriate format is not used. No documentation of sources is provided.

3.9 points

Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.

4.11 points

Appropriate format and documentation are used, although there are some obvious errors.

4.63 points

Appropriate format and documentation are used with only minor errors.

5.2 points

No errors in formatting or documentation are present.

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We offer 100% pure content, you do not have to worry about your professor knowing it’s not your work. Do not worry about your details, since we do not share our client’s information. We value your privacy and we will only ask you concerning the details of your assignment and not your occupation or other personal details. Contact us to get that boost grade for your paper. Health Records and Information Technology Help Organization and management of data and ensuring that it is secure and of good quality can be hectic and time consuming. Health records deals with classifying and categorizing information to maintain a patient’s medical history. You may be studying a diploma or certificate program, do not worry for we handle all. Most students claim to have difficulties in managing between their classwork and their day to day affairs. We have guidelines which will aid you to navigate through the course easily. Our services are approved globally and you can confirm this with the overwhelming feedback we receive from our clients. We are overwhelmed with assignment papers from different students globally seeking our services. Health records and information technology course involves a lot of concentration in arrangement of data. Our writers have skills in the course and we make your work easy. Do not stress with an overload of undocumented data, just send it to us and we will sort you. Capstone Project Help When you are tasked with writing a capstone project, the lecturer expects a unique capstone project that strictly follows the guidelines. Although you might read several guides on how to write a capstone project, chances are you will not write an outstanding capstone project your first time. You need capstone project writing help from an expert who has been writing capstone projects for a long time. Our capstone project writing service experts will write an outstanding capstone project with high analytical skills. Our capstone project writing experts will stick to the provided guideline and use the paper structure and create relevant content for your capstone project. Our capstone project writing service writers have access to premium academic resources, and we guarantee to only use credible, relevant, and up-to-date information. Your paper will be referenced appropriately, and a reference page and annotated bibliography will be attached to your final document. We don't tolerate any form of plagiarism. All capstone projects writing starts from scratch. Again, we use premium plagiarism checker tools such as Turnitin and Copyscape. We understand how crucial deadlines are crucial in the academic world. We do not want our client fretting over the capstone project submission deadline. That’s why we will always submit your paper before the scheduled time. You can always inquire from our professional customer service team on the progress of your capstone project paper. Do you need timely and professional help writing a capstone project? Place your order today and enjoy our unique capstone project writing service. Mental Health and Psychiatry Assignment Help This is a branch of science that mainly deals with diagnosis of mental and emotional health in people. Mental health issues are very rampant in our society today. It is said that a big no of people have a mental health condition. Many of our clients claim that the course involves a lot of studying and dealing with people with mental health conditions at a community level. This limits them to concentrate on their classwork and barely have time to do their assignments. DrNursingpapers.com got you covered because we handle all assignments of any course. We produce high quality academic papers and many students claim that our help assists in their grade boost. We are highly rate and our services won’t disappoint you; try us today. Our writers are always prepared to tackle and work on your assignments at any time of the day. We do not limit the number of questions you can post. You are allowed to send as many questions as you can. One thing about our services is that they are efficient and affordable. You will have good content at a very friendly price. We also offer discounts to our customers at certain seasons of the semester. This is to help you in your coursework and to enable you to have at a fair price.	Are you a nursing student pursuing community oral health? Are your practical’s taking much of your time and have no time for your assignments? We got you covered; at DrNursingpapers.com we offer assignment help services. We understand your course deals with you mainly being in the community with people teaching and offering dental services and helping them prevent dental diseases by teaching good oral hygiene. You may not have time to attend to your assignments and other personal needs, making life really busy for you. We are here to help you offload and give you time to unwind. Our professional writers will take care of your assignment, visit our website and get assisted. Our papers are efficient and the proof is on our sites where we have overwhelming flow of customers requiring our services. Our skills will help boost your grades to get your desired score. We are just one message away. Plagiarism is forbidden and those found with such faults are disqualified. We encourage our writers to be creative and innovative. You do not have to worry your work will resemble that of your friends. Creativity and fresh content is our mantra, try us today.. Community Health Nursing Assignment Help Are you training to be a midwife or a nurse? Is serving the community a passion you have? As a community health nursing student most of your time will be in the field. If you are pursuing this course then you have a passion in helping people and caring about their well-being. We understand this and that’s why at DrNursingpapers.com, we have a program that tackles your assignment and we have a record of time keeping and delivering efficient papers. Our professional writers are skilled and are competent of tackling your homework. We also help by giving guidelines for your practical’s. You may major in general nursing, community or common nursing; we specialize in all community health programs. We have been ranked as the best nursing assignment writers and our customers gladly come back for our services. We have emergency services where you need your assignment done within a short duration of time. Our writers are always ready to help you at any particular time of the day. Visit our websites at DrNursingpapers.com place your order and write the time required to submit. Nursing Assignment Help Are you a nursing student being stressed by your assignments, classwork or your course in general? Is your schoolwork interfering with your leisure time? That trip with your friends, the movies with your soul mate, we are here to relieve your burden, stress no more. Dr.Nursingpapers.com has professional and competent writers who will assist you and help do your assignment. Our websites offer professional nursing services and connecting with us is very easy. Nursing has a variety of major courses and we handle all. Get to our site and place an order, specify your major on the list of courses available then submit. We work 24/7, do not feel left out when you have limited time to finish your assignment. We select competent and skillful writers to handle your assignments. PhD and masters level writers are the ones who handle your assignments and we consider the level of education of the individual. Diploma or certificate they will write based on the level and not complicate the assignment. Coursework Help You labor in your assignments CATs and your classwork in general to help boost your grade during the final exams. get a good grade to secure a good job in future and live your desired life. We understand that your course work majorly involves you being physically in the field as a nursing student. This does not allow you to concentrate on your assignments or have free time to enjoy your leisure time. Do you need that grade boost and school is taking much of your time? That’s why we are here to help you. Our writers are well skilled to write your college assignments and give you time to relax and catch up with family and friends. Do not let life pass you by while you can do everything and not mess up your leisure or your studies. Assignments can be time consuming since they are given in bulk. You can be given up to five assignments to do on a weekend. No one wants to only focus only on school all year long and not have time to do other things. We are here to help you relieve and carry the load. We offer help to all academic levels of education; secondary schools, university and colleges; diploma, degree, PhD and masters levels are included. We have not left behind other people that would need us to write for them. Thesis and research papers, case study assignments and essay writing are also included in our programs. Nursing Research Paper Assignment Help According to our survey and data collected, we find that research papers assignments among nursing students are many. Most students do not have the time to process raw data and compile, it tends to be hectic and time consuming. You send the research topic to us and we will write the best paper for you. Our professional writers have experience in research writing for the many papers they have written. We follow the instructions given by your lectures and use the approved research format globally. We do the data findings, data analysis and writing the whole process for you. Research is not as hard as people make it sound. Due to the level of experience our writers have, it is easy for them to write and produce the best content. We are an accredited site in which we receive many research papers from students all over. We give plagiarism free papers and our content is fresh. Order with us, you won’t be disappointed. Visit our site place your order; write your academic level, your assignment, duration of time to be done and your type of paper.

Clinical Medicine Assignment Help

Community Oral Health Assignment Help

This is a field that deals with the study and practice of medicine based on examining the patient and the data is documented and store in a medical record. When doing this course, you will spend most of your time in the laboratory as you labor to discover and understand the field of medicine. As a student, you have extracurricular activities you have to handle, and besides that you have a life to live and explore.

Clinical medicine assignments are tackled specifically by our clinical medicine officers. This is to ensure you are provided with highly qualified papers and correct content from someone who has gone through the course. Our professional writers are practicing officers, this giving you a privilege to know more on what happens in the field. This will also help you acquire knowledge and have exposure in your field.

We are resourceful whether you are in health records management, forensic medicine and clinical sciences. We cover all areas of clinical medicine and give sufficient and excellent results. You are allowed to interact with the writer and ask questions, seek clarity or correct where necessary. We are here to ensure you get the right and most efficient and satisfying services from us.

Nutrition and Dietetics Assignment Help

Poor dieting among children especially infants is a major issue in growth and development. This is a course that deals with helping people maintain healthy weights and overall general health .the field emphasizes mainly on public health, hence educating the masses. As a student you spend most of your time in the field and not having enough time to concentrate on your assignments.

We have a group of professionals that mainly deals with nutrition and dietetics assignments. Our clients always comeback for our services for we fully give as per the requirements. Do not be left behind, order with us by visiting our website and placing your order. We offer 100% pure content, you do not have to worry about your professor knowing it’s not your work.

Do not worry about your details, since we do not share our client’s information. We value your privacy and we will only ask you concerning the details of your assignment and not your occupation or other personal details. Contact us to get that boost grade for your paper.

Health Records and Information Technology Help

Organization and management of data and ensuring that it is secure and of good quality can be hectic and time consuming. Health records deals with classifying and categorizing information to maintain a patient’s medical history. You may be studying a diploma or certificate program, do not worry for we handle all.

Most students claim to have difficulties in managing between their classwork and their day to day affairs. We have guidelines which will aid you to navigate through the course easily. Our services are approved globally and you can confirm this with the overwhelming feedback we receive from our clients. We are overwhelmed with assignment papers from different students globally seeking our services.

Health records and information technology course involves a lot of concentration in arrangement of data. Our writers have skills in the course and we make your work easy. Do not stress with an overload of undocumented data, just send it to us and we will sort you.

Capstone Project Help

When you are tasked with writing a capstone project, the lecturer expects a unique capstone project that strictly follows the guidelines. Although you might read several guides on how to write a capstone project, chances are you will not write an outstanding capstone project your first time. You need capstone project writing help from an expert who has been writing capstone projects for a long time. Our capstone project writing service experts will write an outstanding capstone project with high analytical skills.

Our capstone project writing experts will stick to the provided guideline and use the paper structure and create relevant content for your capstone project. Our capstone project writing service writers have access to premium academic resources, and we guarantee to only use credible, relevant, and up-to-date information.

Your paper will be referenced appropriately, and a reference page and annotated bibliography will be attached to your final document. We don't tolerate any form of plagiarism. All capstone projects writing starts from scratch. Again, we use premium plagiarism checker tools such as Turnitin and Copyscape.

We understand how crucial deadlines are crucial in the academic world. We do not want our client fretting over the capstone project submission deadline. That’s why we will always submit your paper before the scheduled time. You can always inquire from our professional customer service team on the progress of your capstone project paper. Do you need timely and professional help writing a capstone project? Place your order today and enjoy our unique capstone project writing service.

Mental Health and Psychiatry Assignment Help

This is a branch of science that mainly deals with diagnosis of mental and emotional health in people. Mental health issues are very rampant in our society today. It is said that a big no of people have a mental health condition. Many of our clients claim that the course involves a lot of studying and dealing with people with mental health conditions at a community level. This limits them to concentrate on their classwork and barely have time to do their assignments.

DrNursingpapers.com got you covered because we handle all assignments of any course. We produce high quality academic papers and many students claim that our help assists in their grade boost. We are highly rate and our services won’t disappoint you; try us today. Our writers are always prepared to tackle and work on your assignments at any time of the day.

We do not limit the number of questions you can post. You are allowed to send as many questions as you can. One thing about our services is that they are efficient and affordable. You will have good content at a very friendly price. We also offer discounts to our customers at certain seasons of the semester. This is to help you in your coursework and to enable you to have at a fair price.

Are you a nursing student pursuing community oral health? Are your practical’s taking much of your time and have no time for your assignments? We got you covered; at DrNursingpapers.com we offer assignment help services. We understand your course deals with you mainly being in the community with people teaching and offering dental services and helping them prevent dental diseases by teaching good oral hygiene. You may not have time to attend to your assignments and other personal needs, making life really busy for you.

We are here to help you offload and give you time to unwind. Our professional writers will take care of your assignment, visit our website and get assisted. Our papers are efficient and the proof is on our sites where we have overwhelming flow of customers requiring our services. Our skills will help boost your grades to get your desired score. We are just one message away.

Plagiarism is forbidden and those found with such faults are disqualified. We encourage our writers to be creative and innovative. You do not have to worry your work will resemble that of your friends. Creativity and fresh content is our mantra, try us today..

Community Health Nursing Assignment Help

Are you training to be a midwife or a nurse? Is serving the community a passion you have? As a community health nursing student most of your time will be in the field. If you are pursuing this course then you have a passion in helping people and caring about their well-being. We understand this and that’s why at DrNursingpapers.com, we have a program that tackles your assignment and we have a record of time keeping and delivering efficient papers.

Our professional writers are skilled and are competent of tackling your homework. We also help by giving guidelines for your practical’s. You may major in general nursing, community or common nursing; we specialize in all community health programs. We have been ranked as the best nursing assignment writers and our customers gladly come back for our services.

We have emergency services where you need your assignment done within a short duration of time. Our writers are always ready to help you at any particular time of the day. Visit our websites at DrNursingpapers.com place your order and write the time required to submit.

Nursing Assignment Help

Are you a nursing student being stressed by your assignments, classwork or your course in general? Is your schoolwork interfering with your leisure time? That trip with your friends, the movies with your soul mate, we are here to relieve your burden, stress no more. Dr.Nursingpapers.com has professional and competent writers who will assist you and help do your assignment.

Our websites offer professional nursing services and connecting with us is very easy. Nursing has a variety of major courses and we handle all. Get to our site and place an order, specify your major on the list of courses available then submit. We work 24/7, do not feel left out when you have limited time to finish your assignment.

We select competent and skillful writers to handle your assignments. PhD and masters level writers are the ones who handle your assignments and we consider the level of education of the individual. Diploma or certificate they will write based on the level and not complicate the assignment.

Coursework Help

You labor in your assignments CATs and your classwork in general to help boost your grade during the final exams. get a good grade to secure a good job in future and live your desired life. We understand that your course work majorly involves you being physically in the field as a nursing student. This does not allow you to concentrate on your assignments or have free time to enjoy your leisure time.

Do you need that grade boost and school is taking much of your time? That’s why we are here to help you. Our writers are well skilled to write your college assignments and give you time to relax and catch up with family and friends. Do not let life pass you by while you can do everything and not mess up your leisure or your studies.

Assignments can be time consuming since they are given in bulk. You can be given up to five assignments to do on a weekend. No one wants to only focus only on school all year long and not have time to do other things. We are here to help you relieve and carry the load.

We offer help to all academic levels of education; secondary schools, university and colleges; diploma, degree, PhD and masters levels are included. We have not left behind other people that would need us to write for them. Thesis and research papers, case study assignments and essay writing are also included in our programs.

Nursing Research Paper Assignment Help

According to our survey and data collected, we find that research papers assignments among nursing students are many. Most students do not have the time to process raw data and compile, it tends to be hectic and time consuming. You send the research topic to us and we will write the best paper for you.

Our professional writers have experience in research writing for the many papers they have written. We follow the instructions given by your lectures and use the approved research format globally. We do the data findings, data analysis and writing the whole process for you. Research is not as hard as people make it sound. Due to the level of experience our writers have, it is easy for them to write and produce the best content.

We are an accredited site in which we receive many research papers from students all over. We give plagiarism free papers and our content is fresh. Order with us, you won’t be disappointed. Visit our site place your order; write your academic level, your assignment, duration of time to be done and your type of paper.

NRS 455 Benchmark – Case Study: Mr. D. Assessment