NR 603 Weeks 1 to Week 8 Entire Coursework

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NR 603 Advanced Clinical Diagnosis And Practice Across The Lifespan Practicum

NR 603 Course Material Weeks 1 – 8

NR 603 Week 1 Comparison and Contrast Assignment (7 Variants):

Comparison between Dementia and Delirium, Concussive Syndrome and Traumatic Brain Injury, Migraine and Post-Concussive Syndrome, Migraine Headache and Concussive Syndrome, Trigeminal Neuralgia and Giant Cell Arteritis, Migraine Headache and Tension Headache, Benign Paroxysmal Positional Vertigo & Meniere’s Disease

Requirements

For Week 1 of the course there is no case study given to you by the faculty. Instead you will … assigned to diseases to compare and contrast based on the first letter of your last name . This information will … posted in the course announcements under Week 1 Welcome as well as the “Assignment” portion of the Week 1 module.

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

You will research the two areas of content assigned to you. Compare and contrast them in discussion post 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 in the categories below. Evaluation of mastery… student’s ability to demonstrate specific understanding of how to … differ and relate to one another. Address the following topics below:

  1. Presentation
  2. Pathophysiology
  3. Assessment
  4. Diagnosis
  5. Treatment

NR 603 Weeks 1 to Week 8 Entire Coursework

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

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NR 603 Week 2 Case Discussion: Pulmonary Part One (2 Versions)

The purpose of this assignment is for students to:

  1. Improve their ability to formulate diagnoses based on clinical presentation of patients
  2. 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:

  1. Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)
  2. Develop management plans based on current scientific evidence and national guidelines. (PO 5)
  3. Educate patients on treatment decisions (WO1)
  4. Select an evidence-based article to support the plan of care for the case study patient. (WO2)
  5. Analyze national guidelines and apply them to specific case study situations. (WO3)
  6. Review appropriate antibiotic prescribing guidelines. (WO4)

NR 603 Weeks 1 to Week 8 Entire Coursework

Requirements

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 … 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 backat 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.…….

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 … for Michelle given 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 … to address.
  • Address Michelle’s request for an antibiotic.

  • What clinical decision did the NP make?
  • What benefit would a peak flow meter offer? Should this … included?

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NR-603 Week 2 Part Two: Case Study Follow Up Visit Discussion (2 Versions)

Purpose

The purpose of this assignment is for students to:

  1. Improve their ability to formulate diagnoses based on clinical presentation of patients
  2. Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of Pulmonary disorders
  3. Design a relevant treatment plan

Activity Learning Outcomes

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

  1. Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)
  2. Develop management plans based on current scientific evidence and national guidelines. (PO 5)
  3. Educate patients on treatment decisions (WO1)
  4. Select an evidence-based article to support the plan of care for the case study patient. (WO2)
  5. Analyze national guidelines and apply them to specific case study situations. (WO3)
  6. 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 … at 110. Physical exam is otherwise unremarkable. The MA has swabbed her for Influenza A- test is positive.

Discussion Questions Part Two:

  1. 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.
  2. 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 … to make your decision, how a referral is made and defend your position.
  3. Discuss relevant education and follow up plan.

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NR 603 Week 3 Case Discussion: Cardiovascular (2 Versions)

Discussion Questions

  • What Leads Demonstrate the ST Depression?
  • Is Lorene Hypertensive per ACA 2017 Guidelines? Compare the ACA guidelines to JNC 8 guidelines and discuss what treatment you recommend for her BP and why.
  • What is the Primary diagnosis causing Lorene’s chest pain? Include ICD 10 codes (no differentials)
  • What other secondary diagnoses does Lorene have that should be addressed? (Include the rationale and a reference for your diagnoses)
  • Design a treatment plan and discuss how each intervention is applicable to Lorene’s case. Consider the following interventions:
    • Labs
    • Durable Medical Equipment Diagnostic tests- discuss the goal/purpose
    • Any consultation with outside providers/services
    • Medications- discuss why you chose each specific medication
    • Referrals- who and why
    • Follow up- why and when
    • Education- specific and measureable
    • Lifestyle Changes- specific to her cultural preferences, values and beliefs

NR 603 Weeks 1 to Week 8 Entire Coursework

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NR-603 Week 3 Quiz: Solutions, Possible Q & A, Topics

NR 603 Week 3 Quiz (Possible Q & A)
  1. Question: Per 2013 ACC/AHA guidelines, which patient below would NOT benefit from statin therapy?
  2. Question: Which of the following patients should be on high-intensity statin therapy, if tolerated?
  3. Question: For someone who is intolerant to higher doses of statins, has tried 2-3 statins…what do we recommend?
  4. Question: You have a patient with ASCVD but no comorbidities. Their LDL has gone down 30% from baseline and they are on maximally tolerated statin therapy.  Is this patient appropriate for non-statin therapy and if so, what do you recommend?
  5. Question: IG is a 47 yo male with CAD s/p MI 2015. He is currently prescribed atorvastatin 20 mg/day. Pt states he is unable to tolerate higher doses and refuses to try another statin. LDL 114 mg/dL. What is the next best step?
  6. Question: YZ is a 67 yo female with DM and 10 year risk score 11.1%. She is currently prescribed atorvastatin 80 mg once daily with reported adherence. Current LDL-C 141 mg/dL. What is the next best step for cardiovascular risk reduction.
  7. Question: TL is a 52 yo black male overbooked in your clinic today for evaluation of fasting labs per primary provider request. He is without complaints.
    Pertinent medications include amlodipine 10 mg/day and atorvastatin 20 mg/day
    + tobacco use, 3-4 beer/night Labs: TC 302, HDL 21, TG 1167, direct LDL 152, SCr 1.1
    BP 145/78, height 74 inches, weight 113.4 kg
  8. Question: Which of the following drugs inhibits factor IIa (thrombin) and factor Xa by activating antithrombin?
  9. Question: Which of the following drugs have pharmacogenomic information in the FDA label? Select all correct answers (there may be more than one).
    Clopidogrel   B. Atorvastatin   C. Metoprolol    D. Warfarin.   (they all do)
  10. Question: Variants in which of the following genes have the most compelling evidence for association with clopidogrel response?
  11. Question: Brown a 45-year-old African American male has elevated lipids. What should the nurse practitioner do next?
    *A thyroid stimulating hormone (TSH) level
  12. Question: Which of the following medications may have an unfavorable effect on a hypertensive patient’s blood pressure?
  13. Question: Which group of medications would … detrimental if used to treat a patient who has heart failure
  14. Question: A patient with hypertension has been … with gout. Which home medication may have contributed to this episode of gout?
  15. Question: Which of the … class of drugs is preferred treatment for a diabetic with stage II hypertension?
  16. Question: You are caring for a 30-year-old white male in your office with a BP of 144/90. He has never had a diagnosis of hypertension. He doesn’t check his blood pressure at home. He has a family history of hypertension. What are your recommendations?
  17. Question: You are treating a young adult female with HTN and migraine headaches. Which class of medications could you choose to treat both?
  18. Question: A 42-year-old male presents with the following lipid profile. He is not on any medications for cholesterol or herbal supplements…….What medication would you recommend?
  19. Question: You are caring for a 68-year-old male who has been taking atorvastain (Lipitor) for 8 weeks. He complains of fatigue, muscle aches, and dark-colored urine. Which of the following is the most appropriate treatment plan?
  20. Question: What would you advise this patient regarding taking his atrovastatin (Lipitor)?
  21. Question: A 58 year old male presents to your office with an episode of chest tightness in his substernal area that radiated to his back while he was jogging. It was … with rest. Which of the following does this best describe?
  22. Question: Which of the following antihypertensive medications would you avoid prescribing for an elderly white female with the comorbid diagnosis of osteoporosis?
  23. Question: What is the most common cause of left ventricular hypertrophy in the United States
  24. Question: Which of the following heart sounds is …. with heart failure?
  25. Question: While performing a routine physical exam on a 60-year-old hypertensive male, you notice a bruit over the carotid area on the left side of the neck. There is no induration of the skin. This patient is at higher risk for
  26. Question: A 72-year-old female presents to your office with gradual difficulty breathing, non-productive cough, bilateral swelling of her feet, and a 10 pound weight gain. Upon examination you hear crackles and rhonchi with an S3 heart sound. What is the most likely diagnosis?
  27. Question: What is your treatment plan for this patient with difficulty breathing, cough, weight gain, edema, and S3 heart sounds?
  28. Question: You are treating a 49-year-old female who presents with fatigue and palpitations. You check her apical pulse and she is irregular and tachycardic. You obtain an EKG and it reveals afib with rapid ventricular response. What is your treatment plan?
  29. Question: Upon examination of a 17-year-old during a sports physical, you hear a split S2 during inspiration that disappears during expiration. The patient denies chest pain and dyspnea. What will you tell the mother and patient regarding your findings?
  30. Question: Which of the following findings are suggestive of renovascular hypertension?
  31. Question: Selma has acute peripheral arterial occlusion of a lower extremity. Before you begin your examination, you know that it:
  32. Question: Marvin, age 56, is a smoker with diabetes mellitus. He has just been … as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis?
  33. Question: Nathan, age 63, comes for his annual physical. He has a history of mild hypertension and hyperlipidemia that he has not been successful in treating by diet and weight loss. His only complaint is a problem with impotence. On physical examination, you note a palpable, pulsatile abdominal mass in the umbilical region; a bruit above the umbilical region; and diminished femoral pulses. You suspect:
  34. Question: Which of the following usually indicates hyperlipidemia?
  35. Question: Ted, age 18, is to have a cardiac screening examination to determine if he can play college basketball. The … test of choice for detecting hypertrophic cardiomyopathy or idiopathic left ventricular hypertrophy is a(n):
  36. Question: Which of the following conditions or medications can increase triglycerides?
  37. Question: What is the most important question to ask when a client presents with chest pain?
  38. Question: Pathological U waves on the electrocardiogram are most commonly … with which disorder?
  39. Question: Cough, loss of taste, and rash are adverse effects … with which class of antihypertensive agents?
  40. Question: According to the Eighth Joint National Committee JNC 8 guidelines, what is the goal BP level in healthy patients age 60 and older?
  41. Question: Signs of right-sided heart failure include:
  42. Question: Rick is modifying his diet to try to lose weight, but after 3 months, he has not lost any weight, even though he has complied with his diet plan. A follow-up lipid profile reveals the following: total cholesterol, 238 mg/dL; triglycerides, 100 mg/dL; high-density lipoprotein cholesterol, 28 mg/dL; and low-density lipoprotein cholesterol, 190 mg/dL. What would you recommend?
  43. Question: Jeremiah has been on lipid-lowering therapy (statins) for 2 years. He is new to your practice. He says, “I haven’t had my liver function tests (LFTs) in a while to check if my cholesterol medication is causing a problem.” What do you tell him?
  44. Question: Which of the following statements is true about hypertension (HTN) during pregnancy?
  45. Question: Michaels has a long-standing cardiac problem. His electrocardiogram rhythm strip is shown below. Which medication should he be taking to prevent a pulmonary or cerebral problem?
    Afib rhythm
  46. Question: While much teaching is … for your client with congestive heart failure, the most beneficial thing you can tell him that might prevent rehospitalization may … :
  47. Question: A patient with a shallow ulcer on foot with edema to that leg presents. The patient the effected leg has had a chronic dull pain for the last year. Based on these findings the nurse practitioner suspects what diagnosis?
NR-603 Week 3 Quiz (Study Topics)

Heart Failure (ch 121)

  • Congestive heart failure (CHF) risks
  • CHF typical presentation
  • NYHA Classification of CHF
  • AHA/ACC 2009 – staging system of heart
  • HFrEF stands for
  • HFpEF stands for
  • HFmrEF stands for
  • CHF Diagnosis orders
  • CHF treatment & management
  • CHF treatment & management : ACE targets
  • CHF treatment & management : Beta blocker targets
  • **CHF treatment & management : 2016 guidelines**
  • ARNI – ARB combined w neprilysin
  • Other management guidelines for CHF
  • Top 10 challenges of CHF management

High Cholesterol ( ch 211)

  • Hyperlipidemia LDL-C (mg/dL)
  • Triglycerides (mg/dL) HDL-C
  • 10-year ASCVD risk (IB) assessment
  • Lifetime ASCVD risk assessment
  • Other tests of value for ASCVD assessment
  • Lifestyle recommendations forASCVD prevention
  • TLC for hyperlipidemia ; Nutrition
  • Exercise recommendations for hyperlipidemia/BP
  • Primary prevention for ASCVD; Statin Medications
  • Secondary prevention for ASCVD; Statin Medications
  • What do you assess prior to starting Statin therapy
  • Common secondary causes of hyperlipidemia
  • Complimentary medicine for hypercholesterolemia
  • Co-enzyme Q 10 doses
  • interpret labs and ASCVD risk assessment:

 HTN- (ch 122)

  • Define hypertension, both systolic and diastolic
  • Differentiate between:
  • Discuss the prevalence of primary and secondary hypertension in this country
  • Discuss the procedure for obtaining an accurate blood pressure
  • Compare office blood pressure to ambulatory blood pressure monitoring and home monitoring in the diagnosis and treatment of hypertension
  • Outline and explain each portion of the work-up for the patient with primary and secondary hypertension. Include important aspects of:
  • Formulate treatment goals for hypertension
  • Manage the treatment of hypertension including lifestyle modification and pharmacologic therapy based on the JNC 7 algorithm
  • Describe the following for Thiazide-diuretics:
  • Describe the following for Beta-Blockers:
  • Describe the following for Ca Channel Blockers:
  • Describe the following for ACE-Inhibitors:
  • Describe the following for Aldosterone antagonists:
  • Discuss the use of Osteopathic Manipulation in the treatment of hypertension
  • Outline follow-up visits for the treatment of hypertension
  • What are causes of secondary hypertension? (hint ABCDE)
  • Define hypertension for children and adolescents
  • Discuss the relationship between BP & CVD
  • What specific questions should you ask during the history?
  • What specific questions should you ask during the review of systems?
  • What specifically should you look at when performing a physical exam on a pt whom you suspect has HTN
  • Describe what lab and diagnostic tests would be useful to determine cause of secondary hypertension?
  • Describe recommended lifestyle modifications
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  • Discuss the treatment of hypertension in special groups such as:
  • Describe the favorable outcomes for drug considerations in treatment of HTN
  • Describe the unfavorable outcomes for drug considerations in treatment of HTN
  • Define resistant hypertension
  • List possible reasons for resistant hypertension
  • Discuss patient compliance for treatment of HTN
  • Differentiate secondary causes of hypertension based of clinical presentation:
  • Discuss the treatment of hypertension in special groups such as:

 MI- ( ch 120)

  • Types of MI
  • Anterior wall MI
  • Septal Wall MI
  • lateral wall MI
  • Inferior wall MI
  • RV infarction
  • Symptoms of MI
  • 5 components of Pain Assessment
  • Diagnositc Test for MI
  • Tx and *N intervention for MI
  • Drug therapy for MI
  • Additional *N care for MI
  • Discharge planning for MI

PE (pulmonary embolism)  

  • Define PE: Pulmonary Embolus.
  • What does it reduce?
  • What do the effects produce?
  • Blockage of pulmonary arteries by thrombus, fat or air embolus, or tumor tissue and Obstructs alveolar perfusion is what condition?
  • Pulmonary embolism most commonly affect what lobes?
  • What are risk factors for pulmonary embolism?
  • What is the most common symptom of pulmonary embolism(PE)?
  • S/S of PE are dependent on size and extent of?
  • Alveolar necrosis and hemorrhage, Abscess, and Pleural effusion are s/s is from what complication that can happen from PE?
  • What complication from PE Results from hypoxemia associated with massive or recurrent emboli and Right ventricular hypertrophy?
  • … for PE gets Elevated with any clot degradation and False negatives with small PE?
  • What diagnostic test is used most frequently for dx test and requires IV contrast media?
  • What diagnostic test is used if pt can’t have contrast?
  • … test is the most sensitive but invasive?
  • ______ is key for PE?
  • Collaborative care for PE:
  • Goals of treatment for PE:
  • Examples of supportive care for PE?
  • Examples of fibrinolytic agents used for PE?
  • What surgical therapy should be used for a massive PE?
  • What surgical therapy prevents migration of clots in pulmonary system?
  • Nursing management for PE:
  • What should a nurse teach to a pt with PE?
  • Evaluation:
NR 603 Week 3 Quiz (Correct Solutions)
  1. Question: Which of the following drugs does the 8th Joint National Committee (JNC-8) 2014 Evidence Based Guidelines for the Management of High Blood Pressure in Adults recommend for the initial treatment for Caucasian males with microalbuminuria?
  2. Question: A 58 year old male presents to the clinic with a several year history of uncontrolled hypertension. You perform your physical assessment. Which group of physical findings is commonly seen in target organ change in uncontrolled hypertension?
  3. Question: A 44 year old male patient presents to the clinic for evaluation of an episode of chest tightness that radiated to his back that he had earlier in the day when he was out for a walk. He states that once he came home and sat down, the chest tightness resolved. What is the most likely cause of the chest tightness?
  4. Question: A 60 year old woman comes in to the clinic complaining of nausea, shortness of breath, and a dull pain in the middle of her back while playing tag in the yard with her grandchildren yesterday. Her past medical history includes CAD, Type 2 DM, and HTN. Lab work reveals negative Troponins….The most appropriate diagnostic testing includes:
  1. Question: Exercise tolerance Test (ETT) is the first line approach to detecting CAD in stable patients. However, ETT is contraindicated for some patients. Knowing when to consult with specialists is an important part of NP practice. Which patient should … referred to Cardiology to ordering and Exercise Tolerance Test?
  2. Question: A 60 year old male with a history of Type 2 Diabetes and HTN comes in for a follow-up Blood Pressure Check to evaluate the recent medication/diet/exercise plan you prescribed at his visit 3 months ago. Hi BMI is 20
  • His Blood Pressures sitting and standing are
  • 138/80 mm/Hg
  • 132/76 mm/Hg
  • What is the best analysis of the … treatment plan?
  1. Question: This hypertensive drug is the first choice for diabetic and renal failure pts per National Guidelines.
  2. Question: … cause of death for women in the United States is
  3. Question: You are reviewing the labs of a 50 year old patient who … to you for a physical examination. You note, upon review of her lab, that her triglycerides are 670. Triglyceride levels over 500 mg/dl raise an immediate concern for which of the following:
  4. Question: An 82 year old obese female patient presents to the clinic complaining of gradually increasing shortness of breath, weight gain of 4 pounds in the last week and atrial fibrillation on EKG. The most likely cause of her symptoms is:

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NR 603 Week 4 Clinical VISE Assignment

Purpose

The VISE assignment (Virtual Interactive Student Evaluation) is to evaluate student progress in clinical, based on per course clinical objectives.  This will be a mid-term check to identify and assist students who may be struggling with clinical critical thinking and communication.  Students who do not pass the VISE on the first attempt will be placed on a clinical PIP and given a second attempt at passing the VISE prior to course end.  The student must successfully pass the VISE to pass clinical within a course.

Directions

These will … done by phone between the VP and the student sometime between the beginning of week 3 and the end of week 5. Immediately following the VISE the VP and student will do the mid-term phone call check in and review of clinical. VPs should have clinical logs pulled up to review with the student.

603 – Referral to specialist – The VP (professor) will review the student’s clinical logs, from the past two weeks, and select one patient with a complex chronic illness who needs a specialist referral. The professor will notify the student of the patient selected, prior to the call. During the VISE assignment call, the professor will act as specialist taking the call.

The student is to do the following:

  • Pick the correct specialty to refer to
  • Give a SNAPPS summary to the specialist
  • Answer the specialist’s questions about the patient

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NR-603 Week 4 APEA Predictor Exam (Board Questions/Answers/Rational)

  1. Question: A 40-year-old man presents to his NP for evaluation of flank pain that radiates towards his groin with associated nausea and vomiting. The pain came on suddenly and is … as intermittent and crampy. Physical examination reveals some diffuse left-sided abdominal pain to palpation but no other significant abnormalities. Laboratory …, including a complete blood count, serum chemistry, and urinalysis. All labs are normal, except for the urinalysis, which shows microscopic hematuria. Based on this patient’s symptoms and urinalysis results, a diagnosis of nephrolithiasis is suspected. Which of the following is consider the Gold Standard in the diagnosis of nephrolithiasis?
  2. Question: A 52-year-old man presents for further treatment and management of renal stones. He has been trying to increase his fluid intake per the NP’s recommendations. Past medical history includes 3 episodes of passing stones over the past 5 years, all requiring visits to the emergency department for pain control. The patient had not presented for follow-up until the third episode occurred, at which time he was given a strainer and instructed to bring any stones to the office for analysis. Stone analysis was … that the patient has uric acid stones. Which of the following medications would help treat this patient?
  3. Question: A 48-year-old woman with a past medical history of hypertension and obesity presents with severe, crampy abdominal pain, nausea, an inability to get comfortable, and blood in her urine. Her vital signs are stable. Her physical examination is significant for left flank pain and left lower quadrant abdominal pain, but no other abnormalities are noted. A complete blood count and serum chemistry are unremarkable. Urinalysis is positive for blood but is otherwise negative. A CT scan with stone protocol is … and reveals a 3-mm calculus. How should this patient … managed?
  4. Question: Which of the following is NOT a … risk factor for kidney stone formation?
  5. Question: Which of the following medications should NOT increase the risk of kidney stone formation?

NR 603 Weeks 1 to Week 8 Entire Coursework

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NR 603 Week 5 APEA Predictor Assignment Part One

  • 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 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
  • 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:
  • Discuss how the three differential diagnoses differ from each other in: occurance, pathophysiology and presentation.
  • 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

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NR-603 Week 5 APEA Predictor Part Two

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 … 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 basedon that disorder. The case should … clear and include all elements of a normal case that might … presented in class (subjective, objective, assessment, and full five (5) point plan). The clinical logs will be helpful for this process, or notes you have taken in clinical regarding cases. The case should … clear, organized, and meet the following guidelines:

Week 5 Part 2: Due by end of Week 5

  • Post your first line treatment plan based on one dx your differential list in SOAP format.
  • Responds to at least one student’s CC write up and all faculty questions posted directly to you.

NR 603 Weeks 1 to Week 8 Entire Coursework

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NR 603 Week 6 Mental Health Clinical Presentation Part 1

Requirements: For Week 6 of the course there will not … a case study given to you by the faculty. Instead … assigned a mental health disorder commonly seen in primary care & 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 & evidence-based literature. The case should … presented in class (subjective, objective, assessment, and full 5 point plan).  The clinical practicum documentation will … helpful for this process, or notes you have taken in clinical regarding cases.  The case should … 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. The case should lead the class toward the mental health diagnosis assigned to you by your instructor.

Specific Guide: 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 … overly simple. Like your weekly case studies, it should include subjective data that loosely represents the … you have been given. But includes 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.

NEXTLeading 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 … invented case. Your treatment plan should address any national guidelines as appropriate for the …

Participating in part one: As a student you will … student, whom has no responses to their posting. In your response to your peer you must include the following: Your top (3) differentials based on the information provided, the primary … how you would treat that … Use references to support your response.

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NR 603 Weeks 1 to Week 8 Entire Coursework Exam help

NR-603 Week 6 Mental Health Final Treatment Plan/Analysis – Part 2

Requirements: For Week 6 of the course there will not … a case study given to you by the faculty. Instead … assigned a mental health disorder commonly seen in primary care & 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 & evidence-based literature. The case should … presented in class (subjective, objective, assessment, and full 5 point plan).  The clinical practicum documentation will … helpful for this process, or notes you have taken in clinical regarding cases.  The case should … clear, organized, and meet the following guidelines:

Week 6 Part Two – Turning in your final SOAP/Analysis: The final SOAP will include your case as posted in part one and two of the clinical case presentation. After you write out the SOAP include the following sections in a large area called ANALYSIS:

  1. Pathophysiology and Pharmacology: For the primary diagnoses in the case, write a brief summary of the underlying pathophysiology and tie pharmacological treatment chosen in the reversal or control of that pathology.
  2. Additional analysis of the case: This includes national guidelines that were or … how care was unique but … in guidelines.
  3. Follow-up: This means how the patient was doing when seen a second time if this applies. This would … their response to your plan of care.
  4. Quality: Include that considered in hindsight or changes you would make in seeing similar patients in future with the same complaint, history, exam, or diagnosis. Add anything you learned from discussion in the class that shed new light on this patient.
  5. Coding and Billing. Any or all CPT and ICD-10 codes that should … used (List them and name them only.

Written in a word document and submitted in the Week 6 case study summary.

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NR 603 Weeks 1 to Week 8 Entire Coursework

NR 603 Week 7 Quiz Solutions (Possible Q & A, Topics)

NR 603 Week 7 Quiz (Possible Questions & Answers)

Osteo Arthritis

  • Question: Which patient below should be screened for osteoporosis?
  • Question: … medication is recommended by the American college of rheumatology as first line agent for a patient who has been unsuccessful with non-pharmacologic interventions for osteoarthritis pain?
  • Question: Which joints are least commonly involved in osteoarthritis?
  • Question: A 75-year-old female who is otherwise healthy has mild osteoarthritis in her right knee. She complains of pain not relieved by acetaminophen 2000 mg daily. What should … done?
  • Question: An 80-year-old patient is very active but presents today with posterior hip pain for the past week. Which of the following is least likely part of the differential diagnosis?
  • Question: A 62-year-old female presents with atraumatic right knee pain. On exam she has mildly swollen right knee that is not war or tender to touch. She has a negative McMurry test. Her x-ray demonstrates tibiofemoral joint narrowing and visualization of osteophytes. How should the nurse practitioner interpret the results of this x-ray?

Rheumatoid Arthritis

  • Question: Which findings are most commonly … with rheumatoid arthritis?
  • Question: Which of the following test if positive is part of the criteria for systemic lupus erythematosus (SLE)?

NR 603 Weeks 1 to Week 8 Entire Coursework

NR 603 Week 7 Quiz (Study Topics)

QUIZ will end focusing on the assessment, diagnosis and treatment of Osteo and Rheumatoid Arthritis.

OSTEO ARTHRITIS

  • progressive loss of cartilage
  • joint pain (progressive deterioration)
  • osteophytes (bone spurs)
  • cartilage disintegrates
  • bone & cartilage “float” into joint (crepitus)
    Smokers increased risk, more in women.…………document continue 

RHEUMATOID ARTHRITIS

  • common connective tissue disease (joint destruction)
  • chronic, progressive, systemic
  • synovial joints
  • autoantibodies form & attack healthy tissue (inflammation)
    symmetrical
    ……………………document continue


NR 603 Week 7 Quiz (RA & OA)

RA                                                          OA

  • Identifying factors
  • First line treatment
  • What do you monitor during treatment
  • What’s effected
  • Unilateral vs bilateral

Polymyalgia Rheumatica              Temporal Arteritis (giant cell)

  • Identifying factors
  • First line treatment
  • What do you monitor during treatment
  • What’s effected
  • Unilateral vs bilateral

Systemic lupus Erythematous

  • Identifying factors
  • First line treatment
  • What do you monitor during treatment
  • What’s effected

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NR-603 Week 7 Open Forum Discussions – Inflammatory Disorders

This is a required but not graded open forum discussion. An open forum encourages you to post freely without the requirements of traditional discussion posts. What questions/insights do you have about inflammatory disorders? Are you comfortable with your knowledge of pathophysiology, risk factors, and diagnosis? How about diagnostic testing? What types of inflammatory disorders have you encountered in clinical? The floor is open to reinforce your learning.

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NR 603 Weeks 1 to Week 8 Entire Coursework

NR 603 Week 8 Reflection (MSN Outcome 4, MSN Essential IV, Competencies 7)

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.

NR 603 Weeks 1 to Week 8 Entire Coursework paper help

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.

**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.

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NR-603 Week 8 My Evaluations Log – Clinical Evaluation

PATIENT INFO

VISIT INFO

  • Minutes

Client Complexity

Student Level of Function

CODING

  • Diagnosis Information

COMPETENCIES

  • Skills & Procedures
  • Notes

NR 603 Weeks 1 to Week 8 Entire Coursework

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