NR603 2021 December Discussions Latest (Full)

NR603 Advanced Clinical Diagnosis and Practice across the Lifespan Practicum

Week 1 Discussion

Compare and Contrast Assignment

Purpose

The purpose of this assignment is for learners to:

Improve their knowledge base and understanding of disease processes in Neurology

Have the opportunity to integrate knowledge and skills learned throughout all core courses in the FNP track and previous clinical courses.

Demonstrate the ability to analyze the literature be able to perform an evidenced-based review of disease presentation, diagnosis and treatment.

Demonstrate professional communication and leadership, while advancing the education of peers.

Demonstrate the ability to take information from assigned readings and translate it into the way you would describe it to a patient or family member in your own words.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

Interpret subjective and objective data to develop appropriate diagnoses and evidence based management plans for patients and families with complex or multiple diagnoses across the lifespan. (CO 1)

Develop management plans based on current scientific evidence and national guidelines. (CO 4)

Requirements:

For Week 1 of the course there is no case study given to you by the Faculty. Instead you will be assigned two diseases to compare and contrast based on the first letter of your last name. This information will be posted in the Course Announcements under Week 1 Welcome as well as the “Assignment” portion of the Week 1 module and will change every session.

A comparison and contrast assignment’s focus is to identify and explore similarities and differences between two similar diseases. The goal of this exploration is to bring about a better understanding of both diseases.

You will research the two areas of content assigned to you and compare and contrast them in a discussion post. NOTE: A comparison and contrast assignment is not about listing the info regarding each disease separately but rather looking at each disease side by side and?discussing?the similarities and differences given the categories below. Consider how each patient would actually present to the office. Paint a picture of how that patient would look, act, what story they would tell.  Consider how their history would affect their diagnosis, etc. Evaluation of mastery is focused on the student’s ability to demonstrate specific understanding of how the diagnoses differ and relate to one another.?Address the following topics below in your own words:

Presentation

Pathophysiology

Assessment

Diagnosis

Treatment

Compare and contrast the following diagnoses as assigned:

Student Last Name -Topic

(Find the corresponding first letter of your last name to find your topic assignment for this discussion)

A-E Benign Positional Vertigo and Meniere’s Disease

F-J – Dementia and Delirium

K-O- Trigeminal Neuralgia and Giant Cell Arteritis

P-T = Post Concussive Syndrome and Traumatic Brain Injury

U-Z = Migraine Headache and Tension Headache

Throughout the Week: Participate in Interactive Dialogue with faculty and students responding to their Part 1 Discussion post moving the discussion forward.

 

NR603 Advanced Clinical Diagnosis and Practice across the Lifespan Practicum

Week 2 Discussion

DQ1 Case Discussion Pulmonary – Part 1

Purpose

The purpose of this assignment is for students to:

Improve their ability to formulate diagnoses based on clinical presentation of patients

Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of Pulmonary disorders

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)

Develop management plans based on current scientific evidence and national guidelines. (PO 5)

Educate patients on treatment decisions (WO1)

Select an evidence-based article to support the plan of care for the case study patient. (WO2)

Analyze national guidelines and apply them to specific case study situations. (WO3)

Review appropriate antibiotic prescribing guidelines. (WO4)

Requirements:

Week 2: Case Discussion: Pulmonary Part One

Setting: A free medical clinic that provides health care for the under-insured.

Your next patient, Michelle G., age 40, is a regular of the clinic and the last patient of the day. The chart states she is here for recent episodes of shortness of breath.

You enter the room and Michelle G is dressed in work clothes, standing up looking at a health poster on the wall. You introduce yourself and ask her what brings her to the clinic today. “I think I may have a cold. I’ve been having a hard time breathing on and off lately.”

HPI: “I notice I’m short of breath mostly at work but by the time I get home feel fine. No episodes of shortness of breath on the weekends that I can recall. But a few hours back at work and I start to feel like I cannot catch my breath again. A few months ago this happened and it was so bad I left work and went to urgent care where they gave me a breathing treatment of some kind and sent me home on an antibiotic. I would like you to give me another antibiotic. She denies sputum. No new allergy triggers noted. She denies heartburn.

PMHx: Michelle G. reports her overall health as good.

Childhood/previous illnesses: eczema as a child

Chronic illnesses: Has seasonal allergies, spring is her worst season. Was seen by an allergy specialist ten years ago, Took allergy shots for five years with great results, now only takes Zyrtec when needed.

Surgeries: Cholecystectomy

Hospitalizations: childbirth x 3.

Immunizations: up-to-date on all vaccinations.

Allergies: Strawberries-Rash; erythromycin- severe GI upset.

Blood transfusions: none

Drinks alcohol socially, smoked 1 pack per week for 3 years in her 20’s. Denies illicit drug use.

Sleeps 6 to 7 hours a night. Exercises four to five days per week.

Current medications: Multivitamin, Zyrtec

Social History: Married, lives with husband and 3 children. Worked in advertising up until 18 months ago when she got laid off. In order to help with the household finances she took a job as a Baker’s assistant at an Artisan Bread Bakery. She arrives at 4 a.m. every morning to begin baking breads/pastries for the day.

Family History:?Children are healthy- daughter currently has a sinus infection. Parents are deceased. Mother at age 80 from congestive heart failure. Father died at age 82 from lung cancer, diagnosed when metastasized to brain. PGM: died from unknown causes, PGF: Stroke at age 82. MGM: died at 83, had HTN, atherosclerosis and many heart attacks. PGF: died at 71 from complications of COPD.

PE: Height 5’10”, Weight 140 pounds

Vital signs : BP 130/70, T 98.0, P 75, R 18 Sao2 98% on RA

General: 40-year-old Caucasian female appears stated age in no apparent distress. Alert, oriented, and cooperative. Able to speak in full sentences and does not appear breathless. Skin: Skin warm, dry, and intact. Skin color is pale pink, no cyanosis or pallor.

 

HEENT: Head normo-cephalic. Hair thick and distribution even throughout scalp.

Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact.

Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus non-tender

Nose: Nares patent with thin white exudate noted. Mucosa appears boggy and pale. Deviated septum noted. Sinuses non-tender to palpation.

Throat: Oropharynx pink, moist, no lesions or exudate. Tonsils 1+ bilaterally. Teeth in good repair, no cavities noted. Tongue smooth, pink, no lesions, protrudes in midline. Neck supple. No cervical lymphadenopathy or tenderness noted. Thyroid midline, small and firm without palpable masses.

Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. Slight wheezing noted inspiration and on forced expiration. Wheezing does not clear with forced cough.

CV: Heart S1 and S2 noted, RRR, no murmurs noted, no displaced PMI. Peripheral pulses equal bilaterally, no peripheral edema

Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organo-megaly noted.

Diagnostic Testing:

Review of the patient’s EMR reveals an old CXR from last winter when she had Bronchitis.

CXR Report: 11/7/2016

This is a PA and lateral chest radiograph on Ms. Michelle X, performed on 11/7/16. Clinical information: low grade fever, productive cough, malaise.

Findings: Cardio-mediastinal silhouette is normal. B/L lung fields are clear. There are no effusions. The bony thorax appears normal. No opacities or fluid. Diaphragm normal.

Impression: Normal chest radiograph without pathology.

Click here to view CXR?(Links to an external site.) (Links to an external site.)

You suspect an obstructive/restrictive process and order Pulmonary Function Testing

Pre-Bronchodilator Challenge- FEV1/FVC 60%, FVC decreased

Post Bronchodilator Challenge- FEV1/FVC 75%

Discussion Questions Part One:

What is your primary diagnosis for Michelle given the pattern of occurrence of symptoms, exam results, and recent history? Include the rationale and a reference for your diagnoses.

What is your first-line treatment plan for Michelle including medications, labs, education, referrals, and follow-up? Identify the drug class of each medication you prescribe and exactly what symptom it is targeted to address.

Address Michelle’s request for an antibiotic.

DQ2 Case Discussion Pulmonary – Part 2 Follow up Visit

Purpose

The purpose of this assignment is for students to:

Improve their ability to formulate diagnoses based on clinical presentation of patients

Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of Pulmonary disorders

Design a relevant treatment plan

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)

Develop management plans based on current scientific evidence and national guidelines. (PO 5)

Educate patients on treatment decisions (WO1)

Select an evidence-based article to support the plan of care for the case study patient. (WO2)

Analyze national guidelines and apply them to specific case study situations. (WO3)

Review appropriate antibiotic prescribing guidelines. (WO4)

Requirements:

Michelle continues to work in the bakery and her asthma has been well controlled on a low-dose inhaled corticosteroid inhaler, Singular 10mg daily, and Albuterol prn which she uses 1-2 times per week. Michelle presents to the clinic with an acute illness that developed 2 days ago and has a respiratory rate of 24, mild SOB with exertion, O2 saturation of 94%, and complaint of inspiratory and expiratory wheezing. She is able to speak and states her temperature over the last 2 days has been 101 to 102 F. Cough is productive of white sputum. Influenza A is going around the bakery. Exam findings show a woman who appears her stated age and is alert and oriented and though calm, is having mild work of breathing. AR 110 BPM, BP is 150/85, RR: 24, Temp 101.4. She has a nonproductive, dry cough, is mildly short of breath, fair chest expansion, + inspiratory/expiratory wheezes, no rales, no rhonchi. Auscultation reveals no thrills, gallops or extra heart sounds. Apical rate is elevated at 110. Physical exam is otherwise unremarkable. The MA has swabbed her for Influenza A- test is positive.

Discussion Questions Part Two:

Determine appropriate treatment plan for Michelle. Discuss medications, doses, Durable Medical Equipment, and any testing, and apply these directly to her case. Provide your rationale with evidence.

Decide whether she is safe to return home, include any prescriptions, or if a referral to a higher level of care is required. Discuss the criteria used to make your decision, how a referral is made and defend your position.

Discuss relevant education and follow up plan.

 

 

 

 

 

NR603 Advanced Clinical Diagnosis and Practice across the Lifespan Practicum

Week 3 Discussion

Case Discussion: Cardiovascular

Purpose

The purpose of this assignment is for students to:

Improve their ability to formulate diagnoses based on clinical presentation of patients

Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of cardiovascular disorders

Design relevant treatment plan

Link pathophysiologic concepts to medication choices

Collaborate without outside providers and resources

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)

Develop management plans based on current scientific evidence and national guidelines. (PO 5)

Educate patients on treatment decisions (WO1)

Select an evidence-based article to support the plan of care for the case study patient. (WO2)

Analyze national guidelines and apply them to specific case study situations. (WO3)

Review appropriate antibiotic prescribing guidelines. (WO4)

 

NR603 Advanced Clinical Diagnosis and Practice across the Lifespan Practicum

Week 4 Discussion

Open Forum Discussion

This is a required but not graded open forum discussion.

What questions do you have as you are preparing the predictor exam this week? Are you struggling to organize your studying? Are there particular topics you find challenging? Please post your questions and discussions here.

 

 

 

 

NR603 Advanced Clinical Diagnosis and Practice across the Lifespan Practicum

Week 5 Discussion

DQ1 APEA Predictor Assignment – Part 1

Purpose

The purpose of this assignment is for learners to:

Identify opportunities for improvement in their knowledge base.

Improve their knowledge base and understanding of a disease process identified as an opportunity area on the APEA predictor exam.

Have the opportunity to integrate knowledge and skills learned throughout all core courses in the FNP track and previous clinical courses.

Demonstrate the ability to analyze the literature be able to perform an evidenced-based review of their case, diagnosis, and plan, while guiding and taking feedback from peers regarding the case.

Demonstrate professional communication and leadership, while advancing the education of peers.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

Interpret subjective and objective data to develop appropriate diagnoses and evidence based management plans for patients and families with complex or multiple diagnoses across the lifespan (CO 1).

Develop management plans based on current scientific evidence and national guidelines (CO 4).

Requirements

For Week 5 of the course the faculty will not be providing a case study. Instead you will choose from an area that you have an opportunity for improvement that was identified on your APEA predictor exam. You will research that area of content in relation to complaints and disorders that commonly occur in family practice. Please work up a case study that begins with a chief complaint commonly seen in primary care based on that body system. The case should be clear and include all elements of a normal case that might be presented in class (subjective, objective, assessment, diagnostic testing and 5 point plan in part 2.The clinical logs will be helpful for this process, or notes you have taken in clinical regarding cases. The case should be clear, organized, and meet the following guidelines:

Week 5 Part 1: Due by Tuesday 11:59 p.m. MT

Step 1. Review your Week 4 APEA Predictor Exam Results and focus on the “Percent Correct by Knowledge Area” Choose a knowledge area on which you scored the lowest to work on this week.

Step 2. Once you’ve chosen the subject, research and work up a common chief complaint from that system that you haven’t learned already in the program and present your findings in the discussion threads. Push yourself to explore diagnoses in this area that are still common to primary care, but not a repeat of content learned in this or other courses.

Step 3. Respond to at least one other student’s CC work up as well as any questions posed to you by faculty.

Work up includes:

Chief complaint, PMHx, Demographics, PSHx, allergies, lifestyle, HPI

Associated risk factors/demographics that contribute to the chief complaint and differential diagnoses

Three common differential diagnoses represented by the CC including pathophysiology and rationale in the identified body system i.e., if pulmonary was your body system than a chief complaint could be persistent cough and three pulmonary differentials;

Discuss how the three differential diagnoses differ from each other in: occurrence, pathophysiology and presentation (NOTE: Simply listing the diagnoses and their occurrence, pathophysiology and presentations separately does not confer an understanding of how they differ. Your discussion should compare and contrast these items against each other among the three differentials chosen);

Relevant testing required to diagnose/evaluate severity of the three differential diagnoses; and

Review of relevant National Guidelines related to the Diagnosis and Diagnostic testing for these diagnoses

Respond to at least one Student’s CC write up and all faculty questions posed directly to you.

DQ2 APEA Predictor – Part 2

Purpose

The purpose of this assignment is for learners to:

Identify opportunities for improvement in their knowledge base.

Improve their knowledge base and understanding of a disease process identified as an opportunity area on the APEA predictor exam.

Have the opportunity to integrate knowledge and skills learned throughout all core courses in the FNP track and previous clinical courses.

Demonstrate the ability to analyze the literature be able to perform an evidenced-based review of their case, diagnosis, and plan, while guiding and taking feedback from peers regarding the case.

Demonstrate professional communication and leadership, while advancing the education of peers.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

Interpret subjective and objective data to develop appropriate diagnoses and evidence based management plans for patients and families with complex or multiple diagnoses across the lifespan (CO 1).

Develop management plans based on current scientific evidence and national guidelines (CO 4).

 

NR603 Advanced Clinical Diagnosis and Practice across the Lifespan Practicum

Week 6 Discussion

Mental Health Clinical Presentation – Part 1

Purpose

The purpose of this assignment is for learners to:

Have the opportunity to integrate knowledge and skills learned throughout all core courses in the FNP track and previous clinical courses.

Demonstrate an advancing understanding of the patient with a mental health disorder in primary care.

Demonstrate the ability to analyze the literature/ previous patients seen in the clinical setting be able to perform an evidenced-based review of their case, diagnosis, and plan, while guiding and taking feedback from peers regarding the case.

Demonstrate professional communication and leadership, while advancing the education of peers.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

Develop management plans based on current scientific evidence and national guidelines. (CO4)

Prioritize treatment based on relevant clinical presentation. (CO6)

Requirements:

For Week 6 of the course there will not be a case study given to you by the faculty. Instead you will be assigned a mental health disorder commonly seen in primary care and?you will create a case study based on that disorder. You may create a case study either from a previous clinical patient experience or if you have not had a patient in clinical that represents your assigned topic you may research your disease using the week’s classroom material and the evidence-based literature in the field. The case should be clear and include all elements of a normal case that might be presented in class (subjective, objective, assessment, and full 5 point plan).? The clinical practicum documentation will be helpful for this process, or notes you have taken in clinical regarding cases.? The case should be clear, organized, and meet the following guidelines:

Week 6 Part One:

This part goes in part one and should begin?with subjective and objective data just like we do in your weekly case study discussion.??Do not put diagnosis until your peers respond.

WEEK 6 Part One:?The case should lead the class toward the mental health diagnosis assigned to you by your instructor.

WEEK 6 Part One Specific Guidelines:

If this is an actual patient from clinical- Include their actual chief complaint, demographic data, HPI, PMHX, PSHX, medications, allergies, subjective and objective findings without identifying the patient’s name.

If this is a fictitious case you’ve created from the literature/readings you should design an example patient and include chief complaint, demographic data, HPI, PMHX, PSHX, medications and allergies, subjective and objective findings. Be mindful that the background data for the case should bear some relevance to the diagnosis.

The case?should not be overly simple.?Like your weekly case studies, it should include subjective data that loosely represents the diagnosis you have been given, but includes some elements of the pathophysiology/presentation of the disease.

You must include the following elements in part one: subjective: chief complaint/HPI, demographic data, HPI, PMHX, PSHX, subjective and objective findings.

NEXT:

Leading the discussion in part one:? You must respond to any student who posts regarding your case with a substantial response, either answering their questions or noting their response and acting as leader. You also must respond to any faculty responses to your initial posting. Use references to support your responses. Remember: Your response to your peers is part of where you demonstrate your knowledge of the disease you were assigned. You should be discussing hallmark symptoms, diagnostic tools etc along with discussing the student’s impressions and conclusions. ?Once your peers respond you can share the primary diagnosis and treatment plan that actually occurred if it is a live patient, and the ideal treatment plan if it is an invented case. Your treatment plan should address any national guidelines as appropriate for the diagnosis.

Participating in part one:?As a student you will be required to respond to at least one other student, whom has no responses to their posting**.?In your response to your peer you must include?the following: Your top three (3) differentials based on the information provided, the primary diagnosis you are leaning toward, and first line treatment for how you would treat that diagnosis. Use references to support your response. *DEADLINE – YOUR ONE REPSONSE TO A STUDENT IN DISCUSSION #1 IS DUE BY THURSDAY AT 11:59 p.m. MT SO THAT THE STUDENT CAN INTERACT WITH YOU AS WE DO IN OTHER CASES.? **If all students have a response, then choose the student with the least responses to their posting.

 

NR603 Advanced Clinical Diagnosis and Practice across the Lifespan Practicum

Week 7 Discussion

Case Study Discussion

Purpose

The purpose of this assignment is for students to:

Improve their ability to formulate diagnoses based on clinical presentation of patients

Design relevant treatment plan

Link pathophysiologic concepts to medication choices

Collaborate without outside providers and resources

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

Describe the psychodynamic principles of alcohol, opioids, stimulants and benzodiazepines

Discuss harm reduction principles in SUD

Discuss FDA approved treatment options for SUD

List the benefits of using medication assisted treatment (MAT) for SUD

Identify resources to complete the DATA waiver process

Discuss when and how to taper patients off of common addictive medications, such as benzodiazepines and psychostimulants

Identify treatment options for special populations

Requirements

Complete the following case studies:

1. The patient is a 58-year-old woman with chronic pain due to inflammatory arthritis. She presents for her first appointment with you in a primary care office. She states that she is aware that she is asking for an early refill of her Oxycontin however she is traveling out of state and she is concerned that she may have a flare up on her trip.

Apply the steps in SBIRT to this scenario

Identify additional questions for this patient

Develop a treatment plan for this patient

2.The patient is a 24-year-old man brought to your clinic by his family for an evaluation. The patient states that he is struggling with prescription pain pills and wants help. He appears to be in opioid withdrawal; he describes anorexia and diarrhea, he is yawning and sweating upon examination. He scores 15 on the Clinical Opioid Withdrawal Scale (COWS), indicating moderate withdrawal.

Initiate office-based buprenorphine/naloxone (Suboxone) with a plan for observation.

Include your rationale for each treatment decision

Develop a treatment plan for this patient that includes ongoing MAT and psychosocial treatment interventions.

Construct a safe taper schedule for a patient taking alprazolam (Xanax) 2mg TID. Include a brief narrative explaining the evidence for tapering a patient who has been on a benzodiazepine for an extended amount of time.

 Foli, K. J., Huang, W., Adams, N., Kersey, S., Good, B., Ott, C., & Duha, M. S. (2021). Nurses’ Substance Use Education Through a Massive Open Online Course (NSUE-MOOC). Purdue University, School of Nursing, West Lafayette, Indiana.

 

NR603 Advanced Clinical Diagnosis and Practice across the Lifespan Practicum

Week 8 Discussion

Reflection

Reflect back over the past eight weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #4, the MSN Essential IV, and the Nurse Practitioner Core Competencies # 7. 

Program Outcome #4:  Integrate professional values through scholarship and service in health care. (Professional identity)

MSN Essential IV: Translating and Integrating Scholarship into Practice Recognize that the master’s-prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results.

Nurse Practitioner Core Competencies # 7

Health Delivery System Competencies

1. Applies knowledge of organizational practices and complex systems to improve health care delivery.

2. Effects health care change using broad based skills including negotiating, consensus-building, and partnering.

3. Minimizes risk to patients and providers at the individual and systems level.

4. Facilitates the development of health care systems that address the needs of culturally diverse populations, providers, and other stakeholders.

5. Evaluates the impact of health care delivery on patients, providers, other stakeholders, and the environment.

6. Analyzes organizational structure, functions and resources to improve the delivery of care.

7. Collaborates in planning for transitions across the continuum of care.

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