Digestive Discussion Rubric (original post & reply; 4 points) – Written, Video,

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Digestive
Discussion Rubric (original post & reply; 4 points) – Written, Video, and Virtual Submission
Instructions:
Choose a submission method: written, video, or virtual (if available) as stated in the discussion forum description.
Follow the associated guidelines for each specific submission method in Guidelines for Discussion and Replies – Written Video Virtual Submission
Provide substantive answers and any additional required items based on submission method
Written and video submissions are submitted to the discussion forum. If virtual submission is allowed, it is submitted during a scheduled meeting.
Deadlines and required items vary by submission method
Written submissions – Written original post due
Video submissions – Video original post and separate reference list due
Virtual submission (if offered) – “Live” presentation of content and scholarly source due during scheduled virtual meeting
Questions:
Read the scenario below and identify the likely digestive system disorder the patient is experiencing.
Explain the underlying pathophysiology (aka. cellular/tissue changes) and relate it to abnormal examination and diagnostic findings.
Explain additional diagnostic testing, medical treatment, and nursing care to treat the patient and/or prevent future complications.
Scenario:
A 52-year old female is in the emergency department for hematemesis. She reports vomiting a large amount of dark red blood and almost “passed out”. Her partner called 911 after finding her kneeling over the toilet and groaning. She was cooperative, but lethargic and weak. She had to be lifted by paramedics onto the gurney for transport. She reports weakness, fatigue, abdominal distention and “heaviness”, dyspnea, shortness of breath (SOB) with exertion, and an unintentional 15 lb. weight gain.
Past medical & family history
She was diagnosed with depression and alcohol dependence 5 years ago. She was prescribed paroxetine for depression and takes it as prescribed. She attended alcohol rehabilitation and remained sober for about 2 years, but began drinking alcohol again to cope with the stress during the COVID-19 pandemic. She has smoked half a pack of cigarettes daily since her early 20s. She has a history of hepatitis C infection 8 years ago. She has a history of breast cancer in situ and was treated with a right lumpectomy 6 years ago.
Her father died at the age of 58 from alcoholic liver disease; and he had a history of type 2 diabetes, hypertension, hyperlipidemia, and osteoarthritis. Her mother died at the age of 64 from a stroke; and she had a history of breast cancer and lupus. Her sister is alive at age 48 with a history of lupus and endometriosis.
Vital signs
Heart rate = 132 beats/min, regular
Respirations = 28 breaths/min, slightly labored
Oxygen saturation = 90% on 2L of oxygen via nasal canula
Temperature = 99.8° Fahrenheit (oral)
Blood pressure = 92/54 mmHg
Pain = 5/10 (epigastric)
Physical examination
Neurologic – lethargic, easily aroused, oriented, cooperative, sclera jaundiced
Skin – cool, dry, pale, intact, conjunctiva jaundiced, skin color appropriate for ethnicity
Abdomen – bowel sounds hypoactive. Abdomen slightly firm and distended. Abdomen tender in right upper quadrant. Enlarged liver palpable. Small amount of dark, yellow, clear urine.
Cardiovascular – heart rate rapid and regular. S1 and S2 heard. Peripheral pulses thready and 1+, pedal edema 1+, bilateral jugular venous distention present. No abnormal heart sounds.
Pulmonary – lung sounds clear in apices, but bases diminished with crackles; SOB with exertion
Musculoskeletal – full range of motion, strength 3/5 in extremities
Diagnostic test results
Chest x-ray – lungs with moderate pulmonary edema
12-lead electrocardiogram (ECG) – sinus tachycardia, no acute ischemic changes
Esophagogastroduodenoscopy (EGD; aka. upper endoscopy) – esophagus with 2 medium-sized varices at the proximal and mid esophagus with bleeding. No other abnormalities.
Computerized tomography (CT) scan of chest and abdomen – Enlarged liver with fibrosis, nodularity, and irregular contour. Esophageal thickening. No free air or other abnormalities.
Serum results – abnormal results and normal ranges below, all other results within their normal range
Blood urea nitrogen = 41……………………………..(6-20 mg/dL)
Creatinine = 2.8……………………………………………(0.9-1.3 mg/dL)
Total protein = 4.0………………………………………..(6.0-8.3 gm/dL)
Albumin = 2.7……………………………………………….(3.5-5.0 gm/dL)
Bilirubin (total) = 2.4…………………………………….(0.2-1.3 mg/dL)
Aspartate aminotransferase (AST) = 73……….(10-59 U/L)
Alanine aminotransferase (ALT) = 50…………..(10-40 U/L)
Ammonia = 92……………………………………………..(10-80 mcg/dL)
Red blood cells (RBC) = 3.9………………………….(4.2-5.4 x 1,000,000 cells/μL)
Hemoglobin (HGB) = 8.2……………………………..(14.0-17.0 gm/dL)
Hematocrit (HCT) = 26.7……………………………..(41-51%)
Platelets (PLT) = 112.4…………………………………(150-400 x 1000 cells/μL)
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Criteria
Unacceptable
Below Average
Average
Above Average
Excellent
Criterion Score
Original Post
0 points
Did not post; or minimal, uninformative answer
1 point
Brief or somewhat uninformative answer. Content somewhat incomplete, inappropriate, and/or incomprehensible
1.4 points
Communicated a good understanding of the topic with content that is mostly comprehensive, accurate, and meaningful
1.6 points
Communicated a good understanding of the topic with content that is mostly comprehensive, accurate, meaningful, and evidence-based. Incorporated information from 1 current (<5 years), appropriate, and professional, source. In addition: Written: Information from sources is paraphrased with citations and references provided Video: Reference list provided Virtual: Discussed and provided details from a current (<5 years), appropriate, and professional source(s) (not the textbook) 2 points Communicated a solid understanding of the topic with content that is generally comprehensive, accurate, meaningful, current, and evidence-based. Incorporated information from 2 current (<5 years), appropriate, and professional, sources. Stayed within word or time limit. In addition: Written: Information from sources is paraphrased with citations and references provided Video: Reference list provided Virtual: Discussed and provided details from a current (<5 years), appropriate, and professional source(s) (not the textbook) Score of Original Post,/ 2Criterion score has been overridden Reply to the Original Post of Another Student or Virtual Participation 0 points Reply minimal, inappropriate, and/or uninformative; or no reply 0.5 points Reply brief or somewhat informative . Content incomplete, inappropriate, and/or incomprehensible 0.7 points Reply mostly constructive that enhanced the discussion by elaborating on topics. Content mostly complete, appropriate, and/or comprehensible 0.8 points Written: A substantive and constructive reply that enhanced the discussion. Content mostly complete, appropriate, and/or comprehensible. Reply incorporated information from at least 1 current (<5 years), appropriate, and professional source. Information from sources paraphrased with citations and reference provided. Video: A substantive and constructive reply that enhanced the discussion. Content mostly complete, appropriate, and/or comprehensible. Reply incorporated information from at least 1 current (<5 years), appropriate, and professional source. Reference list provided. Virtual: Participated adequately with the instructor and other students by addressing most questions/comments from instructor and/or others. 1 point Written: A substantive and constructive reply that enhanced the discussion. Content generally complete, appropriate, and/or comprehensible. Reply incorporated information from at least 1 current (<5 years), appropriate, and professional source. Information from sources is paraphrased with citations and references provided. Stayed within word limit. Video:A substantive and constructive reply that enhanced the discussion. Content generally complete, appropriate, and/or comprehensible. Reply incorporated information from at least 2 current (<5 years), appropriate, and professional sources. Information from sources is paraphrased with citations and references provided. Stayed within word limit. Virtual: Participated effectively with the instructor and other students by addressing questions/comments from instructor and/or others. Score of Reply to the Original Post of Another Student or Virtual Participation,/ 1Criterion score has been overridden Professional Delivery 0 points Written: Did not participate meaningfully and/or generally unprofessional writing Video: Did not participate meaningfully and/or generally unprofessional presentation Virtual: Did not participate meaningfully and/or generally unprofessional presentation and/or conduct 0.25 points Written: Significant errors in organization, essay format, grammar, spelling, and/or APA style; decreased comprehension. Video: Significant difficulties with clarity and/or sound. Met some guidelines for duration, and/or technology. Met all guidelines for professionalism. Many errors in reference list. Virtual: Not applicable 0.35 points Written: Multiple errors in organization, essay format, grammar, spelling, and/or APA style. Video: Multiple difficulties with clarity, sound, duration, technology, presentation, conduct, and/or reference list. Virtual: Multiple issues related to presentation and/or conduct. 0.4 points Written: Few/minor errors in organization, essay format, grammar, spelling, and/or APA style. Video: Few/minor difficulties with clarity, sound, duration, technology, presentation, conduct, and/or reference list. Virtual: Minor issues related to presentation and/or conduct. 0.5 points Written: Content logically organized using essay format. Generally correct grammar, spelling, and APA style for all parts. Video: Generally clear and audible. Met all guidelines for duration, professionalism, and technology. Generally correct APA style for reference list. Virtual: Met all guidelines for presentation and conduct. Score of Professional Delivery,/ 0.5Criterion score has been overridden Participation & Timeliness 0 points Written: No original post, no reply Video: No original post, no reply Virtual: Not applicable 0.25 points Written: Late original post without reply OR no original post but makes reply Video: Late original post without reply OR no original post but makes reply Virtual: Not applicable 0.35 points Written: Timely original post without reply Video: Timely original post without reply Virtual: Not applicable 0.4 points Written: Late original post with reply to the original post of another student Video: Late original post with reply to the original post of another student Virtual: Not applicable 0.5 points Written: Timely original post and reply to the original post of another student Video: Timely original post and reply to the original post of another student Virtual: Attended meeting on time Score of Participation & Timeliness,/ 0.5Criterion score has been overridden Rubric Total Score Total Score of Topical Discussion: Original Post & Reply (4 points),/ 4Criterion score has been overridden Overall Score Overall Score Excellent 3.6 points minimum Above Average 3.2 points minimum Average 2.8 points minimum Below Average 2 points minimum Unacceptable 0 points minimum

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