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NR601-Primary care of the maturing and aged family praticum

NR601:Week 7: Reflection

Purpose 

Students will complete a self-reflection assignment for the purpose of validating their personal progress and academic growth in NR 601. The goal for this activity is to engage the student in considering how their clinical abilities and professional growth are advancing .

Activity Learning Outcomes 

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

  1. Reflect upon how the assigned program outcome, MSN Essential and NONFP competencies have been achieved in NR 601. (WO7.4) (CO1-7)
  2. Link course assignments and clinical activities to the assigned program outcome, MSN Essential and NONPF competencies. (WO7.4) (CO1-7) 

Due Date 

Assignment must be submitted by Saturday 11:59 p.m. MT of Week 7 

A 10% late penalty will be imposed for discussions posted after the deadline on Saturday Week 7 regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Saturday (i.e. student will receive an automatic 0).  

Total Points Possible:  40 

Requirements: 

Reflect over the past seven weeks and describe how the achievement of the course outcomes in this course have prepared you to meet: 

  1. MSN program Outcome # 5 
  2. MSN Essential # VIII  
  3. NONPF Nurse Practitioner Core Competency # 8   

Chamberlain College of Nursing Program Outcome #5  

Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice. (Extraordinary nursing) 

Masters Essential VIII: Clinical Prevention and Population Health for Improving Health

  1. Integrate clinical prevention and population health concepts in the development of culturally relevant and linguistically appropriate health education, communication strategies, and interventions. 
  2. Design patient-centered and culturally responsive strategies in the delivery of clinical prevention and health promote on interventions and/or services to individuals, families, communities, and aggregates/clinical populations.

NONPF: #8 Ethics Competencies

  1. Integrates ethical principles in decision making. 
  2. Evaluates the ethical consequences of decisions. 
  3. Applies ethically sound solutions to complex issues related to individuals, populations and systems of care.

Students will reflect on each of the listed outcomes or competencies listed above individually and provide two (2) examples for each. Examples can be from course assignments or clinical experiences.  

Review the assignment rubric for specific requirements for this reflection post.

**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.

DISCUSSION CONTENT  Category           Points  %  Description  Program Outcome Achievement  12  30  The reflection specifically identifies and addresses the pre-determined program outcome and provides two (2) or more examples of how the student specifically achieved or had exposure to this outcome during this course/clinical.  MSN Essential Competency  12  30  The reflection specifically identifies and addresses the pre-determined program outcome and provides two (2) or more examples of how the student specifically achieved or had exposure to this competency during this course/clinical.  NP Competency Achievement  12  30  The reflection specifically identifies and addresses the pre-determined program outcome and provides examples of how the student specifically achieved this competency during this course/clinical.  1.Integrates ethical principles in decision making.  2.Evaluates the ethical consequences of decisions.  3.Applies ethically sound solutions to complex issues    related to individuals, populations and systems of care      36  90  Total CONTENT Points= 36 pts  DISCUSSION FORMAT  Category  Points  %  Description  Grammar, Syntax, APA  4  10  APA format, grammar, spelling, and/or punctuation are accurate, or with zero to one error.        Total FORMAT Points= 4 pts        DISCUSSION TOTAL=40 points 
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NR601-Primary care of the maturing and aged family praticum Uncategorized

NR601:Week 6: Post-Menopausal and Sexuality

Week 6: Post-Menopausal and Sexuality Issues in the Maturing and Older Adult

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Purpose

The purpose of this student discussion is to discuss Post-Menopausal and Sexuality Issues in the Maturing and Older Adult

Activity Learning Outcomes

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

1) Discuss the symptoms related to genitourinary syndrome of menopause (GSM) (WO 6.2,6.3) (CO 1,3,5)

2) Reflect on personal comfort level when performing a sexual history on the maturing an older adult. (WO 6.2,6.3) (CO 1,3,5)

Due Date: 

The initial posting to the graded collaborative discussions is due by Wednesday, 11:59 p.m. MT.  

Peer responses and responses to faculty must be posted prior to the week deadline of Sunday 11:59 MT.  

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).  

Total Points Possible: 70

Requirements:

Ageism and gender bias can affect to whom and how we ask about sexual health, sexual activity, and concerning symptoms. Depending on your own level of comfort and cultural norms this can be a tough conversation for some providers but this is an important topic. As this week’s required NAMS videos discussed, women are wanting us to ask about sexual concerns. This week we also reviewed sexually transmitted diseases and the effects of ageism on the time to diagnosis so it is necessary to ask these questions and provide good education for all patients. You will not know any needs unless you ask.

Discussion Questions:

  • Review the required NAMS videos. What was the most surprising statement or topic that you heard in the videos? Explain why this was surprising to you.
  • What is GSM? What body systems are involved? How does GSM affect a woman’s quality of life?
  • Review one aspect of treatment that Dr Shapiro recommends for GSM and include an EBP journal article or guideline recommendation in addition to referencing the video in your response.

Sexuality and the older adult

  • What is your level of comfort in taking a complete sexual history? Is this comfort level different for male or female patients? If so, why?
  • How will this week’s information impact the way you will interact with your mature and elderly clients in the future?
DISCUSSION CONTENT Category Points % Description Application of Course Knowledge   30 44  initial discussion post includes the following: 1) Discusses the most surprising information learned in the required NAMS videos. 2) GSM explanation includes definition, involved body systems and how GSM affects a woman’s quality of life. 3) Discusses Dr Shapiro’s GSM treatment recommendations AND includes an EBP journal article or guideline recommendation in addition to referencing the video in the response. 4) Assesses level of comfort in taking a complete sexual history. 5) Summarizes how the discussion’s sexuality information will impact future interactions with mature and elderly clients Support from Evidence-Based Practice (EBP)  15 21  1. Discussion post is supported with appropriate, scholarly sources; AND   2. Sources are published within the last 5 years ; AND  3. Reference list is provided and in-text citations match; AND  4. Includes a minimum of one scholarly reference, textbook is not used Interactive Dialogue  15  21  1. Student provides a substantive* response to at least one topic-related post of a peer; AND  2. Student provides a substantive response to any faculty questions asked regarding the initial student post.   3. Evidence from appropriate scholarly sources are included;   4. Submits a minimum of two posts on two different days.  (*) A substantive post adds new content or insights to the discussion thread and information from student’s original post is not reused in peer or faculty response    60 86% Total CONTENT Points= 40 points DISCUSSION FORMAT Category Points % Description Organization  5  7 1) Discussion is presented in a logical format, AND  2) Responses are in sequence with the listed bullet points AND  3) The discussion response is understandable and easy to follow AND 4) All responses are relevant to the discussion topic.  Grammar, Syntax, Spelling & Punctuation  5  7  Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*    10 14% Total FORMAT Points= 10 points       DISCUSSION TOTAL=____ out of 70 points
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NR601-Primary care of the maturing and aged family praticum

NR601:Week 5: Case Study Assignment

ASSIGNMENT CONTENT  Category  Points  %  Description  Assessment: Primary diagnosis     24   15   Presentation of the case study patient’s primary diagnosis includes the following required elements:   Diagnosis is consistent with the cited guideline recommendations or scholarly reference, ICD10 code is listed, rationale statement includes a one to two sentence paraphrased pathophysiology statement. The rationale statement includes pertinent positive and negative subjective and objective findings from the history and physical exam, which links this diagnosis to the case study patient. Pertinent lab results are included and interpreted within the rationale statement.  Assessment: Secondary diagnosis (es)    16   10   Presentation of the case study patient’s secondary diagnosis (es) include (s)the following required elements:   Diagnosis is consistent with the cited guideline recommendations or scholarly reference, ICD10 code is listed, rationale statement includes a one to two sentence paraphrased pathophysiology statement. The rationale statement includes pertinent positive and negative subjective and objective findings from the history and physical exam, which links this diagnosis to the case study patient. Pertinent lab results are included and interpreted within the rationale statement.   Evidence-Based Practice (EBP)   40   25   National guidelines are used to support all diagnoses and develop the management plan.    The American Diabetes Association Standards and Medical Care in Diabetes-2019 or later, (or article related to 2019 or later Guidelines) are used to support the primary diagnosis and develop the management plan.    Every diagnosis rationale must include an in-text citation to a scholarly reference as listed in the Reference Guidelines document. Each action step or order within all plan sections includes an in-text citation to an appropriate reference as listed in the Reference Guidelines document. Reference interpretation is accurate.   Plan: Diagnostics   8  5  All ordered diagnostics tests are linked to a diagnosis listed in the assessment section and include a paraphrased EBP rationale with citation and include date when test should be performed (ie: today, 1 week, 1 month). Further testing/diagnostics for the differential diagnosis is included. Plans are consistent with the cited guideline recommendations or scholarly reference.    Plan: Medications  8  5  The plan includes both prescribed and OTC medications written in prescription format.  The plan includes a minimum of one OTC medication. Each prescribed and OTC medication is linked to a diagnosis listed in the assessment section    Diagnosis is clearly stated in the rationale statement. And includes a paraphrased rationale EBP rationale   Plan: Education  8  5  All education steps are linked to a diagnosis, paraphrased, and include an EBP rationale.     This section is written exactly how you would discuss the education to the patient. Use vocabulary which the patient can understand, not medical terminology.   Section includes personalized detailed education on diagnoses, medications, diet, exercise and any warning signs.  Personalized diet and exercise recommendations are appropriate for the case study patient and include specific instructions for the case study patient such as a specific exercise- length of time to exercise and frequency/week. Any published diet recommendations, such as a Mediterranean diet, will include a rationale statement as to why this recommendation is beneficial for the case study patient.    Plans are consistent with the guideline recommendations or scholarly reference.   Plan: Referrals   8  5  All recommended referrals are appropriate for the patient diagnoses:   each referral is linked to a specific diagnosis each which was listed in the assessment section and includes a paraphrased EBP rationale.  All referrals related to the primary diagnosis are obtained from the ADA guidelines.  Plans are consistent with the cited guideline recommendations or scholarly reference   Plan: Follow up   8  5  Follow up includes a specific time/date to return to PCP office. EBP rationale with in text citation is included.  Only follow up information is listed in this section. Additional information, such as future testing, education or referrals are not listed in follow up but within the appropriate paper sections. Plans are EBP and consistent with the guideline recommendations.  Assessment of comorbidities    16  10  The ADA guidelines includes a Comprehensive Medical Evaluation and Assessment of Comorbidities section which includes comorbidities that providers should consider when managing disorders of glucose metabolism.    Choose one of the listed comorbidities from the ASSESSMENT OF COMORBIDITIES subsection*     Explain the significance of and the relationship between your primary diagnosis and your chosen comorbidity. Explain how one diagnosis affects the other diagnosis in no more than 3-5 sentences. Include any recommended screening, diagnostic testing, and referrals in no more than 2-3 sentences.    * the chosen comorbidity cannot be any secondary diagnosis already discussed in your paper’s assessment section.   Medication costs  8  5   All monthly medication costs are calculated, including the current medications the patient may be already taking.   A total cost for all the month’s medication is included.    All medications including OTCs are included.    Medication cost reference source is included.  Summary/reflection statement regarding medication costs and any medications changes based on cost  or polypharmacy concerns is included.         Total CONTENT Points= [144 pts]  ASSIGNMENT FORMAT  Category  Points  %  Description  Grammar, Syntax, APA      8  5  APA format, grammar, spelling, and/or punctuation are accurate, or with zero to one error. All referenced information is cited, “according to” is not used. All cited information is paraphrased, no quotes are included in the paper.   Organization   8  5  Paper is developed in a logical, meaningful, and understandable sequence.   Provided assignment template is used to develop the paper.  The rationale length does not exceed template directions. The paper length does not exceed 10 pages, excluding title page and references.            Total FORMAT Points= [16 pts]        ASSIGNMENT TOTAL=160 points 

Rubric

NR601_Week 5 Case Study _Nov19

CriteriaRatingsPts
This criterion is linked to a Learning Outcome Assignment Content Possible Points = 144 Points Assessment of primary diagnosis  


1)the ICD10 code is listed in parentheses next to diagnosis. 


2) Diagnosis is consistent with the cited guideline recommendations or scholarly reference 


3) Includes a one to two sentence paraphrased pathophysiology statement. 


4) The rationale statement includes pertinent positive and negative subjective and objective findings from the history and physical exam, which links this diagnosis to your patient. Pertinent lab results are included and interpreted within the rationale statement


(4 required elements)
24 pts Excellent All 4 required elements are present 22 pts V. Good 1 required element is missing 20 pts Satisfactory 2 required elements are missing 12 pts Needs Improvement 3 required elements are missing 0 pts Unsatisfactory 4 required elements are missing  OR Section includes information that does not pertain to the case study patient such as pregnancy information or gender information that does not pertain to the case study patient’s listed gender or age.24 pts
This criterion is linked to a Learning Outcome Assessment of secondary diagnosis (es) 1) the ICD10 code is listed in parentheses next to diagnosis. 


2) Diagnosis is consistent with the cited guideline recommendations or scholarly reference 


3) includes a one to two sentence paraphrased pathophysiology statement. 


4) The rationale statement includes pertinent positive and negative subjective and objective findings from the history and physical exam, which links this diagnosis to your patient. Pertinent lab results are included interpreted within the rationale statement.


(4 required elements)
16 pts Excellent All 4 required elements are present 14 pts V. Good 1 required element is missing 13 pts Satisfactory 2 required elements are missing 8 pts Needs Improvement 3 required elements are missing 0 pts Unsatisfactory 4 required elements are missing  OR Section includes information that does not pertain to the case study patient such as pregnancy information or gender information that does not pertain to the case study patient’s listed gender or age.16 pts
This criterion is linked to a Learning Outcome Evidence-Based Practice National guidelines are used to support all diagnoses and develop the plan.  


1) The American Diabetes Association Standards and Medical Care in Diabetes-2019 or later, (or article related to 2019 or later Guidelines) are used to support the primary diagnosis and develop the plan.  


2) Every diagnosis rationale must include an in text citation to a scholarly reference as listed in the Reference Guidelines document. 


3) Each action step or order within all plan sections includes an in text citation to an appropriate reference as listed in the Reference Guidelines document.  


4) Reference interpretation is accurate


(4 required elements)
40 pts Excellent All 4 required elements are present 36 pts V. Good 1 required element is missing 33 pts Satisfactory 2 required elements are missing 20 pts Needs Improvement 3 required elements are missing 0 pts Unsatisfactory 4 required elements are missing40 pts
This criterion is linked to a Learning Outcome Plan: Diagnostics 1) All ordered diagnostic test  are presented individually 


2) All ordered diagnostics tests are linked to a diagnosis listed in the assessment section  


3) All ordered tests include a paraphrased EBP rationale with citation and include date when test should be performed (ie: today, 1 week, 1 month)  


4) Plans are consistent with the cited guideline recommendations or scholarly reference


(4 required elements)
8 pts Excellent All 4 required elements are present 7 pts V. Good 1 required element is missing 6 pts Satisfactory 2 required elements are missing 4 pts Needs Improvement 3 required elements are missing 0 pts Unsatisfactory 4 required elements are missing8 pts
This criterion is linked to a Learning Outcome Plan: Medications Each  listed medication 


1) is linked to a diagnosis listed within the assessment section or a current patent medication


2) an OTC medication is included in recommended medications 


3) includes a paraphrased EBP rationale for prescribing  


4) written in prescription format  


( 4 required elements)
8 pts Excellent All 4 required elements are present 7 pts V. Good 1 required element is missing 6 pts Satisfactory 2 required elements are missing 4 pts Needs Improvement 3 required elements are missing 0 pts Unsatisfactory 4 required elements are missing8 pts
This criterion is linked to a Learning Outcome Plan: Education This section is written exactly how you would discuss the education to the patient. Use vocabulary which the patient can understand. 


1) All education steps are linked to a diagnosis which was listed in the assessment section, paraphrased, and includes an EBP rationale.  


2) Section includes personalized detailed education on diagnoses, medications, diet, exercise and warning signs. 


3) Personalized diet and exercise recommendations which include specific instructions and are appropriate for the case study patient.


4) Plans are consistent with the cited guideline recommendations or scholarly reference


( 4 required elements)
8 pts Excellent All 4 required elements are present 7 pts V. Good 1 required element is missing 6 pts Satisfactory 2 required elements are missing 4 pts Needs Improvement 3 required elements are missing 0 pts Unsatisfactory 4 required elements are missing8 pts
This criterion is linked to a Learning Outcome Plan: Referral 1) each referral is linked to a specific diagnosis which was listed in the assessment section. 


2) All referrals related to the primary diagnosis are obtained from the ADA guidelines.


3) each referral includes a paraphrased EBP rationale. 


4) Referral plans are consistent with the cited guideline recommendations or scholarly reference


( 4 required elements)
8 pts Excellent All 4 required elements are present 7 pts V. Good 1 required element is missing 6 pts Satisfactory 2 required elements are missing 4 pts Needs Improvement 3 required elements are missing 0 pts Unsatisfactory 4 required elements are missing8 pts
This criterion is linked to a Learning Outcome Plan: Follow-Up 1) Includes a specific time frame or date to return to PCP office.  A time range is not acceptable (i.e. 2-4 weeks)  


2) Includes EBP rationale with in text citation for chosen follow up date  


3) Plans are EBP and consistent with the cited guideline recommendations.  


4) Only follow up information is listed in this section.  


( 4 required elements)
8 pts Excellent All 4 required elements are present 7 pts V. Good 1 required element is missing 6 pts Satisfactory 2 required elements are missing 4 pts Needs Improvement 3 required elements are missing 0 pts Unsatisfactory 4 required elements are missing8 pts
This criterion is linked to a Learning Outcome Assessment of comorbidities 1) Comordidity chosen was listed within the listed comorbidities from the Assessments of comorbidities subsection*  


2) Discussed significance of and the relationship between primary diagnosis and chosen comorbidity.  


3) Explain how one diagnosis affects the other diagnosis in no more than 3-5 sentences.  


4) Included any recommended screening, diagnostic testing, and referrals in no more that 2-3 sentences.  


* the chosen comorbidity cannot be any secondary diagnosis already discussed in your paper’s assessment section


( 4 required elements)
16 pts Excellent All 4 required elements are present 14 pts V. Good 1 required element is missing 13 pts Satisfactory 2 required elements are missing 8 pts Needs Improvement 3 required elements are missing 0 pts Unsatisfactory 4 required elements are missing  OR the chosen comorbidity is also a secondary diagnosis already discussed within the paper’s  assessment section16 pts
This criterion is linked to a Learning Outcome Medication Costs All monthly medication costs are calculated  


1 )All medications including current medications and OTCs are included.  


2) Each medication cost is calculated individually  


3) a total cost for the month’s medication is calculated 


4) Summary/reflection statement is included regarding medication costs and any medications changes based on cost or polypharmacy concerns


( 4 required elements)
8 pts Excellent All 4 required elements are present 7 pts V. Good 1 required element is missing 6 pts Satisfactory 2 required elements are missing 4 pts Needs Improvement 3 required elements are missing 0 pts Unsatisfactory 4 required elements are missing8 pts
This criterion is linked to a Learning Outcome Assignment Format Possible Points = 16 Points Grammar, Syntax, APA 


 APA format, grammar, spelling, and/or punctuation are accurate, or with zero to one errors. 


1) All referenced information is cited at the end of the phrase or sentence 


2) All cited information is paraphrased, no quotes are included 


3) “according to” or “per” is not used when citing a scholarly source
8 pts Excellent APA format, grammar, spelling, and/or punctuation are accurate, or with zero to one errors.     Three required elements are present 7 pts V. Good Two to four errors in APA format, grammar, spelling, and syntax noted.     Three required elements are present 6 pts Satisfactory Five to seven errors in APA format, grammar, spelling, and syntax noted.”    1 required element is missing 4 pts Needs Improvement Eight to nine errors in APA format, grammar, spelling, and syntax noted.     OR   2 required elements are missing 0 pts Unsatisfactory Post contains ten or greater errors in APA format, grammar, spelling, and/or punctuation.   OR   3 required element are missing8 pts
This criterion is linked to a Learning Outcome Organization Paper is developed in a logical, meaningful, and understandable sequence  


 1) Provided assignment template is used to develop paper  


2) Rationale length does not exceed template directions.  


3) All required sections are included within the assignment  


4) The paper length does not exceed 10 pages. (not including title page and references)
8 pts Excellent All 4 required elements are present 7 pts V. Good 1 required element is missing 6 pts Satisfactory 2 required elements are missing 4 pts Needs Improvement 3 required elements are missing 0 pts Unsatisfactory 4 required elements are missing8 pts
This criterion is linked to a Learning Outcome Late Penalty Deductions Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment. Quizzes and discussions are not considered assignments and are not part of the late assignment policy.0 pts Manual Deductions 0 pts Manual Deductions0 pts
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NR601-Primary care of the maturing and aged family praticum

NR601:Week 3: Psychiatric Disorders

Week 3: Psychiatric Disorders and Screening

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Purpose 

The purpose of student discussions is to provide the opportunity for application of depression and anxiety screening tools to a selected case patient.   

Activity Learning Outcomes 

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

  1. Explain the purpose of two selected screening tools (CO7)
  2. Interpret the scoring criteria of two selected screening tools (CO7)
  3. Discuss the mechanism of action, side effects and expected onset of action for a selected medication (CO4)

Due Date:   

The initial posting to the graded collaborative discussions is due by Wednesday, 11:59 p.m. MT.   

Peer responses and responses to faculty must be posted prior to the week deadline of Sunday 11:59 MT.   

 A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).

Total Points Possible70

Requirements: 

Anxiety and depression are the most common psychiatric problems you will encounter in your primary care practice. 

Review this case study 

HPI: KF, 56-year-old Caucasian female presents to office with complaints of “no energy and not wanting to go out.” These symptoms have been present for about 3 months and seem worse in the morning and improve slightly through the day. It is hard to get out of bed and get the day started because does not feel rested when she wakes up in the morning.  KF reports a “loss of joy”. States” I really don’t feel like going anywhere or doing anything”.  She tries to do at least one social activity a week, but it can be really exhausting. Reports she also has difficulty completing projects for work, she cannot stay focused anymore. She reports not feeling hungry, so she is not eating regularly and has lost some weight.  KF has been a widow for 2 years. Her husband died unexpectedly, he had a MI. She recently got a puppy, which she thought would help with the loneliness, but the care of the puppy seems overwhelming at times. Rest and exercise, specifically yoga and meditation seem to help her feel better. At this time, she does not want to do either, it seems like too much effort to get up and go. She has not tried any medications, prescribed or otherwise. She reports drinking a lot of coffee, but that does not seem to help with her energy levels.  

Current medications: Excedrin PM about once a week when she can’t sleep, seems to help a bit. NKDA.  

PMH: no major illnesses. Immunizations up to date.  

SH: widowed, employed full time as a consultant. Drinks 1 glass of wine almost every night. No tobacco use, no illicit drug use. Previously married 20 years ago while living in France, reports an abusive relationship. The French government gave custody of her son to the ex-husband. She returned to US without her son 10 years ago. She sees her son two times a year, they skype and text “all the time” but she misses him. Her son is now an adult and is considering moving to the US.   

FH: Parents are alive and well. Has one son, age 21, he is healthy but lives in France with his father. 

ROS  

CONSTITUTIONAL: reports weight loss of 4-5 pounds, no fever, chills, or weakness reported. Daily fatigue.   

HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclera. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.  

CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.  

RESPIRATORY: No shortness of breath, cough or sputum.  

GASTROINTESTINAL: Reports decreased appetite for about 3 months. No nausea, vomiting or diarrhea. No abdominal pain or blood.  

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.  

GENITOURINARY: no burning on urination. Last menstrual period 4 years ago.  

PSYCHIATRIC: No history of diagnosed depression or anxiety. Reports history of great anxiety due to verbal and concern for physical abuse, reports feeling very sad and anxious when divorcing and leaving her son in France. Did not seek treatment. She started to feel better after about 4 months.  

ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia  

ALLERGIES: No history of asthma, hives, eczema or rhinitis.  

Discussion Questions:  

  1. Research screening tools for depression and anxiety. Choose one screening tool for depression and one screening tool for anxiety that you feel are appropriate to screen KF.
  2. Explain in detail why each screening tool was chosen. Include the purpose and time frame of each chosen tool.
  3. Score KF using both of your chosen screening tools based on the information provided (not all data may be provided, those areas can be scored as not present). Pay close attention to the listed symptom time frame for your chosen assessment tool.  In your response include what questions could be scored, and your chosen score.  Interpret the score according to the screening tool scoring instructions. Assume that any question topics not mentioned are not a concern at this time.
  4. Identify your next step for evaluation and treatment for KF. Remember to consider both physical and mental health differential diagnoses when answering this question.   (2-3 sentences).
  5. What medication or treatment is appropriate for KF based on her screening score today? Provide the rationale. Any medications should include the medication class, mechanism of action of the medication and why this medication is appropriate for KF. Include initial prescribing information.  
  6. If the medication works as expected, when should KF expect to start feeling better? 
DISCUSSION CONTENT  Category  Points  %  Description  Application of Course Knowledge    21   30  Initial discussion post includes the following:  1) two screening tools chosen- 1 for depression, one for anxiety  2)  Student explains rationale for both screening tool choices (2-3 sentences)   3) both screening tools are scored using provided case study information only AND scores are interpreted using tool scoring guidelines.  4) Next steps for treatment includes physical health diagnoses and suggested necessary diagnostics  5) Medication choice is listed. Rationale includes medication class, mechanism of action and initial prescribing information and education to include side effects and when KF should notice efficacy.  Support from Evidence-Based Practice (EBP)   14  20   1. Discussion post is supported with appropriate, scholarly sources; AND    2. Sources are published within the last 5 years ; AND   3. Reference list is provided and in-text citations match; AND   4. Includes a minimum of one scholarly reference, textbook is not used  Interactive Dialogue   21  30   1. Student provides a substantive* response to at least one topic-related post of a peer; AND   2. Student provides a substantive response to any faculty questions asked regarding the initial student post.    3. Evidence from appropriate scholarly sources are included;    4. Submits a minimum of two posts on two different days.   (*) A substantive post adds new content or insights to the discussion thread and information from student’s original post is not reused in peer or faculty response     56  80%  Total CONTENT Points= 56 points  DISCUSSION FORMAT  Category  Points  %  Description  Organization   7  10   1) Discussion is presented in a logical format, AND   2) Responses are in sequence with the listed bullet points AND   3) The discussion response is understandable and easy to follow AND  4) All responses are relevant to the discussion  topic.     Grammar, Syntax, Spelling & Punctuation   7  10   Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*       14  20%  Total FORMAT Points= 14 points        DISCUSSION TOTAL=____ out of  70 points  

Direct Quotes

Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.

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NR601-Primary care of the maturing and aged family praticum

NR601:Week 2: COPD Case Study Part 2

Purpose 

Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice.  The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group. 

Activity Learning Outcomes 

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

  1. Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1) (CO 2,3,4,5)
  2. Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses. (WO 2.2) (CO 2,4)  
  3. Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)

Due Date 

Student enters initial post to part one by 11:59 p.m. MT on Thursday; responds substantively to at least one topic-related post of a peer including evidence from appropriate sources AND all direct faculty questions in parts one by Sunday, 11:59 p.m. MT. 

 A 10% late penalty will be imposed for discussions posted after the deadline on Thursday 11:59pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT. 

Total Points Possible50 

Case Study – Part 2

You ordered a CXR and spirometry at the previous visit and he returns today to review the results. Physical exam and symptoms are unchanged since last visit. Vital signs at this visit are: Temp-98.3, P-68, RR-20, BP 152/90, Height 68.9in., Weight 258 pounds, O2sat 94% on RA 

CXR Result: 

No acute infiltrates or consolidations are seen. Cardiac and mediastinal silhouettes are normal. No hilar enlargement is evident. Osseous thorax is intact. 

Spirometry Results: 

Pre-Bronchodilator  Post-Bronchodilator    Predicted  Actual  %Predicted  Actual  % Predicted  % Change  FVC (L)  4.52  3.01  67  3.08  68  2  FEV1 (L)  3.40  1.58  46  1.60  47  1  FEV1/FV   .75  .52  —  .52  —  0 

Requirements/Questions:

  1. What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case)
  2. Identify the corresponding ICD-10 code.
  3. Provide a treatment plan for this patient’s primary diagnosis which includes:
    • Medication*
    • Any additional testing necessary for this particular diagnosis*
    • Patient education
    • Referral
    • Follow up
  4.  Provide an active problem list for this patient based on the information given in the case.
  5.  Are there any changes that you would also make to this patient’s overall treatment plan at this time? Must provide an EBP argument for each treatment or testing decision.

*If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST be supported with an evidence-based practice  (EBP) argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office. 

Over-the-counter (OTC) and RXs must be written in full as if handing a prescription to the patient in the office.   

Example:   

Amoxicillin 500 mg capsule  

1 tab po BID q 10 days  

Disp #20 no refills   

DISCUSSION CONTENT  Category  Points  %  Description  Application of Course Knowledge  15  30%  Student chooses one appropriate diagnosis for the patient; AND  Diagnosis is supported with strong pertinent positive and negative subjective and objective data from parts 1 & 2; AND  The ICD code for the diagnosis is correct; AND  Treatment plan for primary diagnosis includes medication, additional testing, patient education, and referral; AND  Prescription and OTC medications are written appropriately as a RX and all components are correct; AND  Treatment decisions (medication, additional testing, referrals) are supported with appropriate EBP arguments; AND   An accurate problem list is presented based on case information; AND   Student discusses changes (or not) to the overall treatment plan for the patient for pertinent issues; AND   An appropriate F/U plan is provided  (9 critical elements)  Support from Evidence-Based Practice (EBP)  15  30%  Discussion post is supported with appropriate, scholarly sources AND  Sources are published within the last 5 years (unless the most current CPG is used) AND  A reference list is provided with in-text citations that match AND  All testing decisions are fully supported with an appropriate EBP argument  (4 critical elements)  Interactive Dialogue  10  20%  Student provides a substantive* response to at least one topic-related post of a peer AND  Includes evidence from appropriate scholarly sources AND  Provides a reference list which match in-text citations AND  Student responds to all direct faculty questions  (4 critical elements)        Total CONTENT Points= 40 pts  DISCUSSION FORMAT  Category  Points  %  Description  Organization  5  10%  Case study response is presented in a logical format, AND  Responses are in sequence with the numbered questions AND  The case study response is understandable and easy to follow AND  All responses are relevant to the case topic  (4 critical elements)  Grammar, Syntax, Spelling & Punctuation  5  10%  Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*          Total FORMAT Points= 10 pts        DISCUSSION TOTAL= 50 pts 
Categories
NR601-Primary care of the maturing and aged family praticum

NR601: Week 2: COPD Case Study Part 1

Purpose 

Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice.  The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group. 

Activity Learning Outcomes 

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

  1. Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1)  (CO,2,3,4,5) 
  2. Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses. (WO 2.2) (CO 2,4)  
  3. Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)

Due Date 

Student enters initial post to part one by 11:59 p.m. MT on Tuesday; responds substantively to at least one topic-related post of a peer including evidence from appropriate sources AND all direct faculty questions in parts one by Sunday, 11:59 p.m. MT. 

 A 10% late penalty will be imposed for discussions posted after the deadline on Tuesday 11:59pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).  

Total Points Possible50 

Case Study – Part 1

Date of visit: November 20,2019 

A 62 year-old Caucasian male presents to the office with persistent cough and recent onset of shortness of breath. Upon further questioning you discover the following subjective information regarding the chief complaint. 

History of Present Illness  Onset  6 months  Location  Chest  Duration  Cough is intermittent but frequent, worse in the AM  Characteristics  Productive; whitish-yellow phlegm  Aggravating factors  Activity  Relieving factors  Rest  Treatments  Tried Robitussin DM without relief of symptoms     Severity  Unable to walk > 20ft without stopping to catch his breath. Last year at this time he routinely walked 1 mile per day without difficulty  Review of Systems (ROS)  Constitutional  Denies fever, chills, or weight loss   Ears  Denies otalgia and otorrhea  Nose  Denies rhinorrhea, nasal congestion, sneezing or post nasal drip.   Throat  Denies ST and redness  Neck  Denies lymph node tenderness or swelling  Chest  Describes a persistent productive cough upon wakening for the last 6 months. Color of phlegm is usually white-yellowish. Shortness of breath with activity.  Cardiovascular  Denies chest pain and lower extremity edema 
History  Medications  Metoprolol succinate ER (Toprol-XL) 50mg daily for hypertension; Multivitamin daily  PMH  Primary hypertension  PSH  Cholecystectomy, appendectomy  Allergies  Penicillin (hives)  Social  Married, 3 children  Senior accountant at a risk management firm  Habits  Former smoker (20 pack-year), quit “cold turkey” when father died; Denies alcohol or illicit drug use.  FH  Father died of MI & CHF at age 59 years (diabetes, hypertension, smoker)  Mother is alive (osteoporosis)   Healthy siblings 

Physical exam reveals the following: 

Physical Exam  Constitutional  Adult male in NAD, alert and oriented, able to speak in full sentences   VS  Temp-98.1, P-66, RR-20, BP 156/94, Height 68.9in, Weight 258 pounds, O2sat 94% on RA  Head  Normocephalic  Ears  Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender.  Nose  Nares patent. Nasal turbinates clear without redness or edema. Nasal drainage is clear.  Throat  Oropharynx moist, no lesions or exudate. Tonsils ¼ bilaterally. Teeth in good repair, no cavities noted.  Neck  Neck supple. No lymphadenopathy. Thyroid midline, small and firm without palpable masses. No JVD  Cardiopulmonary  Heart S1 and S2 with no murmurs, noted. Lungs clear to auscultation bilaterally with faint forced expiratory wheezes in bilateral bases. Respirations unlabored. Legs without edema.  Abdomen  Soft, non-tender. No organomegaly 

Requirements/Questions:

  1. Briefly and concisely summarize the history and physical (H&P) findings as if you were presenting it to your preceptor using the pertinent facts from the case. May use approved medical abbreviations. Avoid redundancy and irrelevant information.
  2. Provide a differential diagnosis (minimum of 3) which might explain the patient’s chief complaint along with a brief statement (2-3 sentences) of pathophysiology for each.
  3. Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis.
  4. Rank the differential in order of most likely to least likely.
  5. Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based practice (EBP) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBP evidence.
DISCUSSION CONTENT  Category  Points  %  Description  Application of Course Knowledge  15  30%  A brief AND concise summary of the history and physical (H&P) findings is presented without redundancy or irrelevant information; AND  Three (3) appropriate diagnoses in the differential are presented which can explain the patient’s chief complaint; AND  A brief statement of pathophysiology is included for each diagnosis; AND  Each diagnosis in the differential is analyzed using pertinent positive and negative subjective and objective findings as support; AND  The differential is ranked in order from most likely to least likely; AND  Clinical reasoning skills are demonstrated by linking testing to diagnoses as applicable; AND  Testing decisions are well supported with EBP arguments that are in-line with the clinical scenario and appropriate for the primary care setting  (7 critical elements)  Support from Evidence-Based Practice (EBP)  15  30%  Discussion post is supported with appropriate, scholarly sources; AND   Sources are published within the last 5 years (unless it is the most current CPG); AND  Reference list is provided and in-text citations match; AND  All testing decisions are fully supported with an appropriate EBP argument  (4 critical elements)  Interactive Dialogue  10  20%  Student provides a substantive* response to at least one topic-related post of a peer; AND  Evidence from appropriate scholarly sources are included; AND  Reference list is provided and in-text citations match; AND  Student responds to all direct faculty questions   (*) A substantive post adds new content or insights to the discussion thread and information from student’s original post is not reused in peer or faculty response  (4 critical elements)        Total CONTENT Points= 40 pts  DISCUSSION FORMAT  Category  Points  %  Description  Organization  5  10%  Case study response is presented in a logical format, AND  Responses are in sequence with the numbered questions AND The case study response is understandable and easy to follow AND  All responses are relevant to the case topic  (4 critical elements)  Grammar, Syntax, Spelling & Punctuation  5  10%  Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*          Total FORMAT Points= 10 pts        DISCUSSION TOTAL= 50 pts