Topic 2: Neurological, Perceptual, And Cognitive Complexities
Objectives:
1. Evaluate functions of the neurological, perceptual, and cognitive systems based on findings.
2. Propose an intervention for a patient with a cognitive complexity.
Assignment 1
Identify a common perceptual, neurological, or cognitive issue and discuss contributing factors. Outline steps for prevention or health promotion for the patient and family.
Assignment 2
Discuss characteristic findings for a stroke and how it affects the lives of patients and their families. Discuss the nurse’s role in supporting the patient’s psychological, emotional, and spiritual needs.Provide an example integrating concepts from the “Statement on the Integration of Faith and Work” located in Class Resources.
Assignment 3-A
Evidence-Based Practice Project: Intervention Presentation on Diabetes
Identify a research or evidence-based article published within the last 5 years that focuses comprehensively on a specific intervention or new treatment tool for the management of diabetes in adults or children. The article must be relevant to nursing practice.
Submit a reference and a working link to the article as a word document.
Assignment 3-B
Case Study: Mr. M.
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. M., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Health History
Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no known allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.
Case Scenario
Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.
Objective Data
1. Temperature: 37.1 degrees C
2. BP 123/78 HR 93 RR 22 Pox 99%
3. Denies pain
4. Height: 69.5 inches; Weight 87 kg
Laboratory Results
1. WBC: 19.2 (1,000/uL)
2. Lymphocytes 6700 (cells/uL)
3. CT Head shows no changes since previous scan
4. Urinalysis positive for moderate amount of leukocytes and cloudy
5. Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mr. M.’s situation. Include the following:
1. Describe the subjective and objective clinical manifestations present in Mr. M.
2. Based on the information presented in the case scenario, state what primary and secondary medical diagnoses should be considered for Mr. M. Formulate a nursing diagnosis from the medical diagnosis and explain why these should be considered and what data is provided for support.
3. What abnormalities would you expect to find and why when performing your nursing assessment using the identified primary and secondary medical diagnoses.
4. Describe the physical, psychological, and emotional effects Mr. M.’s current health status may have on him. Discuss the impact it can have on his family.
5. Discuss what interventions can be put into place to support Mr. M. and his family.
6. Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide a rationale for each.
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.
Prepare this assignment according to the guidelines 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 toLopesWrite. A link to theLopesWritetechnical support articles is located inClass Resourcesif you need assistance. Neurological, Perceptual, and Cognitive ComplexitiesBy Angel Falkner and Sue Z. Green
Essential Questions
What are the pathophysiological changes and abnormal findings associated with neurological, perceptual, and cognitive dysfunctions?
Which neurological health conditions are most prevalent?
How does the nurse manage these health conditions to restore the patient to optimal health?
What measures can a nurse use to transition patients toward independence in managing their own care?
Introduction
Diseases of the neurologic system are multifaceted, often affecting every aspect of a patient’s life. Insult or injury to the brain can leave a patient with lifelong effects requiring psychosocial and physical adjustments that necessitate a great deal of support. While the nurse should be knowledgeable regarding the details of neurologic diseases, it is equally imperative for the nurse to anticipate the varying needs of neuro patients and provide resources and education to manage their care.
Neurological, Perceptual, and Cognitive Complexities
The brain controls the ability to think, enables awareness of and movement within the surrounding environment, and makes interaction with others possible. The brain’s cognitive abilities depend on sensory nerve input from the body. The various parts of the brain must be able to learn new information, recognize familiar persons and objects, recall past experiences, and apply all of these to current thoughts and actions. The spinal nerves must be intact to receive and send sensory and motor messages within the body and brain. Understanding the complexities of the organ, nerves, and various functions helps the nurse in determining care for a person experiencing altered health in this area. Awareness of normal function triggers the notation of changes in expected neurological activity. Diagnostic testing may lead to diagnosis of a neurological condition, demonstrate response to treatment, or reveal progression of a disorder.
Pathophysiology
Normal Function
The nervous system (NS) is responsible for the complex network of communication in the body through transmission of nerve impulses, an electrical stimulus. The various portions of the system have a variety of functions. The nervous system is divided into the
central nervous system (CNS)
and the
peripheral nervous system (PNS)
(see Figure 2.1). Both the CNS and PNS contain
neurons
, the smallest component of the NS (see Figure 2.2). The neuron has two extensions:
dendrites
and
axons
. Dendrites receive the electrical stimuli and transfer the impulses to the body of the neuron. Axons conduct the impulse away from the neuron body to other cells.
Figure 2.1
Components of the Nervous System
Figure 2.2
Anatomy of a Neuron
The following are examples of NS components with specific corresponding parts and functions:
Components of the brain (see Figure 2.3),
Functions of the brain (see Table 2.1),
Functions of the cranial nerves (see Table 2.2), and
Functions of the spinal nerves (see Figure 2.4).
Figure 2.3
Components of the Brain
Table 2.1
Functions of the Brain
Component of the Brain
Function
Cerebral cortex
Thought, voluntary movement, reasoning, perception.
Outer layer of the brain.
Cerebrum consisting of two hemispheres containing the:
Frontal lobe
Occipital lobe
Parietal lobe
Temporal lobe
The cerebrum is divided into two hemispheres, which control the activities of the opposite sides of the body. For example, the left side of the frontal lobe controls the right side of the body and vice versa.
The frontal lobe directs voluntary skeletal actions, influences talking, writing, emotions, intellect, reasoning ability, judgment, and behavior. The Broca’s area within the lobe is responsible for speech. The frontal lobe contains basal ganglia near the lateral ventricles of both cerebral hemispheres. The basal ganglia are responsible for maintenance of balance and movement.
The occipital lobe is the primary visual receptor center and influences the ability to read and understand the written word.
The parietal lobe interprets touch, pain, temperature, and shapes.
The temporal lobe receives and interprets impulses from the ear. The Wernicke’s area within the lobe is responsible for interpreting auditory stimuli.
Diencephalon consisting of:
Thalamus
Hypothalamus
Integration of sensory and motor information.
The thalamus relays sensory information to the cortex, receives information from the cerebral cortex, and transmits the information to the brain and spinal cord.
The hypothalamus regulates body temperature, pulse, respiration, blood pressure, emotions, circadian rhythms, pain perception, appetite (hunger), and water balance (thirst).
The limbic system, located near the hypothalamus:
Aids in the control of emotions.
Aids learning and memory.
Is located near the hypothalamus.
Includes the amygdala, hippocampus, mammillary bodies, and cingulate gyrus.
Brain stem consisting of:
Midbrain
Pons
Medulla oblongata
The midbrain is the relay center for ear and eye reflexes and impulses from regions higher and lower in the brain and spinal cord.
The pons serves as a link of the cerebellum to the cerebrum and the midbrain to the medulla.
The medulla oblongata controls and regulates respiratory function, heart rate and force, and blood pressure. It contains the nuclei for cranial nerves.
Cerebellum
Smooths voluntary movement.
Maintenance of trunk equilibrium.
Maintenance of muscle tone and posture.
Receives information from the cerebral cortex, inner ear, muscles, and joints.
Note.Adapted from
Medical-Surgical Nursing(10th ed.), by S. L. Lewis, L. Bucher, M. M. Heitkemper, M. M. Harding, J. Kwong, & D. Roberts, 2017; “Function of the Nervous System,” by A. Mandal, 2016; and
Health Assessment in Nursing(6th ed.), by J. R. Weber & J. H. Kelley, 2018.
Table 2.2
Function of the Cranial Nerves
Cranial Nerve
Function
Olfactory
Sensory nerve that carries smell impulses from nasal mucous membrane to the brain.
Optic Sight
Sensory nerve that carries sight impulses from the retina to the brain.
Oculomotor
Motor nerve that carries impulses from the midbrain to the brain to control eyeball movement, pupil constriction, and raising of eyelids through contraction of eye muscles.
Trochlear
Motor nerve that carries impulses to the brain to control the eye’s superior oblique muscle for lateral eye movements.
Trigeminal
Sensorimotor nerve that carries impulses of pain, touch, and temperature from the following three areas to the brain:
Ophthalmic nerve carries impulses from the scalp, forehead, and eyes.
Maxillary nerve carries impulses from the upper jaw, upper lip, and cheeks.
Mandibular nerve carries impulses from the lower jaw and chin with the responses of biting, chewing, and clenching.
Abducens
Motor nerve that carries impulses from the lower pons to control lateral eye movements.
Facial
Sensorimotor nerve that carries impulses to and from the pons for tear production and muscle control for the scalp, face, and ears. Carries taste sensation from the anterior two-thirds of the tongue to the brain with response of stimulation of the salivary glands.
Acoustic (Vestibulocochlear)
Sensory nerve that carries impulses from the cochlea and inner ear for hearing and maintenance of balance.
Glossopharyngeal
Sensorimotor nerve that carries taste sensation from the back of the tongue and throat to the medulla with the response of increased secretion of saliva and swallowing.
Vagus
Sensorimotor nerve that carries impulses from the chest and abdominal organs to the medulla to monitor oxygen, carbon dioxide, and pH levels of the blood with the responses related to cardiac action, talking, swallowing, digestive juice production, and gastrointestinal activity.
Spinal Accessory
Motor nerve in the medulla and cervical cord that controls the sternocleidomastoid and trapezius muscles for head rotation and movement of shoulders and larynx.
Hypoglossal
Motor nerve in the medulla that controls muscles of the tongue for talking, swallowing, and movement of food in the mouth.
Note.Adapted from “Function of the Nervous System,” by A. Mandal, 2016; and
Health Assessment in Nursing(6th ed.), by J. R. Weber & J. H. Kelley, 2018.
Figure 2.4
Functions of the Spinal Nerves
Note. Adapted from
Understanding Pathophysiology(6th ed.), by S. E. Huether, K. L. McCance, V. L. Brashers, & N. S. Rote, 2017.
Central Nervous System
The CNS involves the brain, spinal cord, and olfactory and optic nerves (cranial nerves I and II) (Lewis et al., 2017). The CNS communicates through neurons to take in all sensory information, maintain memory, and control bodily functioning and regulation. A sensory electrical impulse travels from neuron to neuron across synapses until it reaches its destinationthe brain or the spinal cord. After the sensory impulse arrives at its destination, a motor impulse is sent in return to illicit skeletal muscle function. The
reflex arc
within the spinal cord provides for immediate reaction to a potentially harmful stimulus. For example, if something feels too hot to the hand, a message is sent to the spinal cord, instead of forwarding to the brain, so that an immediate response is triggered to remove the hand (see Figure 2.5). The automatic action of blinking is another example of this involuntary response (Mandal, 2016). The CNS, particularly the brain, also controls sleep, thought, language, creativity, expression, emotions, personality, and memory (Huether, McCance, Brashers, & Rote, 2017; Taylor, n.d.).
Figure 2.5
Reflex Arc
Peripheral Nervous System
The PNS includes the cranial and spinal nerves and
ganglia
(Lewis et al., 2017; Taylor, n.d.). The PNS is further divided into the
autonomic nervous system (ANS)
and
somatic nervous system
(Mandal, 2017). The somatic nervous system portion of the PNS controls voluntary skeletal muscle movement. The ANS portion commands the
sympathetic nervous system (SNS)
and
parasympathetic nervous system (PSNS)
. The SNS triggers the body’s energy mechanisms in response to stress, eliciting either fight or flight when confronted with a stressor (e.g., if faced with a bear in the woods, the reaction is to take flight and run from the impending danger) (Taylor, n.d.). Stressors include danger, excitement, emotions, embarrassment, or exercise (Taylor, n.d.). The sympathetic response increases respirations and heart rate, releases hormones (such as adrenaline), increases glucose production and release, and decreases digestion as a means of coping with the stress (see Figure 2.6) (Taylor, n.d.).
Figure 2.6
Sympathetic System
The PSNS responses are opposite of the SNS. The PSNS triggers the body’s relaxation response mechanisms (Lewis et al., 2017). The PSNS decreases respirations and heart rate and increases digestion (see Figure 2.7) (Taylor, n.d.). For example, after the stimulus is removed for a fight or flight
sympathetic response, the PSNS restores the heart rate and breathing to previous normal rates.
Figure 2.7
Parasympathetic System
Abnormal Findings
Disruption of normal NS function can occur through an interruption of nerve impulses. This can occur for a variety of reasons, including trauma, infection, cell death caused by oxygen deprivation, diseases or genetic processes, and inflammatory processes. Signs and symptoms also vary depending on the cause. Various common diagnostic tests are commonly used to determine the cause of the dysfunction or monitoring progress for either deterioration or improvements in function (see Table 2.3). This testing leads to diagnosis of some NS dysfunctions that are among the leading causes of death or disability, such stroke or Alzheimer’s disease. For example, if an infection is suspected, a lumbar puncture may be performed. If a stroke is suspected, the person is likely to undergo radiologic studies, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI).
Table 2.3
Common Neurological Diagnostic Tests
Category of Testing
Diagnostic Test
Abnormal Finding
Electrographic Studies
Electroencephalography (EEG)
Brain death, cerebral disease, CNS effects of systemic diseases, or seizure disorders.
Electromyography (EMG)
Detection of lower neuron dysfunction, primary muscle disease, or peripheral vessel disease.
Evoked potentials
Detection of abnormal nerve conduction to diagnose disease, such as multiple sclerosis, or locate nerve damage. May monitor nerve conduction during surgery.
Magnetoencephalography (MEG) and nerve conduction studies
Pinpoints part of the brain involved in a seizure, stroke, or other disorder or injury.
Lumbar Puncture
Cerebrospinal fluid analysis
Fluid that is cloudy, has odor, abnormal specific gravity or pH, presence of red blood cells or microorganisms, abnormal level of white blood cells, glucose, or protein. Higher or lower than normal pressure reading.
Radiologic Studies
Skull and spinal column x-ray
Abnormal vascularity, bone erosion, calcifications, fractures.
Cerebral angiography
Vascular lesions or tumors in the brain.
Computed tomography (CT) scan
Brain atrophy, cysts, edema, hemorrhage, infarction, tumor, or other abnormalities.
Magnetic resonance angiography (MRA)
Abnormal blood flow in the extracranial or intracranial blood vessels.
Magnetic resonance imaging (MRI)
Herniation, multiple sclerosis, seizures, stroke, trauma, tumors.
Myelogram
X-ray with contrast to reveal spinal lesions, such as a herniated or ruptured disc or a spinal tumor.
Positron emission tomography (PET)
Radioactive materials injected in the scan procedure for diagnosis of Alzheimers disease, Parkinsons disease, seizure disorders, stroke, and tumors.
Single-photon emission computed tomography (SPECT)
Radioactive materials injected in the scan procedure to visualize blood flow or glucose utilization. Used in the diagnosis of brain tumor, seizure disorder, and stroke.
Ultrasound
Carotid duplex studies
Increased blood flow velocity indicates stenosis of carotid artery.
Transcranial Doppler
Used to determine intracranial blood flow velocity.
Note.Adapted from
Medical-Surgical Nursing(10th ed.), by S. L. Lewis, L. Bucher, M. M. Heitkemper, M. M. Harding, J. Kwong, & D. Roberts, 2017.
Prevalent Problems
Stroke (CVA)
A stroke or brain attack
occurs when blood flow to an area of the brain is halted by a rupture (
hemorrhagic stroke
) or a
thrombus
(
ischemic stroke
) in a blood vessel supplying the area. When the blood flow ceases, the area of the brain is deprived of oxygen, and brain cells begin to die, also known as a
cerebrovascular accident (CVA)
. The functions of that area of the brain are diminished or lost because of brain cell death and reduction in NS ability to transmit impulses. A
transient ischemic attack (TIA)
occurs when there is a temporary interruption of the blood flow. For example, the person may have temporary weakness of an arm, leg, or one side of the body, or lose aspects of memory or ability to speak, depending on the site and severity of the stroke (National Stroke Association, n.d.g). According to the Centers for Disease Control and Prevention (CDC):
1. every 4 minutes someone dies from a CVA,
2. CVA is the leading cause of adult disability in the United States, and
3. up to 80% of CVAs are preventable (CDC, 2017c).
CVA is the fifth leading cause of death in the United States (CDC, 2017a). Strokes usually occur suddenly and require prompt recognition and medical treatment. The sudden signs and symptoms of stroke include:
numbness or weakness in the face, arm, or leg, especially on one side of the body;
confusion, trouble speaking, or difficulty understanding speech;
trouble seeing in one or both eyes;
trouble walking, dizziness, loss of balance, or lack of coordination; and
severe headache with no known cause (CDC, 2018; National Stroke Association, n.d.d).
Diminishing the long-lasting effects of a CVA depends on rapid recognition and quick interventions. The acronym FAST is useful for the awareness of the public and health care professionals that quick intervention is needed, preferably within 3 hours of the first symptoms. The assessment elements included in the FAST test are explained in Figure 2.8.
Figure 2.8
FAST Intervention
Note.Adapted from “Stroke Signs and Symptoms,” by the Centers for Disease Control and Prevention, 2018.
Stroke-like symptoms can occur with a TIA, and rapid intervention should still occur because it is unknown which condition is occurring (National Stroke Association, n.d.a). A TIA left untreated may lead to a major CVA that may lead to permanent lifelong effects or even death.
Once the patient has been identified as a possible CVA victim, the first diagnostic test to be completed upon arrival to a
certified stroke hospital
is a noncontrast CT scan. This is done to identify whether the CVA is hemorrhagic or ischemic. If the CVA is identified as ischemic there are several lifesaving treatment options that are available. The identification of CVA symptoms and subsequent type of stroke within the 3-hour window enables the practitioner to consider treatment with the intravenous drug
tissue plasminogen activator (tPA)
, which has the capacity to reduce or eliminate life altering symptoms associated with stroke (Cheng & Kim, 2015). This medication is sometimes referred to as the
clot busterbecause its quite literally breaks down the clot that is impeding blood flow to the brain (Cheng & Kim, 2015). Another option for treatment of an ischemic stroke is the endoscopic retrieval of the clot, which may be done in combination with tPA (Mayo Clinic, n.d.).
If the patient is diagnosed with a hemorrhagic stroke, the treatment involves close monitoring of the size of the bleeding within the brain through frequent neurologic assessments and CT scans, as well as discontinuing any medications that may increase risk of bleeding. Treatment also involves tight control of the patient’s blood pressure, treatment with
anticonvulsant medications
to prevent seizures, and
osmotic diuretics
to decrease
intracranial pressure
(Liebeskind, 2017). The patient may be a candidate for surgery, in which the hematoma within the brain is removed and the blood vessels within the area are repaired (Weill Cornell Brain and Spine Center, 2017).
Dementia/Alzheimer’s Disease
Dementia
is a non-age-related decline in cognitive abilities caused by damage to the cerebral hemispheres and subcortical areas for memory and learning (Porth, 2014). The damage is caused by direct trauma, stroke,
Alzheimer’s disease
,
or similar permanent conditions. The impaired cognitive function becomes apparent because of memory disorders, personality changes, and impaired reasoning. Alzheimers disease causes 60% to 80% of all dementia (Porth, 2014). Alzheimer’s dementia is progressive, with symptoms gradually worsening over a number of years. Initially, mild memory loss occurs, but in the final stage the person loses ability to respond to persons or the environment and leads to death. Alzheimers disease is the sixth leading cause of death in the United States (CDC, 2017a). Extracellular amyloid plaques, intracellular neurofibrillary tangles (NFTs), and neuronal death synaptic deterioration, occurs with Alzheimers disease (Ulep, Saraon, & McLea, 2017) (see Figure 2.9).
Figure 2.9
Comparison of a Healthy Brain and Alzheimer’s Brain
Clinical signs and symptoms along with neuropsychological testing and biomarkers can lead to diagnosis of Alzheimers disease (Ulep et al., 2017). Early signs and symptoms of Alzheimers disease include:
Changes in mood, such as depression or other behavior and personality changes;
Confusion with location or passage of time;
Difficulty concentrating, planning, or problem-solving;
Having visual or space difficulties, such as not understanding distance in driving, getting lost, or misplacing items;
Language problems, such as word-finding problems or reduced vocabulary in speech or writing;
Memory impairment, such as difficulty remembering events;
Problems finishing daily tasks at home or at work;
Using poor judgment in decisions;
Withdrawal from work events or social engagements. (Mayo Clinic Staff , 2016, para. 3)
Risk factors for Alzheimers disease include head injury, hypertension, genetics, obesity, older age, sedentary lifestyle, smoking, and type 2 diabetes (Ulep et al., 2017). On average, persons with Alzheimers disease live 8 years after diagnosis, but the range is from 4 to 20 years (Alzheimer’s Association, n.d.d; Ulep et al., 2017). Three stages are noted for the disease’s progression (see Table 2.4).
Table 2.4
Stages of Alzheimer’s Disease
Stage of Alzheimer’s Disease
Signs and Symptoms of Stage
Mild Alzheimer’s Disease (Early Stage)
Challenges performing tasks in social or work settings.
Forgetting material that one has just read.
Losing or misplacing a valuable object.
Problems coming up with the right word or name.
Trouble remembering names when introduced to new people.
Increasing trouble with planning or organizing.
Moderate Alzheimer’s Disease (Middle Stage)
An increased risk of wandering and becoming lost.
Being unable to recall their own address or telephone number or the high school or college from which they graduated.
Changes in sleep patterns, such as sleeping during the day and becoming restless at night.
Confusion about where one is or what day it is.
Feeling moody or withdrawn, especially in socially or mentally challenging situations.
Forgetfulness of events or about one’s own personal history.
Personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior like hand wringing or tissue shredding.
The need for help choosing proper clothing for the season or the occasion.
Trouble controlling bladder and bowels in some individuals.
Severe Alzheimer’s Disease (Late Stage)
Become vulnerable to infections, especially pneumonia.
Experience changes in physical abilities, including the ability to walk, sit, and eventually, swallow.
Have increasing difficulty communicating.
Lose awareness of recent experiences as well as of their surroundings.
Need round-the-clock assistance with daily activities and personal care.
Note.Adapted from “Stages of Alzheimer’s,” by the Alzheimer’s Organization, found at https://www.alz.org/alzheimers-dementia/stages
Currently, there is no cure or reversal for AD. Medications prescribed to treat the cognitive symptoms are memantine, cholinesterase inhibitors, such as donepezil, galantamine, and rivastigmine, or Namzaric, which is a combination of donepezil and memantine (Alzheimer’s Association, n.d.c; Ulep et al., 2017). Treatment is focused on supportive and palliative care of the patient and their caregivers.
Alzheimer’s Disease
Theodore received a call from a police officer when his mother, Aubrey, was found wandering the parking lot of a local grocery store, unable to recall the make, model, or color of her car and other information, such as the day of the week or her address. The officer was able to locate Theodore’s contact information from Aubrey’s wallet. Theodore had noticed that his mother had increasing difficulty with remembering new information or finding objects, but he thought this was a normal part of his mother’s aging. Shortly after this, Aubrey was diagnosed with moderate Alzheimer’s disease and placed on memantine. Theodore explored safer living environments for his mother, eventually moving her to an extended care unit specializing in the care of those with Alzheimer’s disease.
Check for Understanding
1. What symptoms alert the nurse that a person may be experiencing dementia?
2. What are priority nursing actions when a person exhibits signs and symptoms of a CVA?
Nursing Management
Restoration of Function
Restoration of function has various implications depending on the disease or condition affecting the NS of the patient. Acute care of a stroke includes stabilization and aggressive treatment if indicated, then initiation of supportive services, such as physical, occupational, and speech therapies, to begin restoration of function to any areas of deficit. Care for a patient with Alzheimers disease or dementia attempts to maintain health and functioning as long as possible. Interventions center on improving quality of life and maximizing cognitive and physical functioning. When caring for a patient with dementia, the nurse should be aware that dementia may heighten pain sensitivity (Hadjistavropoulos et al., 2014). A pain assessment tool, such as the Pain Assessment in Advanced Dementia tool (PAINAD), assists the nurse in assessment of the pain and comfort level in a patient with dementia (Cornelius, Herr, Gordon, & Kretzer, 2017; Lopez & Molony, 2018; Schofield, 2017; Warden, Hurley, & Volicer, 2003) (see Table 2.5).
Table 2.5
PAINAD Scale
Behavior
Score of 0
Score of 1
Score of 2
Score
Breathing Normal Independent of Vocalization
Normal
Occasional labored breathing. Short period of hyperventilation.
Noisy labored breathing. Long period of hyperventilation. Cheyne-Stokes respirations.
Negative Vocalization
None
Occasional moan or groan. Low-level speech with a negative or disapproving quality.
Repeated troubled calling out. Loud moaning or groaning. Crying.
Facial Expression
Smiling or inexpressive
Sad. Frightened. Frown.
Facial grimacing.
Body Language
Relaxed
Tense. Distressed.
Pacing. Fidgeting.
Rigid. Fists clenched. Knees pulled up. Pulling or pushing away. Striking out.
Consolability
No need to console
Distracted or reassured by voice or touch.
Unable to console, distract or reassure.
Total:
Scoring
The total range: 0-10 points. Total score interpretation: 0 = No Pain and 10 = Severe Pain. Range interpretation: Mild Pain = 0-3, Moderate Pain = 4-6, and Severe Pain = 7-10.
Note. Adapted from “Development and Psychometric Evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale,” by V. Warden, A. C. Hurley, & L. Volicer, 2003,
Journal of the American Medical Directors Association,
4,9-15.
Nutritional Considerations
A healthy nutritional status is a challenge when cognitive changes occur. Maintenance of weight is aided when snack foods are selected that can increase energy and protein intake without increasing volume. These foods may be modified to include butter, cream, grated cheese, milk powder, protein powders, or oral supplements (Lopez & Molony, 2018). Food for snacks and meals should be ones that the person with dementia enjoys and
SHOW MORE…
IFE
The company is Starbucks
Construct an IFE (Internal Factor Evaluation) Matrix by doing the following:
Step 1: See Chapter 4 of the David text to learn how to complete an IFE Matrix.
Step 2: Open your Strategic-Planning Template. Click on the IFE tab at the bottom of the template
Step 3: Use the pertinent data on your company to complete the IFE Matrix in your Strategic-Planning Template.
Step 5: In 250-500 words, address the following prompts:
What strategies do you think would allow the firm to capitalize on its major strengths?
What strategies would allow the firm to improve on its major weaknesses?
PART I
Welcome to the Free Excel Student Template Version 18.1
Dear Student,
By using this Template, you hereby agree to the Copyright terms and conditions. This Template should save you considerable time and allow for your presentation to be more professional. Do not mistake this Template for doing all of the work. Your assignment is to analyze and present strategies for the next three years. You will still need to do the research and enter key internal and external information into the Template. The Template does not gather or prioritize information. It does however assimilate information you enter in a professional way and does many calculations for you once that critical information is entered. Refer to the David & David textbook for conceptual guidelines for developing all matrices and analyses included in this Template. Best of luck with your project. This Template is designed for Textbook editions 17ed and 18th.
Instructions for Using the Template
1
Please read all Template instructions below carefully before you start each new section of this Template. Only type in the green boxes. Refer to the David, David & David textbook for conceptual guidelines for every matrix and analysis in this Template.
2
This Template is organized into three primary parts: Part I, Part II, and the respective data output pages for your respective matrices. All data entered will be entered into Part I or Part II. Part I consists of data entry in developing matrices, where Part II consists of data entry for your financial information, including ratios, financial statements, and projected financial statements. Blue buttons are provided for navigating within and to Part I, yellow buttons are for navigating within and to Part II, orange buttons are for navigating to the respective matrices and pink buttons are for navigating to your financial output tables. The navigation buttons along the top of Part I and Part II may not be visible for Apple users but all other features should work without any problems.
Strengths and Weaknesses
1
Enter into the Template exactly 10 strengths and 10 weaknesses, no more and no less. Your factors should be detailed and actionable rather than vague. For example, the strength: “Sales up nicely” is too vague and not actionable; “Sales were up 15% on women’s apparel in China during 2018” is stated far better. Always be thinking in terms of divisions when writing strengths and weaknesses. Note women’s apparel could be a division for Nike. All divisions do not need to be treated equally; allow more coverage for divisions with more revenue and those most pertinent to your strategic plan.
2
Weights reveal how important a factor is to being successful in the industry. All weights are “industry-based.” A factor of 0.10 for example is 5 times more important than a factor of 0.02 for being successful in the industry. Do not be afraid to include factors with lower weights though. To have a factor make your top 10 list (10 strengths for example out of the 100s the firm likely has), justifies its importance, yet it still may be relatively a lot less important to the industry than others factors you include. Also, be mindful with respect to what industry your firm operates. A moderate priced casual hamburger restaurant may have more in common with a moderate priced chicken restaurant than with McDonalds (cheaper fastfood). Automatically considering McDonalds, Burger King, and Wendy’s as the “industry” just because they all sell hamburgers may not be appropriate. Here, casual moderated priced restaurants may serve better as the “industry.” After entering in the weights, check to make sure the sum of your weights equals 1.0 for your internal factors. Also, arrange your strengths with highly weighted factors listed first; arrange your Weaknesses also with highest weighted factors listed first.
3
In contrast to weights that are industry-based, ratings are company-based and reveal how well your firm is performing. Use the coding scheme given below for ratings in an IFE Matrix: If your strengths are being cut off, simply drag your cursor between the two row numbers on the left to widen the row.
1 = “the response is poor”
2 = “the response is average
3 = “the response is above average”
4 = “the response is superior”
Strengths
Weight
Rating
Actionable
Quantitative
Comparative
Divisional
1
Direct owner ship of 51% of stores
1
y
y
y
y
2
Q2 2018 Same store sales increase 2% globally/4% in China, record profit 6B
2
y
y
y
y
3
Pay employees well, above average pay, Stock options, Parental leave options
2
y
y
y
y
4
Supply Chain Management (consistent quality in raw materials, and flow)
2
y
n
y
y
5
Product Quality and consitency
2
y
n
y
y
6
Ethical Business Values
2
y
n
y
y
7
Brand Equity – Well known brand
1
y
y
y
8
Operational effiicency, and solid Financal Performance – increasing profits (operating margin 6.5% vs industry avg of 5%)
1
y
y
y
y
9
Customer loyalty programs, and chase visa rewards program (53% of us corp store sales)
3
y
y
y
y
10
Reinvestment Strategy, long term stratgeic planning – Multi-faceted strategic plan per region
1
y
y
y
y
Weaknesses
Weight
Rating
Actionable
Quantitative
Comparative
Divisional
1
Emea Market, 11% decline in operating profits 2018
1
y
y
y
y
2
SBUX is highly dependent on the financail performance on North America (77% of profit)
y
y
y
y
3
Higher prices than competition(38% higher)
y
y
y
y
4
Products are not very distinct, other franchises have nearly identical products – Mcdonalds McCafe, Dunkin Donuts and a greater varierty to draw in customers
y
y
y
5
Product Recalls have had detrimental impact on the brand
y
n
y
y
6
Issues with European taxes not being paid ( UK no taxes on 1.2B pounds in 2011-2012)
y
y
y
y
7
Product Standards – unhealthy products, Starbucks built brand on flavoured and sweetened items, does not meet some cultural norms and are high calories, overdependence on coffee products
1
y
y
y
y
8
Starbucks rely’s on foot traffic, not pandemic friendly
n
y
y
9
volatile supply costs
n
n
y
y
10
Customer base is mid to upper calls wage earners
y
y
y
y
Total Weight (Must Equal 1.00)
0.00
0.7725550225
Opportunities and Threats
1
Enter into this Template exactly 10 opportunities and 10 threats, no more no less. Your factors should be detailed and actionable rather than vague. Keep in mind both opportunities and threats should be external in nature. Ask yourself “Does the firm have control over this factor?” If the answer is yes, then it cannot be an opportunity or threat. For example, as a clothing retailer you may have an opportunity to “start selling clothes in China.” This is not an opportunity for two reasons: 1) the firm has internal control over doing business in China, and 2) the statement is a strategy. The underlying opportunity may be “Women in China spent 20% more on athletic apparel in 2018.” Note how this opportunity is specific, actionable, divisional, and external (we cannot control the culture or demand for female athletic apparel). All divisions do not need to be treated equally, allow more coverage for divisions with more revenue and those most pertinent to your strategic plan.
2
Weights reveal how important a factor is to being successful in the industry. Read over the #2 tip under strengths and weaknesses above since the same logic applies for the external factors. After entering in the weights, check to make sure your sum of weights equals 1.0 for all 20 external factors. List factors according with highest weight items first.
3
Ratings again are company-based and reflect how well the firm is addressing the particular factor. Use the coding scheme given below for ratings in an EFE Matrix. If your opportunities are being cut off, simply drag your cursor between the two row numbers on the left to widen the row.
1 = the response is poor”
2 = “the response is average”
3 = “the response is above average”
4 = “the response is superior”
Opportunities
SF
Weight
Rating
WR
Actionable
Quantitive
Comparable
Divsional
1
Premium Experience at Reserve stores with Princi, expand bar service, premium food options
5
0.04
3
0.1063829787
Y
N
Y
y
2
Coffee subscription (Circle K- 200% increase in foot trffic, 70% increaseif food sales, 90-95%RenewAL RATE)
8
0.06
4
0.2269503546
y
Y
y
y
3
Diversification into more products beyond Coffee and Tea into more food products
8
0.06
2
0.1134751773
Y
N
Y
n
4
Emerging markets – enter markets with limited competition, adapt to local markets – ex McDonalds in India does not sell beef, but has ventured into the vegetarian food market.
7
0.05
3
0.1489361702
y
y
y
5
competitive pricing
5
0.04
3
0.1063829787
Y
y
y
6
Follow latest drink trends
9
0.06
3
0.1914893617
y
y
y
7
steady forcast for reveune growth/consumption growth
8
0.06
1
0.0567375887
n
n
n
n
8
Business partnerships and alliances (potentially responsible for sales by 1/3)
4
0.03
3
0.085106383
y
n
y
y
9
Faster Service – Corrective measures to fix long lines – more advanced Machines?
9
0.06
4
0.2553191489
y
y
y
y
10
SelfService Machines
7
0.05
4
0.1985815603
y
y
y
y
Threats
Weight
Rating
1
Dunkin Donuts 2nd in market shars inUSA, and growing with coffe adjacent products
7
0.05
4
0.1985815603
y
y
y
y
2
McDonalds 2nd in market share globally
7
0.05
4
0.1985815603
y
y
y
y
3
Sales decline due to decline in customer traffic
9
0.06
3
0.1914893617
n
n
y
y
4
Brand Relevance – Business incedents (Unionization)
6
0.04
3
0.1276595745
y
n
y
y
5
evolving consumer preferences and tastes
8
0.06
3
0.170212766
y
n
y
y
6
Cyber Security and Data Privacy
4
0.03
3
0.085106383
y
n
y
y
7
Pandemic/Global Recession – temporary clsoed 2K stores in China, 50% of corp stores and 43% ofl licensed stores-lost 915M+ sofar (June 2021)
8
0.06
3
0.170212766
n
y
y
y
8
Increased costs to maintain supply chains, and raw material costs, and high
5
0.04
4
0.1418439716
y
y
y
y
9
Competition from local favourite brands(incumbents) , EMEA has a different coffee culture
9
0.06
3
0.1914893617
n
y
y
y
10
Executive Changeover – Chief Exceutive (Howard Shultz) retiring for the 3rd time
8
0.06
1
0.0567375887
n
n
y
n
141
Total Weight (Must Equal 1.00)
1.00
Competitive Profile Matrix (CPM)
1
To perform the CPM, enter up to 12 critical success factors. You may use some of the ones listed below if you like but try to use ones that are more pertinent to your company. For example, if your case is Delta Airlines, perhaps include on time arrival, extra fees, and frequent flyer points as factors, rather than the canned factors below. In a CPM, factors do not need to be overly specific, but they should be divisional in nature to the extent possible. If Pepsi Co. is your firm, your factors should be about the firm’s soda business, Frito Lay business, bottling business, etc. (Pepsi Co competes in a lot more than just soda) rather than just general “advertising.” Advertising for what division (business) are you referring to? Frito Lay’s advertising, soda marketing, etc. All divisions do not need to be treated equally; allow more coverage for divisions with more revenue and those most pertinent to your strategic plan.
2
After entering in your critical success factors, enter in a weight for each factor; weights are industry-based. Be sure to check the bottom of the “Enter Weight Below” column, to make sure your sum weight is equal to 1.00. It is okay for some factors to receive a low weight and a factor or two to receive a high weight of say 0.20.
3
After entering in your weights, type the name of your company and two other competitors in the corresponding boxes.
4
After entering in the weights and identifying your company and two rival firms, then enter in a Rating (company-based) in the “Enter Rating Below” column for each organization. DO NOT ASSIGN THE COMPANIES THE SAME RATING; TAKE A STAND; MAKE A CHOICE. In a CPM, use the coding scheme provided below for ratings.
1 = “the response is poor”
2 = “the response is average”
3 = “the response is above average”
4 = “the response is superior”
Enter 12 Factors Below
Weight
Your Firm
Rival
Rival
Enter Ratings Below
Advertising
Domestic Market Penetration
Customer Service
Product Variety
International Market Penetration
Employee Dedication
Financial Profit
Customer Loyalty
Market Share
Product Quality
Top Management
Price Competitiveness
0.00
Boston Consulting Group (BCG) Matrix
1
This Template allows for up to 5 divisions. If your company has more than 5 divisions, combine the divisions with the least amount of revenue into division 5, and mention the adjustment to the class during your presentation, or simply focus on the 5 divisions your 3-year plan centers around; check with your professor.
2
In each division, enter a name, followed by the dollar amount in revenues for that division. Do not include M or B for millions or billions, but do drop off zeros. For example, for $100,000,000, you could enter $100,000 or $100, just be consistent.
3
After completing Step 2 in developing a BCG, enter in the dollar amount in revenues for the top rival firm for each division. Note, the top rival may be you and in this situation enter in your company’s revenue for that division. Also, note the top rival may be different for different divisions. For example, if your firm is Avon, Avon’s top rival in its lipstick division may be Revlon, but for nail polish, the top rival in the industry may be L’Oral, and in makeup, Avon may be the market leader. There is no need to label the top rival by name, but you could mention in class as part of your presentation. Be sure to enter in all numbers in the same $ format you used in Step 2 above. If you do not have a perfect apples to apples comparison, (possibly a rival firm combines lipstick and makeup, where your firm separates the two) then estimate as best you can and make note in your presentation.
4
Finally, enter in the industry growth rate (IGR) for each division. Generally, taking the top 2 or 3 rivals for each division (along with your firm), adding their numbers together for the current year and the previous year and using the equation (Current Year – Previous Year) / Previous Year is sufficient to estimate guess of the industry growth rate. This is because generally the top 3 players dominate an industry. Note, using this process also weights larger firms more, which is exactly what you desire. Do not use total revenues; instead, use divisional revenues. Division industry growth rates (IGR) must be between -0.20 and 0.20. If outside these ranges, simply use -0.20 or 0.20 and mention during your presentation.
5
Everything is calculated and positioned for you (Other than Industry Growth Rate in Step 4) including the Relative Market Share Position (RMSP). The BCG matrix in this Template does not produce pie slices to show profits. You may wish to discuss divisional profits in your presentation.
Enter in division names below (If less than 5, leave the other spaces blank and no circles will appear)
Your Firm’s Division Revenues
Top Firm in Industry Division Revenues
Division Market Growth Rate (Step 4)
Relative Market Share Position
NA
NA
NA
NA
NA
Internal – External (IE) Matrix
1
This Template allows for up to 5 divisions. If the company has more than 5 divisions, combine the divisions with the least amount of revenue into division 5, and mention the adjustment to the class during your presentation, or simply focus on the 5 divisions that your 3-year plan centers around; check with your professor.
2
Company wide EFE and IFE scores are automatically entered once you complete the EFE and IFE Matrices.
3
Enter in estimated EFE and IFE Scores for your respective divisions.
4
This Template’s IE matrix does not produce pie slices to show profits.
Enter The Name Of Your Firm
Enter in division names below. If less than 5, leave the other spaces blank and no circles will appear. Remember you could use divisions by geographic region for the BCG and by product/service type for the IE (or vice versa).
Your Firm’s Division Revenues
Estimated IFE Score
Estimated EFE Score
SPACE Matrix
1
Include up to five factors to assess each SPACE axis: Financial Position (FP), Stability Position (SP), Competitive Position (CP), and Industry Position (IP) and the corresponding rating each factor should receive.
2
You may use the factors provided here, but try to determine key factors related to your company and industry in the same manner you did with the CPM. The calculations are done automatically and the rating scale is provided below.
3
Enter in the estimated FP, SP, CP, and IP numbers for up to two competitors. Or, instead of a competitor, you could show the estimated SPACE values for your firm after your proposed recommendations are implemented, ie a Before and After analysis. Or you could do both, just cut and paste the SPACE into PowerPoint then refill in the new data. It is important you fill in all information or Excel will place a circle(s) at the origin of the SPACE since the default will be (0,0) plot, which is the origin.
FP and IP
Positive 1 (worst) to Positive 7 (best)
CP and SP
Negative 1 (best) to Negative 7 (worst)
Enter The Name Of Your Firm
Ratings
Financial Position (FP)
Current Ratio
Debt to Equity
Net Income
Revenue
Inventory Turnover
Industry Position (IP)
Growth Potential
Financial Stability
Ease of Entry into Market
Resource Utilization
Profit Potential
Ratings
Competitive Position (CP)
Market Share
Product Quality
Customer Loyalty
Variety of Products Offered
Control over Suppliers and Distributors
Stability Position (SP)
Rate of Inflation
Technological Changes
Price Elasticity of Demand
Competitive Pressure
Barriers to Entry into Market
Your firm’s X-axis
0.0
Your firm’s Y-axis
0.0
Estimated FP
Estimated IP
Estimated CP
Estimated SP
Competitor 1’s X-axis
0.0
Competitor 1’s Y-axis
0.0
Estimated FP
Estimated IP
Estimated CP
Estimated SP
Competitor 2’s X-axis
0.0
Competitor 2’s Y-axis
0.0
Perceptual Map
1
In this Template’s Perceptual Map, you may include for up to 10 product categories.
2
Enter in the X axis and Y axis dimensions. For example, if developing a map for frozen foods your X axis could range from “low calorie” to “high calorie,” while the Y axis ranges from “low cost” to “high cost.”
3
Enter in the products you wish to compare (up to 10); in the example, these products would be different brands of frozen foods available for purchase. After entering in the products, rate each factor on a scale of 1 to 9. In our example, extremely low calorie would receive a score of 1 or 2, and likewise extremely high calorie should receive a score of 8 or 9.
4
To enhance this analysis, you could mentally draw a line (or two lines) of best fit (through products) and identify areas along the line that do not have (in this example) frozen food products near the line. In this analysis, blank areas of the map are typically the most advantageous for new product creation. Any products that fall well above or below the line, may be over or under serving customers and should be examined closely. Do not blindly follow this rule of thumb however since, for example, a very expensive product may be well off the projected best fit line and yet serve its small customer base quite well. You may with this Template wish to develop several perceptual maps changing your X and Y dimensions. For example, if you are a large food processor, you could examine frozen foods on dimensions other than the ones used here, or you could examine dairy products or any other related products. Simply cut and paste your existing map into Power Point then enter your data for a new map.
Enter The Name of the Dimensions on the X-axis
Enter The Name of the Dimensions on the Y-axis
Enter in up to 10 products
X – axis Rating
Y – axis Rating
Grand Strategy Matrix
1
The Grand Strategy Matrix allows for entry of your firm and up to 5 divisions
2
Rank the X axis from 1 (Extremely Weak Competitive Position) to 9 (Extremely Strong Competitive Position)
3
Rank the Y axis from 1 (Extremely Slow Market Growth) to 9 (Extremely Rapid Market Growth)
X-axis score
Y-axis score
SWOT
1
Click on the SWOT Hyperlink below and add your SLOWEST, and WT Strategies.
QSPM
1.
To perform a QSPM, enter two strategies in the corresponding green boxes below. These two strategies should be derived from your BCG, IE, SPACE, GRAND, and SWOT. In your oral or written project, you will need to provide a recommendations page(s) on your own with the expected cost of each recommendation, ie after performing the QSPM. The recommendations page is followed by an EPS/EBIT Analysis to reveal where best to obtain the needed capital (debt vs equity). You should have multiple recommendations, including perhaps both strategies included in the QSPM, and other strategies for the firm – but no firm can do everything that would benefit the firm due to limited resources.
2.
In developing a QSPM, after entering in your strategies, then rate each strategy based on the strengths, weaknesses, opportunities, and threats (factors). Do not give two strategies the same rating for a particular strength, weakness, opportunity, or threat. (the exception is if you enter 0 to signify a factor “not impacting the choice between strategies” then you MUST enter 0 for both strategies. For example, if Strategy 1 deserves a rating of 4 on a given factor, but that factor has little to do with Strategy 2, just assign a rating of 1 to Strategy 2. (Note QSPM’s will have 0’s across about one half of the rows). Across each row in performing QSPM analysis, use the rating scale below for AS scores.
0 = Not applicable
Strategy One
Strategy Two
1 = Not attractive
2 = Somewhat attractive
3 = Reasonably attractive
4 = Highly attractive
AS Ratings
AS Ratings
Strengths
1
Direct owner ship of 51% of stores
2
Q2 2018 Same store sales increase 2% globally/4% in China, record profit 6B
3
Pay employees well, above average pay, Stock options, Parental leave options
4
Supply Chain Management (consistent quality in raw materials, and flow)
5
Product Quality and consitency
6
Ethical Business Values
7
Brand Equity – Well known brand
8
Operational effiicency, and solid Financal Performance – increasing profits (operating margin 6.5% vs industry avg of 5%)
9
Customer loyalty programs, and chase visa rewards program (53% of us corp store sales)
10
Reinvestment Strategy, long term stratgeic planning – Multi-faceted strategic plan per region
AS Ratings
AS Ratings
Weaknesses
1
Emea Market, 11% decline in operating profits 2018
2
SBUX is highly dependent on the financail performance on North America (77% of profit)
3
Higher prices than competition(38% higher)
4
Products are not very distinct, other franchises have nearly identical products – Mcdonalds McCafe, Dunkin Donuts and a greater varierty to draw in customers
5
Product Recalls have had detrimental impact on the brand
6
Issues with European taxes not being paid ( UK no taxes on 1.2B pounds in 2011-2012)
7
Product Standards – unhealthy products, Starbucks built brand on flavoured and sweetened items, does not meet some cultural norms and are high calories, overdependence on coffee products
8
Starbucks rely’s on foot traffic, not pandemic friendly
9
volatile supply costs
10
Customer base is mid to upper calls wage earners
AS Ratings
AS Ratings
Opportunities
1
Premium Experience at Reserve stores with Princi, expand bar service, premium food options
2
Coffee subscription (Circle K- 200% increase in foot trffic, 70% increaseif food sales, 90-95%RenewAL RATE)
3
Diversification into more products beyond Coffee and Tea into more food products
4
Emerging markets – enter markets with limited competition, adapt to local markets – ex McDonalds in India does not sell beef, but has ventured into the vegetarian food market.
5
competitive pricing
6
Follow latest drink trends
7
steady forcast for reveune growth/consumption growth
8
Business partnerships and alliances (potentially responsible for sales by 1/3)
9
Faster Service – Corrective measures to fix long lines – more advanced Machines?
10
SelfService Machines
AS Ratings
AS Ratings
Threats
1
Dunkin Donuts 2nd in market shars inUSA, and growing with coffe adjacent products
2
McDonalds 2nd in market share globally
3
Sales decline due to decline in customer traffic
4
Brand Relevance – Business incedents (Unionization)
5
evolving consumer preferences and tastes
6
Cyber Security and Data Privacy
7
Pandemic/Global Recession – temporary clsoed 2K stores in China, 50% of corp stores and 43% ofl licensed stores-lost 915M+ sofar (June 2021)
8
Increased costs to maintain supply chains, and raw material costs, and high
9
Competition from local favourite brands(incumbents) , EMEA has a different coffee culture
10
Executive Changeover – Chief Exceutive (Howard Shultz) retiring for the 3rd time
You have completed Part 1.
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Strengths
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Perceptual Maps
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Weaknesses
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Opportunities
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Threats
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SWOT
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CPM
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IE Matrix
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BCG Matrix
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SPACE Matrix
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GRAND
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QSPM
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BCG
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BCG
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IE
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IE
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SPACE
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SPACE
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Perceptual Map
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Perceptual Map
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SWOT
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QSPM
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GRAND
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GRAND
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QSPM
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PART II
Preliminary Financial Data
1
Enter in your preliminary financial data below for your company. This data is used to construct financial statements, financial ratios, and much more.
Income Statement Information
Enter all as Dollar Amounts. Make sure the oldest year is entered into Column 1 throughout this Template. You may NOT Change this sequence as the preset equations will not adjust.
Read the Note to the left CAREFULLY
Reporting Date
Revenue
Cost of Goods Sold
Operating expenses
Interest Expense
Note: If receiving interest credit, enter as NEGATIVE number
Non-recurring Events
Note: If NEGATIVE enter as negative number. Generally this line is for “discontinued operations” and 90% of the time you will enter 0
Tax
Note: If receiving a tax credit, enter as NEGATIVE number
Balance Sheet Information
Current Assets
12/31/99
12/31/99
Cash and equivalents and Short Term Investments
Accounts Receivable
Inventory
Other Current Assets
Long Term Assets
Property, plant & equipment
Goodwill
Intangibles
Other Long-term Assets
Current Liabilities
Accounts Payable
Other Current Liabilities
Long Term Liabilities
Long-term Debt
Other Long-term Liabilities
Equity
Common Stock
Retained Earnings
Treasury Stock
Note: Enter as negative number
Paid in Capital & Other
Company Valuation
1
Enter in the corresponding data below for your firm, and for a rival firm if you desire. The rival can be a firm you wish to acquire or simply just to compare to your case company.
Stockholders’ Equity
0
Note: Determined after you complete the preliminary section.
Net Income
0
Note: Determined after you complete the preliminary section.
EPS
ERROR:#DIV/0!
Note: Determined after you complete the preliminary section and enter in # shares outstanding below.
# Shares Outstanding
Note: Using Current # shares outstanding is okay or # of shares outstanding (issued) on the last day of the fiscal year.
Stock Price
Note: Current Stock price is fine, or the closing price on the last day of the fiscal year.
Goodwill & Intangibles
0
Note: Determined after you complete the preliminary section.
Rival Firm’s Name
Stockholders’ Equity
Net Income
EPS
# Shares Outstanding
Stock Price
Goodwill & Intangibles
EPS/EBIT Analysis
1
Enter in the corresponding data below for your firm.
2
If you notice little to no change in EPS with stock vs debt financing, the total amount of your recommendations is likely too low. Unless of course, you are recommending defensive strategies where you are not acquiring substantial new capital.
Pessimistic
Realistic
Optimistic
EBIT
EPS/EBIT Data
Amounted Needed
Note: This number is the total cost of your recommendations.
Interest Rate
Note: Enter as a decimal.
Tax Rate
Note: Enter as a decimal.
Shares Outstanding
0
Note: Enter in under Company Valuation on this page.
# New Shares Outstanding
ERROR:#DIV/0!
Note: Calculated automatically
Stock Price
$0.00
Note: Enter in under Company Valuation on this page.
Combination Financing Data
Percent Equity Used to Finance
Note: Enter as a decimal.
Percent Debt Used to Finance
Note: Enter as a decimal.
Total Equity and Debt
0.00
Note: Must equal 1.0. Check the two line items above.
Projected Financial Statements
1
Start with the income statement and work your way from top to bottom. Take extreme care to read and understand all notes provided by each line item. See Chapter 8 in the David & David textbook for examples and guidelines in developing projected financial statements.
2
After completing the income statem