NURS 6531: Primary Care of Adults Across the Lifespan

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NURS 6531: Primary Care of Adults Across the Lifespan

NURS 6531 Entire Course Weekly Discussions And Assignments

NURS 6531 Week 1: Competencies of Advanced Nursing Practice

Listen to the patient. Let them tell their story, and then ask them questions afterwards. It’s important when you’re talking to the patient to be sitting across from them so that you can see their expression and you feel like you and the patient have a relationship because you do have a relationship—you should have a relationship. They need to trust you.

—Terry Buttaro, PhD, ANP-BC, GNP-BC, CEN, FAANP, DPNAP

In this quote, Dr. Buttaro is explaining the importance of the practice inquiry that improves patient outcomes, which is outlined in the nine competencies for practice. As you begin to fulfill your Practicum Experience requirements, it is essential to reflect on the value and importance of the competencies that guide your clinical practice. These competencies and rudiments regulate what advanced practice nurses must demonstrate in the professional setting.

This week, prior to examining systemic disorders and their related evaluation tools and treatments, you explore the application of advanced practice nursing competencies to clinical settings. You also examine the relationship between the competencies and rudiments of nursing practice.

Learning Objectives

By the end of this week, students will:

  • Assess the implementation of advanced nursing practice competencies in clinical settings
  • Analyze the relationship between advanced nursing practice competencies and rudiments of nursing practice
  • Analyze theories in nursing practice
  • Understand coding and billing in nursing practice

NURS 6531: Primary Care of Adults Across the Lifespan

Assignment: Practicum Experience – Journal Entry

As a future advanced practice nurse, it is important that you are able to connect your classroom experience to your Practicum Experience. By applying the concepts that you study in the classroom to clinical settings, you enhance your professional competency. Each week, you will  reflect on your Practicum Experiences and relate them to the material presented in the classroom. This week, you begin your Practicum Experiences and will write your first Practicum Journal.

To prepare for this course’s Practicum Experience, address the following in your first Practicum Journal:

  • Select and describe a nursing theory to guide your practice.
  • Develop goals and objectives for your Practicum Experience in this course. When developing your goals and objectives, be sure to keep the seven domains of practice in mind.
  • Create a timeline of practicum activities based on your practicum requirements.

In a one-page journal entry (250-300 words), you should do the following:

  • Describe your practicum goals and objectives using the seven domains of practice
  • Discuss a nursing theory that would be used to guide your practice.
  • Include APA-style citations and references

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NURS 6531: Primary Care of Adults Across the Lifespan

NURS 6531 Week 2: Evaluation and Management of Integumentary Disorders

The most important practical lesson that can be given to nurses is to teach them what to observe—how to observe—what symptoms indicate improvement—what the reverse—which are of importance—which are of none.

—Florence Nightingale, Notes on Nursing: What it is and What it is Not.

Knowing what to observe and how to observe is a key skill for an advanced practice nurse. You begin observing patients from the moment that you enter the examination room, as patient evaluations typically begin prior to any questioning or physical examinations. You can gather patient information through simple visual observations of body language, demeanor, and cognitive ability. Observation is a crucial component of care, as part of the provider-patient relationship is the eye-to-eye contact. For advanced practice nurses, quick observations of the skin (integumentary) can provide clues to guide assessment and diagnosis.

Throughout the remainder of this course, you examine patient case studies and strategies for the evaluation and management of disorders for adults across the lifespan. This week, your studies begin with integumentary  disorders because they are often the first disorders noticed. You explore differential diagnoses for patients with these disorders, the role of patient information in differential diagnosis, and potential treatment options.

Learning Objectives

By the end of Week 2, students will:

  • Assess differential diagnoses for patients with integumentary disorders
  • Analyze the role of patient information in differential diagnosis
  • Evaluate patient treatment options
  • Understand and apply key terms, concepts, and principles related to integumentary disorders
  • Analyze pattern recognition in patient diagnoses

NURS 6531: Primary Care of Adults Across the Lifespan

When entering examination rooms, advanced practice nurses often immediately begin assessing patients by looking for external abnormalities such as skin irritations or cloudy eyes. By making these simple observations, they can determine how to proceed with their patient evaluations. During the patient evaluation, advanced practice nurses will use initial observations to guide them in acquiring the necessary medical history, performing additional assessments, and ordering the appropriate diagnostics. The information obtained during this evaluation process will help in the development of a differential diagnosis. Once a diagnosis is made, the advanced practice nurse can consider potential treatment options and work with the patient to develop a plan of care. For this Discussion, consider the following three case studies of patients presenting with integumentary disorders.

Case Study 1

A 46-year-old male presents to the office complaining of a pruritic skin rash that has been present for a few weeks. He initially noted the rash on his feet, but it then spread to between the fingers, his wrist, and waist. He notes that it does not seem to be on his face or trunk. He recently came home from a trip to Florida where he had stayed in multiple hotels. He takes occasional ibuprofen for knee pain, but denies taking other medications or having other health problems. He has no known drug allergies. The physical examination reveals a male with several tiny vesicles and scales in between the fingers, on the feet and ankles, around the patient’s wrist and around the belt line.

Picture of a hand that is covered in a pruritic skin rash between the fingers, which covers the wrist. The rash does not uniformly cover the hand and is scaly in some areas.

Case Study 2

K.B., a 52 year old Irish American patient who present today complaining of “a mole” on the skin that is changing colors. He said he has had this ‘mole’ for almost two years. K.B. is a construction worker currently residing in Hawaii. As a teen he worked outside and visited the tanning bed several times a month. He is a worried that this “mole” doesn’t look like the others on his body.

On your examination, you note, the lesion as round, dark colored in appearance, and scaly. You also note the mole has an irregular border and about 0.2cm in size.

Depicted on the skin are four moles. In the center is a large mole that is dark colored in appearance, with an uneven colored tone, appears scaly, and has an irregular border. The other three moles depicted appear normal in appearance.

Case Study 3

J.V. 50 year old patient with history of eczema is here today complaining of lesions on the right side of her face and neck. She thinks it is a flare up of her eczema and is asking for a refill of her ointment, TAC 0.1%.

She complains of some ‘itching’ and a bit of ‘tingling and pain’ to the lesions. She’s a pharmaceutical worker and thinks that the ‘pain’ maybe due to contaminate exposure. Denies any other associating symptoms. Below is a photo of the lesions.

Patient presents with lesions on the right side of her face and neck. The lesions are red in appearance and vary in size. They appear scaly and do not uniformly cover the entire region of her face or neck.

To prepare:

  • Review Part 5 of the Buttaro et al. text and the case studies provided
  • You will either select or be assigned one of the three case studies provided.
  • Reflect on the provided patient information including history and physical exams.
  • Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
  • Reflect on potential treatment options based on your diagnosis.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 3

Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected or were assigned a different case study than you did. Based on information missing from the patient history, suggest other possible diagnoses. Respond to questions posed to you during the week.

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NURS 6531 Week 3: Head, Eyes, Ears, Nose and Throat Disorders

As introduced last week, the physical examination of a patient is usually initiated by the observation of external characteristics. Not surprisingly, abnormal or disease manifestations may cause changes to the head, eyes, ears, nose, or throat (HEENT). Understanding the manifestations which may occur when examining the HEENT system is critical for the advanced practice nurse.

This week, we will discuss the examination of the head, eyes, ears, nose and throat, analyze the differential diagnoses, the role of the patient information, and potential treatment options for patients with any disorder affecting this system.

Learning Objectives

By the end of this week, students will:

  • Assess differential diagnoses for patients with HEENT disorders
  • Analyze the role of patient information in differential diagnosis for HEENT
  • Evaluate patient treatment options for HEENT
  • Understand and apply key terms, concepts, and principles related to head, eyes, ears, nose and throat disorders
  • Analyze pattern recognition in patient diagnoses

NURS 6531: Primary Care of Adults Across the Lifespan essay help

In clinical settings, advanced practice nurses may initiate a physical examination of a patient by examining the components of the HEENT system. Assessing primary diagnoses and differential diagnoses as they concern the HEENT system are important in informing your practice in providing optimal care.

For this Discussion, consider the following three case studies of patients presenting with head, eyes, ears, nose, and throat disorders.

Case Study 1

An 86-year-old widowed female is brought to the office by her daughter-in-law. The patient complains of constant tearing and an itchy, burning sensation in both eyes. The patient states this is not a new problem, but it has worsened in the past week and is affecting her vision. The patient complains that her eyes are dry. She thinks the problem must be caused by one of her medications. Her patient medical history is positive for hypertension, atrial fibrillation, and heart failure. She has an allergy to erythromycin that causes rash and elevated liver enzymes. Medications currently prescribed include Furosemide 40 milligrams po twice a day, diltiazem 240 milligrams po daily, lisinopril 20 milligrams po daily, and warfarin 3 milligrams po daily. The physical examination reveals a frail older female with some facial dryness and slight scaling. Her visual acuity is 20/60 OU, 20/40 OD, 20/60 OS. The eyelids are erythematous and edematous with yellow crusting around the lashes. Sclera are injected, conjunctiva are pale, and pupils are equal and reactive to light and accommodation.

Case Study 2

A middle-aged male presents to the office complaining of a two-day history of a left earache. The onset was gradual, but has steadily been increasing. It has been constantly aching since last night, and his hearing seems diminished to him. Today he thinks the left side of his face may even be swollen. He denies upper respiratory infection, known fever, or chills. His patient medical history is positive for Type 2 diabetes mellitus, hypertension, and hyperlipidemia. The patient has a known allergy to Amoxicillin that results in pruritus. Medications currently prescribed include Metformin 1,000 milligrams po twice a day, lisinopril 20 milligrams po daily, Aspirin 81 milligrams po daily, and simvastatin 40 milligrams po daily. The physical exam reveals a middle aged male at a weight of 160 pounds, height of 5’8”, temperature of 98.8 degrees Fahrenheit, heart rate of 88, respiratory rate of 18, and blood pressure of 138/76. Further examination reveals the following:

  • Face: Faint asymmetry with left periauricular area slightly edematous
  • Eyes: sclera clear, conj wnl
  • L ear: + tenderness L pinna, + edema, erythema, exudates left external auditory canal, TM not visible
  • R ear: no tenderness, R external auditory canal clear without edema, erythema, exudates
  • + tenderness L preauricular node, otherwise no lymphadenopathy
  • Cardiac: S1 S2 regular. No S3 S4 or murmur.
  • Lungs: CTA w/o rales, wheezes, or rhonchi.

Case Study 3

A middle-aged female presents to the office complaining of strep throat. She states she suddenly developed a sore throat yesterday afternoon, and it has gotten worse since then. During the night she felt like she was chilled and feverish. She denies known recent contact with anyone else who had strep throat, but states she has had strep before and it feels like she has strep now. She takes no medications, but is allergic to penicillin. The physical examination reveals a slender female lying on the examination table. She has a temperature of 101 degrees Fahrenheit, heart rate of 112, respiratory rate of 22, and blood pressure of 96/64. The head, eyes, ears, nose, and throat evaluation is positive for bilateral tonsillar swelling without exudates. Her neck is supple with bilateral, tender, enlarged anterior cervical nodes.

To prepare:

  • Review the case studies provided in this week’s Resources.
  • You will either select or be assigned one of the three case studies provided.
  • Reflect on the provided patient information including history and physical exams.
  • Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
  • Reflect on potential treatment options based on your diagnosis.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 3

Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study you selected. Describe the role of the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected a different case study than you did. Respond to questions posed to you during the week.

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NURS 6531: Primary Care of Adults Across the Lifespan exam help

NURS 6531 Week 4: Evaluation and Management of Cardiovascular Disorders

Many of the factors that contribute to cardiovascular disorders are preventable or manageable. However, if left unmanaged, patients may suffer from serious complications. When evaluating patients, it is important to consider individual patient factors and behaviors that might increase patient risk of disorders such as hypertension. There are also other conditions that require advanced practice nurses to utilize appropriate and critical thinking to correctly diagnose cardiovascular or other vascular related disorders. For example, consider the following patient case study: Carlos Ferro was unknowingly suffering from a potentially life-threating disorder. He was diagnosed with exercise-induced asthma and was prescribed drugs to treat asthma exacerbations. However, when his symptoms did not improve, he made the decision to receive additional medical care. After three months of asthma treatments, Ferro discovered that he had been misdiagnosed. Ferro was actually experiencing symptoms of deep vein thrombosis in his leg and a pulmonary embolism in each lung (National Blood Clot Alliance, 2012). Fortunately, Ferro’s misdiagnosis was identified and corrected with the appropriate treatments. However, blood clots are often misdiagnosed or unrecognized until severe medical complications arise. For this reason, as the advanced practice nurse caring for patients, it is critical that you immediately identify signs and symptoms of blood clots and other cardiovascular disorders.

This week, you examine Hypertension, Myocardial Infarctions, causes for types of anemia, and focus on the misdiagnosis of blood clots. You also explore diagnoses and treatments for hypertension, myocardial infarction, anemic patients and examine strategies for preventing the misdiagnosis of blood clots.

Learning Objectives

By the end of this week, students will:

  • Assess patients with histories of cardiovascular disorders
  • Evaluate health promotion strategies for patients with cardiovascular disorders
  • Understand and apply key terms, concepts, and principles related to the evaluation and management of cardiovascular disorders
  • Assess diagnoses for patients
  • Evaluate treatment and management plans
  • Analyze pattern recognition in patient diagnoses

Assignment: Board Vitals

This week you will be responding to twenty Board Vitals questions that cover the following topics:

  • MI
  • HTN
  • Blood Clots
  • Anemias

These questions are intended to help you prepare for your Nurse Practitioner certification exam. It is in your best interest to take your time, do your best, and answer each question to the best of your ability.

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NURS 6531 Week 5: Evaluation and Management of Respiratory Disorders

Respiratory disorders can often be well managed when properly diagnosed and treated. As an advanced practice nurse, you must know when to treat, when to order diagnostics, and when to refer for specialized care. Consider a 33-year-old patient, Eileen Rubin. Rubin presented with difficulty breathing and lower back pain. Rather than ordering diagnostics such as blood tests, chest x-rays, or pulmonary function testing, the provider prescribed muscle relaxers for the pain. After her condition worsened, she sought care from another provider who immediately ordered a chest x-ray and blood work. Following the diagnostic testing, she was admitted to the intensive care unit and was diagnosed with sepsis and acute respiratory distress syndrome. She spent weeks in a drug-induced coma and suffered from a collapse of both lungs (Rubin, 2012, p. 34–36). As this case outlines, you must carefully diagnose and treat patients, as failure to order the proper diagnostic tests could result in the loss of a patient’s life.

This week, you examine patient x-rays and distinguish between normal and abnormal x-ray results. You also explore the use of COPD diagnosis, management, and prevention strategies suggested in the clinical guidelines. Finally, you consider patient diagnoses and treatment based on pulmonary function test results.

Learning Objectives

By the end of this week, students will:

  • Assess differential diagnoses for patients with Respiratory disorders
  • Analyze the role of patient information in differential diagnosis for Reparatory disorders
  • Assess patient diagnoses according to x-ray results
  • Evaluate patient treatment options for Respiratory disorders
  • Understand and apply key terms, concepts, and principles related to Respiratory disorders
  • Analyze pattern recognition in patient diagnoses

NURS 6531: Primary Care of Adults Across the Lifespan

Chest x-rays are an invaluable diagnostic tool as they can help identify common respiratory disorders such as pneumonia, pleural effusion, and tumors, as well as cardiovascular disorders such as an enlarged heart and heart failure. As an advanced practice nurse, it is important that you are able to differentiate a normal x-ray from an abnormal x-ray in order to identify these disorders. The ability to articulate the results of a chest x-ray with the physician, radiologist, and patient is an essential skill when facilitating care in a clinical setting. In this Discussion, you practice your interprofessional collaboration skills as you interpret chest x-rays and exchange feedback with your colleagues.

Consider the three patient case studies and x-rays

Note: By Day 1 of this week, your Instructor will assign you to post on one of these patient case studies and x-rays:

Case Study 1

35-year-old Asian male presents to your clinic complaining of productive cough for two weeks. Stated he has had mild intermittent fever with myalgia, malaise and occasional nausea.

  • SH: works as a law clerk
  • PE: NP noted low grade fever (99 degrees), with very mild wheezing and scattered rhonchi.

An x-ray film is presented which shows a cloudy lung that appears slightly distended.

Case Study 2

This is a 44-year-old Caucasian male being seen at your clinics with complaints of complaints of cough for 4 days and worsening. Stated he has had high grade fever. States he feels weak and has been in bed most of the last two days. Complains of exertional dyspnea, followed by dyspnea at rest, non-productive cough and pleuritic chest pain

  • MEDS: Zovirax, Diflucan, magic mouth wash, Zofran, mycostatin, filgrastin
    PMH: HTN, Hep C, HIV/AIDS, thrush
    SH: Past IV Drug abuse; lives in a group home;
    PE: VS: Ht: 5’7, Wt: 150#, BMI 23,

Anorexic male, febrile, tachypneic, tachycardic, with rales and rhonchi. You note decreased in breath sounds, dullness, and egophony

An x-ray film is presented which shows petechial markings on the lungs and which are cloudy in appearance.

Case Study 3

  •  A 50 year old Caucasian female presents to the clinic with complaints of cough for almost 2 weeks. Positive productive green sputum with associated chills, sweating, and fever up to 101.5. She manages a daycare and states that many of the children have had upper respiratory symptoms in the last two weeks. PMH: DM diagnosed 7 years ago, controlled on medications.
  • MEDS: Glyburide 10mg qd
  • PE: She looks ill with continuous coughing and chills.
  • BP 100/80, T: 102, HR: 110; O2Sat 97% on RA.
  • Lungs: +Crackles, increased fremitus
  • Labs: CBC 17,000 cells/mm3 , blood sugar is 120

An x-ray film is presented which shows cloudiness on the lungs and which also shows some scarring on the lungs.

To prepare:

  • Review Part 10 of the Buttaro et al. text in this week’s Resources, as well as the provided x-rays.
  • Reflect on what you see in the x-ray assigned to you by the Course Instructor.
  • Consider whether the patient in your assigned x-ray has an enlarged heart, enlarged blood vessels, fluid in the lungs, and/or pneumonia in the lungs.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 3

Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study you were selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected or were assigned a different case study than you did by providing additional observations and insights. Respond to questions posed to you during the week.

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NURS 6531: Primary Care of Adults Across the Lifespan

NURS 6531 Week 6: Evaluation and Management of Gastrointestinal Disorders

Patients with gastrointestinal (GI) disorders face many daily challenges as they adhere to treatment and management plans. Consider Debbi Wynn, a patient with Crohn’s disease. Wynn compares her disorder to colon cancer, as a variety of medications can treat symptoms but with considerable risks and complications. Her medication regimen and diet restrictions prevent her from accepting invitations to dinner, drinks, movies, and shopping. Sometimes, unexpected “flare-ups” cause her to miss out on important family events such as weddings and funerals. Wynn often faces the challenges alone, as she feels unable to tell others about the adverse effects including intense pain, nausea, bowel obstructions, dehydration, fatigue, and depression (Wynn, 2012). As the advanced practice nurse, you must not only evaluate and treat patients like Wynn, but also help them to develop management plans that will minimize daily challenges related to their disorders.

This week, you examine potential diagnoses for patients with GI disorders. You also evaluate the role of patient information in diagnosis and treatment.

Learning Objectives

By the end of this week, students will:
  • Assess differential diagnoses for patients with gastrointestinal disorders
  • Analyze the role of patient information in differential diagnosis
  • Evaluate patient treatment options for gastrointestinal disorders
  • Understand and apply key terms, concepts, and principles related to the evaluation and management of gastrointestinal disorders
  • Analyze pattern recognition in patient diagnoses

Midterm Exam

This Exam covers the content you have explored throughout the first six weeks of this course.

This exam is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this quiz. You are not allowed to take screen shots or record the exam questions in any other format while taking the exam. You are expected to comply with Walden University’s Code of Conduct.

By Day 7

This exam is due. You have 110 minutes to complete the exam. You may only attempt this exam once.

Submit by Day 7

Assignment: Practicum Experience – Episodic SOAP Note #2

After completing this week’s Practicum Experience, reflect on a patient who presented with abdominal pain. Describe the patient’s personal and medical history, drug therapy and treatments, and follow-up care.

All SOAP notes must be signed and each page must be initialed by your preceptor. When you submit your SOAP Notes, you should include the complete SOAP Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your SOAP Notes using SAFE ASSIGN.

Please Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.

By Day 7 of Week 6

This Assignment is due. You will submit two files for the Week 6 Episodic SOAP Note #2, including a Word document and pdf/images of each page that is initialed and signed by your preceptor by Day 7 of Week 6.

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NURS 6531 Week 7: Evaluation and Management of Renal and Genitourinary (GU) Disorders

Be patient, and that’s almost an impossible thing because you want to grab for it, for the first remedy you can think of and you want the whole world to stop and start focusing on your problem and for most of us, that isn’t going to happen.

—Drew Bouton, prostate cancer survivor

Genitourinary disorders such as prostate cancer often create a feeling of powerlessness, frustration, anxiety, and embarrassment in patients. For many patients, making health-related decisions is difficult when the implications of their diagnoses are severe. Having provider-patient conversations about symptoms, potential treatment options, and patient education can be overwhelming for patients under such stress. However, as the advanced practice nurse, it is essential that you are able to facilitate the treatment and management process through these difficult conversations. Your role in the clinical setting is unique, as it is not only your responsibility to evaluate, diagnose, manage, and educate patients on their disorders, but also to provide emotional and psychological support to patients and their families.

This week, as you study genitourinary disorders, you examine the patient evaluation process. You also explore the diagnosis and treatment of patients with genitourinary disorders.

Learning Objectives

By the end of this week, students will:

  • Assess differential diagnoses for patients with renal and GU disorders
  • Analyze the role of patient information in differential diagnosis for renal and GU disorders
  • Evaluate patient treatment options for renal and GU disorders
  • Understand and apply key terms, concepts, and principles related to renal and GU disorders
  • Analyze pattern recognition in patient diagnoses

NURS 6531: Primary Care of Adults Across the Lifespan

Urinary frequency is a genitourinary disorder that presents problems for adults across the lifespan. It can be the result of various systemic disorders such as diabetes, urinary tract infections, enlarged prostates, kidney infections, or prostate cancer. Many of these disorders have very serious implications requiring thorough patient evaluations. When evaluating patients, it is essential to carefully assess the patient’s personal, medical, and family history prior to recommending certain physical exams and diagnostic testing, as sometimes the benefits of these exams do not outweigh the risks. In this Discussion, you examine a case study of a patient presenting with urinary frequency. Based on the provided patient information, how would you diagnose and treat the patient?

Case Study 1

A 52-year-old African American male presents to an urgent care center complaining of urinary frequency and nocturia. The symptoms have been present for several months and have increased in frequency over the past week. He has been unable to sleep because of the need to urinate at least hourly all day and night. He does not have a primary care provider and has not seen a doctor in more than 10 years. His father died when he was a child in an automobile accident, and his mother is 79 years old and has hypertension. The patient has no siblings. His social history includes the following: banker by profession, divorced father of two grown children, non-smoker, and occasionally consumes alcohol on weekends only.

Case Study 2

This is a 40 year old Hindu married male complaining of sudden high grade fever for the last 2 days. He is complaining of right flank pain with some burning on urination.  PMH: diabetes, HTN. Current meds: metformin 500mg bid, Lisinopril 10mg QD

Case Study 3

A 52 year old woman presented to the clinic for ongoing fatigue and weight loss during the last 6 weeks. She thinks she’s loss at least “10 pounds”. For the past week and a half she’s noted some progressing ‘muscle cramping’ tetany, as well as ‘tingling’ sensation around her mouth and lower extremities. She’s also noted some intermittent colicky abdominal pain. On your exam, you noted a positive Chvostek’s sign. PMH: 20 year history of Crohn’s disease. She also tells you that she is a practicing vegan.

To prepare:

  • Review Part 13 and 17 of the Buttaro et al. text in this week’s Resources.
  • You will either select or be assigned to a patient case study for this Discussion.
  • Review the patient case study and reflect on the information provided about the patient.
  • Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation.
  • Consider types of physical exams and diagnostics that might be appropriate for evaluation of the patient in the study.
  • Reflect on a possible diagnosis for the patient.
  • Review the Marroquin article in this week’s Resources. If you suspect prostate cancer, consider whether or not you would recommend a biopsy.
  • Think about potential treatment options for the patient.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 3

Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected or were assigned a different case study than you did. Respond to questions posed to you during the week.

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NURS 6531 Week 8: Evaluation and Management of Musculoskeletal Disorders

In clinical settings, patients often present with musculoskeletal disorders such as chronic back pain. Drugs are typically prescribed to help manage this type of pain for patients. Of all drugs prescribed, narcotic analgesics are one of the most common, with over 238 million prescriptions prescribed in 2011 (IMS Health, 2012). This prevalence of prescribing narcotics has led to controversy among patients, providers, pharmacies, and lawmakers. Due to the short- and long-term effects of narcotic drugs, the controversy spans from overuse of narcotics to non-medical use of narcotics. For advanced practice nurses, it is essential to carefully observe and watch for signs of drug abuse during patient evaluations. Because not all musculoskeletal disorders require narcotics, a thorough patient evaluation will help to ensure the development of an appropriate treatment plan with patient safety in mind.

This week, you examine the process of evaluating and prescribing treatment to patients with musculoskeletal disorders. You also explore the ethical implications of prescribing narcotics for pain.

Learning Objectives

By the end of this week, students will:

  • Assess differential diagnoses for patients with musculoskeletal disorders
  • Analyze the role of patient information in differential diagnosis for musculoskeletal disorders
  • Evaluate patient treatment options, including opioids, for patients with musculoskeletal disorders
  • Understand and apply key terms, concepts, and principles related to musculoskeletal disorders and the opioid epidemic
  • Analyze pattern recognition in patient diagnoses

NURS 6531: Primary Care of Adults Across the Lifespan

Assignment 1: Practicum Experience – Comprehensive SOAP Note #3

After completing this week’s Practicum Experience, review the Comprehensive SOAP Note Exemplar and Template in this week’s Resources, and reflect on a patient who presented with musculoskeletal disorders or pain. Describe the patient’s personal and medical history, drug therapy and treatments, and follow-up care.

All SOAP notes must be signed and each page must be initialed by your preceptor. When you submit your SOAP Notes, you should include the complete SOAP Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your SOAP Notes using SAFE ASSIGN.

Please Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.

By Day 7 of Week 8

This Comprehensive SOAP Note #3 is due. You will submit two files for the Week 8 Comprehensive SOAP Note #3, including a Word document and pdf/images of each page that is initialed and signed by your preceptor by Day 7 of Week 6.

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NURS 6531 Week 9: Evaluation and Management of Neurologic Disorders

In the United States, stroke is the fourth leading cause of death and a leading cause of adult disability (National Stroke Association, 2012). Of all stroke cases, 20% are recurrent strokes in patients (American Heart Association, 2012). This outlines the importance of patient education for stroke prevention and disorder management. Depending on the patient’s medical history, stroke prevention might be as simple as recommendations for changes in behavior and lifestyle. This was the case for Connie Bentley, an avid weightlifter. She exercised often and was healthy, but her blood pressure always rose when she lifted weights, which eventually caused her to suffer a stroke. After receiving treatment for her stroke, Bentley’s provider recommended that she stop lifting weights, as it would increase her risk of recurrent stroke. Instead, her provider suggested alternative activities such as tai chi, swimming, and hiking (Bentley, 2012). Although this change was difficult for Bentley, she understood the risks because of provider-patient collaboration and education. When developing treatment and management plans that include behavior and lifestyle changes, provider-patient collaboration is essential, as this will increase the likelihood of patient adherence to established plans.

This week, as you explore neurologic disorders, you examine stroke prevention methods for select patient populations.

Learning Objectives

By the end of this week, students will:

  • Assess differential diagnoses for patients with neurological disorders
  • Analyze the role of patient information in differential diagnosis for neurological disorders
  • Evaluate the patient treatment options for neurological disorders
  • Understand and apply key terms, concepts, and principles related to neurological disorders
  • Analyze pattern recognition in patient diagnoses

NURS 6531: Primary Care of Adults Across the Lifespan

Discussion: Diagnosing Neurological Disorders

As an advanced practice nurse, you will likely observe patients who experience neurological disorders. Challenging to the diagnosis of neurological disorders is the realization that many manifestations of disease may not be overt physically.

For this Discussion, consider the following three case studies of patients presenting with neurological disorders.

Case Study 1

80-year-old male Caucasian male brought to the clinic by his wife concerned about his “memory problems”. Per the wife, she has noticed his memory declining but has never interfered with his daily activities until now. He is unable to remember his appointments and heavily relies on written notes for reminder. Just last week, he got lost driving and was not found by his family until 8 hours later. He is unable to use his cell phone or recall his home address or phone number. He has become a “hermit” per his wife. He has withdrawn from participating with church activities and has become less attentive.

PMH: HTN, controlled
Prostate cancer 20 years ago
Dyslipidemia
SH: no alcohol or tobacco use; needs assistance with medications
PE: VS stable, physical exam unremarkable

Case Study 2

A 30-year-old Asian female presents to the clinic with headaches. History of headaches since her teen years. Headaches have become more debilitating recently. Describes the pain as sharp, worsens with light and accompanied by nausea and at times vomiting. Rates the pain as 7/10. Typically takes 2 tabs of OTC Motrin with ‘some help’. “Sleeping it off in a darkened room’ helps alleviate the headache. VS WNL, physical exam unremarkable.

Case Study 3

A 50-year-old African American male presents with complaints of dizziness left arm weakness and fatigue. PMH: poorly controlled diabetes, hypertension, hyperlipidemia
PE: Upon exam, you noted a very mild dysarthria, he understands and follows commands very well. Mild weakness on the left side of the face is noted, and left sided homonymous hemianopsia but no ptosis or nystagmus or uvula deviation.

To Prepare:

  • You will either select or be assigned one of the three case studies provided.
  • Reflect on the provided patient information including history and physical exams.
  • Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
  • Reflect on potential treatment options based on your diagnosis.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 3

Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role of the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected or were assigned a different case study than you did. Respond to questions posed to you during the week.

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NURS 6531: Primary Care of Adults Across the Lifespan exam help

NURS 6531 Week 10: Evaluation and Management of Endocrine, Metabolic, and Hematologic Disorders

Endocrine disorders such as diabetes often require extensive patient treatment and management. In the United States, over 17.4 million patients take medications to treat and manage their diabetes (CDC, 2012). Whenever treatment and management is involved, especially long-term treatment and management, patient education is critical. Through patient education and provider-patient collaboration, you can increase adherence to treatment and management plans, which is essential for patients with endocrine disorders such as diabetes. As the former surgeon general, C. Everett Koop, has said, “Drugs don’t work for patients who don’t take them” (Kocurek, 2009).

This week, as you study endocrine, metabolic, and hematological disorders, you examine the patient evaluation process. You also explore the diagnosis and treatment of patients with endocrine, metabolic, and hematological disorders.

Learning Objectives

By the end of this week, students will:

  • Assess differential diagnoses for patients with endocrine, metabolic, and hematological disorders
  • Analyze the role of patient information in differential diagnosis for endocrine, metabolic, and hematological disorders
  • Evaluate patient treatment options for endocrine, metabolic, and hematological disorders
  • Understand and apply key terms, concepts, and principles related to endocrine, metabolic, and hematological disorders
  • Analyze pattern recognition in patient diagnoses

NURS 6531: Primary Care of Adults Across the Lifespan

In the United States, 25.6 million adults age 20 years or older have diabetes (American Diabetes Association, 2011). If not properly treated and managed, these millions of diabetic patients are at risk for several alterations including heart disease, stroke, kidney failure, neuropathy, and blindness. Proper treatment and management is the key for diabetic patients, and as the advanced practice nurse providing care for these patients, it is your responsibility to facilitate this process. Patient education is critical, as is working with patients to establish a regular pattern for daily activities such as eating and taking medications. When developing care plans for patients, you must keep the projected outcomes of treatment in mind, as well as patient preferences and other factors that might impact adherence to treatment and management plans. In this Discussion, you draw from your Practicum Experience and consider factors that impact the education and treatment of patients with diabetes.

For this Discussion, consider the following three case studies of patients presenting with endocrine, metabolic, and hematological disorders.

Case Study 1

An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia. Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily. There are no known drug allergies. The physical exam reveals a 5’2” older female. Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98%. Further examination reveals the following:
Eyes: + pallor conjunctiva
Cardiac: irregular rhythm. No S3 S4 or M. NO JVD
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: soft, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding
Rectal: no stool in rectal vault

Case Study 2

A 78-year-old female presents to the emergency room after a fall 3 days ago. She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell. She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell. Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals. There are no known drug allergies. The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24. The MCV is normal.

Case Study 3

V.G. is a 47 year old African American male with type 2 diabetes diagnosed two years ago. He is for a follow up and complaining of increased tingling to the lower extremities. PMH: obesity, dyslipidemia, HTN. He quit smoking smoking two years ago. Denies any alcohol use. SH: lives with alone in a subsidized housing. He is a veteran and relies on food stamps and welfare. Works occasionally. MEDS: he lost his medications and hasn’t taken any in about a week. His chart indicates his is on Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD, PE: 5’9, BP: 160/100 RBG: 415.

To prepare:

  • Review Part 17 and 21 of the Buttaro et al. text in this week’s Resources.
  • You will either select or be assigned to a patient case study for this Discussion.
  • Review the patient case study and reflect on the information provided about the patient.
  • Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation.
  • Consider types of physical exams and diagnostics that might be appropriate for evaluation of the patient in the study.
  • Think about potential treatment options for the patient.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 3

Post a an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected or were assigned to a different case than you. Respond to questions posed to you during the week.

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NURS 6531: Primary Care of Adults Across the Lifespan

NURS 6531 Week 11: Evaluation and Management of Mental Health Disorders

Learning Objectives

By the end of this week, students will:

  • Assess differential diagnoses for patients with psychosocial/mental health disorders
  • Analyze the role of patient information in differential diagnosis for psychosocial/mental health disorders
  • Evaluate patient treatment options for psychosocial/mental health disorders
  • Understand and apply key terms, concepts, and principles related to psychosocial/mental health disorders
  • Analyze pattern recognition in patient diagnoses

Final Exam

This Exam covers the content you have explored throughout this course.

This exam is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this quiz. You are not allowed to take screen shots or record the exam questions in any other format while taking the exam. You are expected to comply with Walden University’s Code of Conduct.

By Day 7

This exam is due. You have 110 minutes to complete the exam. You may only attempt this exam once.
Submit by Day 7

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