NR 507 – Week 3 Discussion Purpose The purpose of this discussion is to apply pathophysiological concepts to an individual presenting with cardiovascular dysfunction (heart failure). Related concepts will also be applied that includes potential alterations in fluid and electrolytes and acid/base balance.  Activity Learning Outcomes Through this discussion, the student will demonstrate the ability to: 1. Explore age-specific and developmental alterations in the cardiovascular system. (CO 3, 1)  2. Relate pathophysiological alterations in cardiovascular processes to the development, diagnosis and treatment of heart failure. (CO 4, 2)  3. Examine current evidence to support the management of patients who present with alterations in the cardiovascular system. (CO 5, 3)  Total Points Possible:  100  Requirements: A 64-year-old woman presents to the primary care office with shortness of breath, leg swelling, and fatigue. She has a history of type 2 diabetes and hypertension. She reports that recently she had been able to go for daily walks with her friends, but in the past month, the walks have become more difficult due to shortness of breath and fatigue. She also sometimes awakens in the middle of the night due to shortness of breath and has to prop herself up on three pillows. On physical examination, she is tachycardic (110 beats per minute) and has a blood pressure of 106/74 mm Hg. Fine crackles are noted on inspiration in bilateral bases. The cardiac exam reveals the presence of a third and fourth heart sound and jugular venous distension. 2+ pitting edema is noted in the knees bilaterally. An ECG shows sinus rhythm at 110 bpm with Q waves in the anterior leads. An echocardiogram shows decreased wall motion of the anterior wall of the heart and an estimated ejection fraction of 25%. She is diagnosed with systolic heart failure, secondary to a silent MI.  1. Discuss the pathophysiological mechanisms that can lead to heart failure.  2. Differentiate between systolic and diastolic heart dysfunction  3. Discuss the causes of the patient’s shortness of breath, awakening in the middle of the night and the need to prop herself up on three pillows. Include pathophysiological mechanisms that causes each of these signs and symptoms.  4. Include two points of teaching for this patient  5. Support your response with at least one current evidence based resource.  6. Students must post a minimum of three times in each graded discussion (see participation guidelines below).  DISCUSSION CONTENT Category Points % Description Application of Course Knowledge 30 30% 1. Posts make direct reference to concepts discussed in the lesson or drawn from relevant, evidence based outside sources, AND  2. Posts are on topic and answer all presented questions which demonstrates a solid understanding of the topic.  3. Applies concepts to personal experience in the professional setting and or relevant application to real life, AND  4. Decisions are well support ...

1. NR 507 – Week 3 Discussion
Purpose
The purpose of this discussion is to apply pathophysiological
concepts to an individual presenting with cardiovascular
dysfunction (heart failure). Related concepts will also be
applied that includes potential alterations in fluid and
electrolytes and acid/base balance.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability
to:
1. Explore age-specific and developmental alterations in
the cardiovascular system. (CO 3, 1)
2. Relate pathophysiological alterations in cardiovascular
processes to the development, diagnosis and treatment of heart
failure. (CO 4, 2)
3. Examine current evidence to support the management of
patients who present with alterations in the cardiovascular
system. (CO 5, 3)
Total Points Possible: 100
Requirements:
A 64-year-old woman presents to the primary care office with
shortness of breath, leg swelling, and fatigue. She has a history
of type 2 diabetes and hypertension. She reports that recently
she had been able to go for daily walks with her friends, but in
the past month, the walks have become more difficult due to
shortness of breath and fatigue. She also sometimes awakens in
the middle of the night due to shortness of breath and has
to prop herself up on three pillows. On physical examination,
she is tachycardic (110 beats per minute) and has a blood
pressure of 106/74 mm Hg. Fine crackles are noted on
inspiration in bilateral bases. The cardiac exam reveals the
presence of a third and fourth heart sound and jugular venous

2. distension. 2+ pitting edema is noted in the knees bilaterally.
An ECG shows sinus rhythm at 110 bpm with Q waves in the
anterior leads. An echocardiogram shows decreased wall motion
of the anterior wall of the heart and an estimated ejection
fraction of 25%. She is diagnosed with systolic heart failure,
secondary to a silent MI.
1. Discuss the pathophysiological mechanisms that can lead to
heart failure.
2. Differentiate between systolic and diastolic heart
dysfunction
3. Discuss the causes of the patient’s shortness of breath,
awakening in the middle of the night and the need to prop
herself up on three pillows. Include pathophysiological
mechanisms that causes each of these signs and symptoms.
4. Include two points of teaching for this patient
5. Support your response with at least one current evidence
based resource.
6. Students must post a minimum of three times in each graded
discussion (see participation guidelines below).
DISCUSSION CONTENT
Category
Points
%
Description
Application of Course Knowledge
30
30%
1. Posts make direct reference to concepts discussed in the
lesson or drawn from relevant, evidence based outside sources,
AND
2. Posts are on topic and answer all presented questions which
demonstrates a solid understanding of the topic.
3. Applies concepts to personal experience in the professional
setting and or relevant application to real life, AND
4. Decisions are well supported with evidence-based arguments

3. that are in-line with the scenario; AND
5. Proper rationale and reasoning skills are demonstrated; AND
6. Information is taken from source(s) with appropriate
interpretation/evaluation to develop a comprehensive analysis
or synthesis of the topic
Support From Evidence Based Practice
30
30%
1. Discussion post is supported with appropriate, scholarly
sources; AND
2. Sources are published within the last 5 years (unless it is the
most current clinical practice guideline (CPG); AND
3. Reference list is provided and in-text citations match; AND
4. Provides relevant evidence of scholarly inquiry clearly
stating how the evidence informed or changed professional or
academic decisions
Interactive Dialogue
30
30%
1. Student provides a substantive* response to at least
two topic-related posts of a peer; AND
2. Evidence from appropriate scholarly sources are included;
AND
3. Reference list is provided and in-text citations match; AND
4. Student responds to all direct faculty questions OR if student
was not asked a direct question, student responds to either a
3rd peer post or a faculty question directed towards another
student
(*) A substantive post adds new content or insights to the
discussion thread and information from student’s original post
is not reused in peer or faculty response

4. 90
90%
Total CONTENT Points= 90 pts
DISCUSSION FORMAT
Category
Points
%
Description
Grammar, Syntax, Spelling, & Punctuation
10
10%
Grammar, spelling, and/or punctuation are accurate, or with
zero to one error.
Direct quotes in discussions are limited to one short quotation
(not to exceed 15 words). The quote adds substantively to the
discussion.
(*) APA style references and in text citations are required;
however, there are no deductions for errors in indentation or
spacing of references. All elements of the reference otherwise
must be included.
10
10%
Total FORMAT Points= 10 pts
100
100%
DISCUSSION TOTAL=100 points
ASSIGNMENT 02
EN120 English Composition I

5. Directions: Be sure to make an electronic copy of your answer
before submitting it to Ashworth College for grading. Unless
otherwise stated, answer in complete sentences, and be sure to
use correct English spelling and grammar. Your response should
be a maximum of two (2) double-spaced pages. Refer to the
“Assignment Format” page for specific format requirements.
You are required to write a descriptive paragraph for this
assignment for a total of 100 points. You may choose any
person you have known personally or any place that was
important in your life as your topic. However, you must
demonstrate mastery of the following in your paragraph.
Therefore, the depth (length) of your paragraph must be
sufficient to demonstrate these concepts.
a. Topic Sentence – Be sure this is a general statement that
states the person, place, or thing you will describe. Highlight
this sentence in aqua blue. (10 points)
b. Body Sentences – Be sure to select ideas and write sentences
that appeal to the senses (sight, sound, smell, taste, and/or
touch) and that are definitely related to the topic sentence. The
quality and relationship of these sentences will be evaluated.
(10 points)
c. Coherence: Be sure that you organize your paragraph in the
best way possible. A coherent paragraph is clear, logical, and
readable.
(1) Order: Select the best order for your paragraph (time,
space, or importance). Select transitions for your paragraph that
demonstrate your understanding of the order. At a minimum,
you must use three (3) transitions to demonstrate your
understanding of this concept. Highlight these transitions in
yellow. (15 points)

6. (2) Related Sentences: Be sure to repeat words and ideas; use
synonyms and substitutions to demonstrate your understanding
of this concept. Highlight these related words or sentence parts
in gray. (15 points)
d. Sentence Structure: In your paragraph, demonstrate your
understanding of the following sentence structures. You must
demonstrate at least one (1) of EACH of the following
structures. Highlight these in green. (5 points each, for a
possible total of 20 points)
(1) Coordinating conjunction
(2) Semicolon
(3) Conjunctive adverb
(4) Subordinate clause followed by an independent clause
e. Concluding Sentence: Be sure to complete your paragraph
with a well-written concluding sentence. (15 points)
f. Mechanics and Grammar – Be sure that you complete the final
step of the writing process: proofreading. Your paragraph
should be free from sentence construction errors and should be
spell-checked. (15 points)
This is the end of Assignment 02.

7. Grading Rubric
Please refer to the rubric on the following page for the grading
criteria for this assignment.
EN120 English Composition I: Assignment 02: Descriptive
paragraph
CATEGORYExemplarySatisfactoryUnsatisfactoryUnacceptable
10 points8 points5 points0 points
Topic sentence
engagingly and
effectively
names the
person, place or
thing to be
described.
Topic sentence
effectively
names the

8. person, place or
thing to be
described.
Topic sentence fails
to clearly specify the
person place or
thing to be
described
Topic sentence fails
to specify the
person place or
thing to be
described.
10 points8 points5 points0 points
Sentences
effectively and
engagingly use
words and
phrases that
appeal to the
senses.
Sentences
effectively use
words and
phrases that
appeal to the
senses.
Sentences use very
few words and
phrases that appeal
to the senses.
Sentences do not
include words and
phrases that appeal
to the senses.
30 points20 points10 points0 points

9. Paragraph uses
the best
possible order
to include
repetition that
engagingly
employs
synonyms and
other effective
substitutions.
Paragraph uses
a coherent,
logical order
and includes
repetition by
way of
synonyms and
other effective
substitutions.
Paragraph fails to
provide a coherent,
logical order that
includes repetition
by way of synonyms
and other effective
substitutions.
The paragraph
follows no
coherent or logical
order and fails to
use techniques of
substitution.
20 points15 points10 points0 points
Paragraph uses
more than 4
sentences with

10. compound
clauses in the
body and
conclusion.
Paragraph uses
3 sentences
with compound
clauses in the
body and
conclusion
Paragraph uses 2
sentences with
compound clauses
in the body and
conclusion
Paragraph does not
offer sentences
with compound
clauses in the body
and conclusion
Sentence
Structure
Topic Sentence
(10 points)
Coherence (30
points)
Body
Sentences (10
points)
15 points10 points5 points0 points
Excellent: strong
clear and
engaging
Good: strong
and clear
Weak: The

11. conclusion is
ineffective
The sentence offers
no conclusion
15 points10 points5 points0 points
Student makes
no grammatical
or spelling
errors.
Student makes
1 grammatical
or spelling
error.
Student makes 2
grammatical or
spelling errors.
Student makes
more than 2
grammatical or
spelling errors.
Concluding
Sentence
Grammar and
Mechanics