NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

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NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

NURS 6550 Entire Course Weekly Discussions And Assignments

NURS 6550 Week 1: Medicolegal Considerations and the Role of the Advanced Practice Nurse

Consider this description of acute care: “Acute care encompasses a range of clinical health-care functions, including emergency medicine, trauma care, pre-hospital emergency care, acute care surgery, critical care, urgent care, and short-term inpatient stabilization” (Hirshon et al., 2013).

As the description suggests, the acute care setting is the highest level of acuity for advanced practice nurses. In this setting, advanced practice nurses take on multiple roles and responsibilities as they perform comprehensive health assessments, communicate with multidisciplinary care teams, develop treatment plans that meet the individual needs of patients, and document the care they provide.

This week, as you begin to explore the role of the advanced practice nurse in the acute care setting, you will examine medicolegal responsibilities of advanced practice nurses in relation to documenting and coding the services they provide to patients. You also will explore laws and regulations that determine the roles and scope of practice for advanced practice nurses.

Learning Objectives

By the end of this week, students will:

  • Analyze medicolegal responsibilities of advanced practice nurses
  • Compare medical coding in primary and acute care settings
  • Evaluate laws and regulations for advanced practice nurses

    As an advanced practice nurse (APN), you will be responsible for identifying the ICD-10 diagnosis code, CPT code for procedures, and the E&M code for billing of services. Most nurses have not been involved in the coding of diagnoses or procedures, so these systems are probably unfamiliar to you. In this discussion, we will explore all three coding systems.

    International Classification of Disease, 10th Edition, (ICD-10) is the system used to identify the diagnosis for the patient. The system is very specific and selecting the correct code can facilitate the approval of procedures as well as correct billing of services.

    Current Procedural Terminology (CPT) are codes that identify procedures that have been completed or tests that are requested. Most CPT codes are related to what is considered appropriate ICD-10 codes. For instance, you would not code a bronchoscopy 0BJ08ZZ and relate it to a diagnosis code of low back pain M54.5. The reimbursement would probably be denied because the diagnosis and procedure do not correlate.

    Evaluation and management (E&M) codes are used to determine the complexity of services provided to the patient. Specific documentation must be included in the patient visit note to support the E&M code billed. Improper coding, undercoding, or overcoding can have serious implications for patients, providers, and the provider’s care setting. For this Discussion, you will examine potential coding issues in case studies and consider the medicolegal responsibilities of the advanced practice nurse.

    Case Study 1

    The APN working in urgent care sees a patient with a right ankle sprain. What ICD-10 code would be appropriate for this patient encounter? What additional information and documentation is needed for a correct ICD-10 to be identified?

    Case Study 2

    The APN inserts a radial arterial line in an ICU patient with a hypertensive crisis. What ICD-10 and CPT code would be appropriate for this procedure? Identify any additional information and documentation that is needed for correct coding.

    Case Study 3

    Samantha Smith is an APRN that wrote this note on a patient in the hospital.

    Name: Mr. Xxxxx

    Patient and wife in to review the evaluation for SIADH (secretion of inappropriate diuretic hormone). His sodium is now corrected to 136 with water restriction.
    CT shows old right frontal infarction which he denies having any symptoms of. There is mild cerebral atrophy consistent with age.
    CT of chest shows 2 mm nodule in right apex, possible granuloma.
    CT abdomen unremarkable.

    Impression:

    1. SIADH, improved
    2. Pulmonary nodule, small
    3. Frontal CVA, asymptomatic
    4. Rule out macro vascular disease

    Plan:

    1. Monitor pulmonary nodule with repeat CT scan in 6 months
    2. Pulmonary medicine consult
    3. Neurology consult. He will schedule
    4. Carotid duplex study
    5. Continue fluid restriction

    Samantha, the APN, billed Medicare a 99233 and provided this note as documentation of the service.

    Questions:

    1. What level of E&M coding does this note qualify for? Select one of the following and explain why this level of coding is appropriate. 99231, 99232, 99233, 99234
    2. What levels of history, examination, and medical decision making are included in the note?
    3. What elements are missing in this note that would help qualify it for a higher level of coding and reimbursement? What suggestions would you make to the APN to expand her documentation to bill at a higher level?

    Case Study 4

    Lisa Smith, an acute care advanced practice nurse, is making hospital rounds on the same patients her colleague nurse practitioner saw yesterday. It took her 50 minutes to see 10 of her patients and 30 minutes to see each of the remaining patients on her list. She used the same code for all visits—99233.

    Questions:

    1. Is the AG-ACNP’s use of the same billing code (99233) appropriate for all of the patient’s seen based on the amount of time spent with each patient?
    2. What level of documentation must be included in each note to support this code?
    3. How does the selection of this one code impact clinical practice and billing?

    To prepare:

    • Select one of the provided case studies. (Note- your instructor may assign the case to be completed)
    • Review the information provided and prepare answers to the questions posed in the case study.

    Post on or before Day 3 a summary of your answers related to the case study selected.  Discuss the medicolegal implications for coding and how it would impact the role and responsibilities of the advanced practice nurse.

    Read a selection of your colleagues’ responses.

    Respond on or before Day 6 to at least two of your colleagues on two different days who selected a different case study than you. Share additional insights or alternative perspectives.

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NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

NURS 6550 Week 2: Psychosocial Health Conditions

Psychosocial health conditions present many challenges in acute care settings. Consider a hospitalized patient who has depression and suffers from panic disorders. Such a patient not only may have comorbid health conditions but, like many patients diagnosed with psychosocial health conditions, also is more likely to be noncompliant with treatment regimens. Patients with psychosocial health conditions also have an increased risk of being readmitted to the hospital (American Hospital Association, 2012).

As an advanced practice nurse, you will often be the first point of contact for patients seeking treatment for psychosocial health conditions. Therefore, it is essential that you be able to stabilize and manage patients with multiple conditions, help them develop strong support systems, and ensure adherence to treatment plans.

This week, as you explore presentations of psychosocial health conditions in acute care settings, you will examine strategies for assessing, diagnosing, and treating patients with psychosocial health conditions.

Learning Objectives

By the end of this week, students will:

  • Evaluate patients with psychosocial health conditions
  • Develop differential diagnoses for patients with psychosocial health conditions
  • Develop treatment plans for patients with psychosocial health conditions

NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I essay help

In acute care settings, patients with psychosocial health conditions may present with a variety of complex symptoms that require comprehensive assessment. The results from this assessment are crucial to developing a diagnosis and creating an individualized treatment plan for a patient. For this Discussion, you focus on the assessment as you consider case studies of patients with psychosocial health conditions. You determine what history should be collected from the patients as well as what physical exams and diagnostic tests should be conducted, and you formulate a differential diagnosis with several possible conditions.

To prepare:

  • Review this week’s media in Assessment of Psychosocial Health Conditions and select one of the three case studies.
  • With the case study you selected in mind, reflect on the patient information provided.
  • Think about the health history you would need to collect from the patient.
  • Consider what physical exams and diagnostic tests would be appropriate to help you gather more information about the patient’s condition. Reflect on how results might be used to make a diagnosis.
  • Identify at least five possible conditions to consider in a differential diagnosis for the patient.

By Day 3

Post a description of the health history you would need to collect from the patient in the case study you selected. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five possible conditions for the patient’s differential diagnosis and justify why you selected each.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition and justify your reasoning.

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NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I essay help

NURS 6550 Week 3: Conditions of the Eye, Ear, Nose, and Throat

Symptoms of eye, ear, nose, and throat (EENT) conditions are among the most common complaints for patients. When patients with EENT conditions reach the level of acuity necessary for inpatient care, proper diagnosis can be challenging, because many EENT symptoms can be associated with multiple conditions. As the advanced practice nurse, you must be able to differentiate symptoms and recognize typical and atypical presentations of EENT conditions.

This week, you will examine limitations and challenges of clinical practice. Then, as you study patient presentations of EENT conditions in acute care settings, you will explore strategies for assessing, diagnosing, and treating patients with these conditions.

Learning Objectives

By the end of this week, students will:

  • Analyze limitations and challenges of clinical practice
  • Evaluate patients with eye, ear, nose, and throat conditions
  • Develop differential diagnoses for patients with eye, ear, nose, and throat conditions
  • Develop treatment plans for patients with eye, ear, nose, and throat conditions

NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I exam help

The nursing field requires professionals to be committed to life-long learning and growth. Because a large part of this learning and growth is achieved through clinical experiences, it is invaluable for advanced practice nurses to be able to apply knowledge recently gained from clinical experiences to new situations. By collaborating with colleagues and sharing these experiences and knowledge, advanced practice nurses can further enhance their professional competency.

This week in order to demonstrate collaborative learning; discuss a situation in your acute hospital experience of a collaboration that occurred. Reflect on the experience and the impact it had on your care of this patient. How will this experience possibly impact you in your future practice with these type of patients? What are some limitations and challenges you encountered during this clinical experience?

To prepare:

  • Reflect on this week’s clinical experiences.
  • Consider one limitation or challenge you encountered.
  • Think about how you overcame this limitation or challenge and how this might impact your future practice in acute care settings.

By Day 3

Post a description of at least one limitation or challenge you encountered during your clinical experience this week. Explain how you overcame this limitation or challenge and how this might impact your future practice.

Read a selection of your colleagues’ responses.

By Day 6

Respond to two colleagues by sharing additional insights or alternative perspectives.

NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

Assignment: Assessing, Diagnosing, and Treating EENT Conditions

Many EENT conditions have common symptoms and are often the result of underlying health disorders. Therefore, to ensure proper diagnosis, it is essential for advanced practice nurses to perform comprehensive assessments when patients present with EENT complaints. For this Assignment, as you examine this week’s i-Human patient case study, consider how you might evaluate and treat patients presenting with EENT conditions.

To prepare:

  • Review this week’s Learning Resources. Consider how to assess, diagnose, and treat conditions of the eye, ear, nose, and throat.
  • Review this week’s i-Human case studies. Based on the patient information provided, think about the health history you would need to collect from the patient
  • Consider what physical exams and diagnostic tests would be appropriate to help you gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
  • Identify three to five possible conditions to consider in a differential diagnosis for the patient.
  • Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
  • Reflect on a treatment plan for the patient that includes health promotion and patient education strategies.

To complete:

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Patients Case Player Student Manual in the Week 1 Learning Resources

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NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

NURS 6550 Week 4: Conditions of the Cardiovascular System

Jeff Cole was hospitalized at age 60 for cardiomyopathy with congestive heart failure. As a result of a timely evaluation and diagnosis, Cole had a more positive health outcome than the majority of other patients with his condition. By working closely with Cole to develop a personalized treatment plan, his health care provider was also able to improve his long-term prognosis (St. Anthony’s Medical Center, 2014).

After the initial recovery, patients like Cole often struggle to adhere to treatment plans. However, by collaborating with patients and developing regimes that consider their lifestyle needs, you can help improve health outcomes for patients with cardiovascular conditions.

This week, as you explore the etiology and clinical presentations of cardiovascular conditions in acute care settings, you will examine strategies for assessing, diagnosing, and treating patients with cardiovascular conditions.

Learning Objectives

By the end of this week, students will:

  • Evaluate patients with cardiovascular conditions
  • Develop differential diagnoses for patients with cardiovascular conditions
  • Develop treatment plans for patients with cardiovascular conditions

Cardiovascular conditions are among the leading causes of hospitalization, and they are of particular importance because they often require immediate medical responses. This makes it essential that you not only be able to identify quickly signs and symptoms of these conditions but also be fluent in current evidence-based treatment guidelines. For this Assignment, as you examine this week’s i-Human patient case study, consider how you might evaluate and treat patients who present with cardiovascular conditions

To prepare:

  • Review this week’s Learning Resources. Consider how to assess, diagnose, and treat conditions of the cardiovascular system.
  • Review this week’s i-Human case study. Based on the patient information provided, think about the health history you would need to collect from each patient
  • Consider what physical exams and diagnostic tests would be appropriate to help you gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
  • Identify three to five possible conditions to consider in a differential diagnosis for the patient.
  • Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
  • Reflect on a treatment plan for the patient that includes health promotion and patient education strategies.

To complete:

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Patients Case Player Student Manual in the Week 1 Learning Resources.

By Day 7

This Assignment is due.

Assignment 2: Board Vitals

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

  • Cardiovascular System

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NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

NURS 6550 Week 5: Conditions of the Respiratory System

Victor, a 40-year-old patient, presented to the emergency department with complaints of a high fever and breathing difficulty. Although his symptoms were typical for common respiratory conditions, the underlying cause was much more serious. After Victor lost consciousness and fell into a coma, it was discovered that he had bilateral pneumonia and acute respiratory distress syndrome (ARDS). What had begun as a quick visit to the emergency department for breathing difficulty resulted in a lengthy hospital stay and months of rehabilitation (Sharp Healthcare, 2014).

As Victor’s case demonstrates, patients who present to acute care settings with respiratory problems require immediate attention, because symptoms may worsen quickly and lead to severe health outcomes. In your role as advanced practice nurse, you must identify patients who may be at risk of serious underlying health conditions and respond appropriately.

This week, you will explore presentations of respiratory conditions in acute care settings, you will examine strategies for assessing, diagnosing, and treating patients with respiratory conditions.

Learning Objectives

By the end of this week, students will:
  • Evaluate patients with respiratory conditions
  • Develop differential diagnoses for patients with respiratory conditions
  • Develop treatment plans for patients with respiratory conditions

For this discussion you will select one of the following case studies. You will then discuss pertinent differential diagnoses and identify a leading diagnosis. Consider treatment strategies and develop a management plan for the patient. Please state appropriate dosages for any recommended pharmacologic interventions and/or provide specific orders for nonpharmacologic treatments. Discuss age specific strategies for educating patients and families on the respiratory disorder and the management plan.

Case #1

A 44 year old man seeks treatment due to sudden onset of shaking chills, fever, and productive cough. He states he has had some nasal congestion and achiness for about 1 week but was fine before that. The fever and chills started last night. He has had a couple of coughing fits and produced some yellow colored sputum. He has smoked 1 pack per day for 15 years. He normally does not take any medications. The patient is allergic to PCN and Keflex.

 

Physical Exam: BP 132/77 HR 88 RR 20 T 102 oxygen saturation 100%

S1S2 regular rate and rhythm. No murmur, gallops, or thrills

Lungs are clear except for bronchial breath sounds and end inspiratory crackles in the R lower lobe.

Case #2

A 26 year old with history of asthma is brought to the ED by ambulance with complaints of severe shortness of breath that began about 30 minutes ago. The patient is unable to talk due to her SOB. EMS states they were called to her home by her mother. An albuterol inhaler was present and she has tried to use it twice.

 

PE BP 140/78 HR 92 RR 34 T 98.2

Extremely short of breath and anxious

S1S2 with normal rate and rhythm

Expiratory wheezes are heard throughout the lung fields.

Case #3

A 38 year old woman is admitted for repair of a fracture left wrist. Patient states that she has a 3 month history of non-productive cough that has continued to get worse. The cough is nonproductive and worse at night or after exercise. She has gotten progressively more short of breath during her exercise routine and has had to stop exercising after 20 minutes due to coughing fits. She has never smoked and denies any nasal congestion, headache, fever, or weight loss.

 

PE BP 134/87 HR 82 RR 22 T 98.2

S1S2 with normal rate and rhythm

Lungs are clear with expiratory wheezes heard in the bases

Chest x-ray is normal.

Case #4

A 58 year old man arrives in urgent care center with complaints of shortness of breath. He states that he has been short of breath in the past but only on exertion. He has become more short of breath over the past few months with in occurring at rest now. Over the past several nights, he has slept in the recliner. He reports a productive cough and usually the sputum is white in color. He has smoked 2 packs per day for 15 years. He does not have a primary physician or health insurance. He came in today because he couldn’t catch his breath this morning and got scared.

 

PE – BP 135/85 HR 96 RR 28 T 97.6

He appears uncomfortable with labored respirations and cyanotic lips.

No lymphadenopathy, carotid bruits, or JVD. He is using accessory muscles to breath.

Wheezes and rhonci notes throughout all lung lobes.

S1S2 regular rate and rhythm.

No cyanosis, edema, or clubbing of the extremities.

Case #5

A 21 year old male who comes to the ER complaining of left sided rib pain with increasing shortness of breath over the last 24 hours. He has a non productive cough and T is 100.8 orally. He was recently released from the hospital after a motorcycle accident in which he sustained a clavicle fracture, and 2 left sided rib fractures, and a cerebral contusion.

On exam he appears cyanotic, has respiratory distress and inspiratory crackles over the left base. Current weight is 205 lbs. Height is 6’0”

 

VS – BP 106/88 P 98 RR 38 T 102

Labs results:

  • FIO2 0.21      Hb 14
  • pH 7.56      Na 140
  • pCO2 25      K 4.2
  • PO2 40      Cl 106
  • HCO3 20      CO2 20
  • SaO2 78%
  • Hg 12.6
  • WBC 15,000

Case #6

A 65-year-old female suddenly becomes hypotensive one day following surgery for a fractured femur. Her ABG before surgery on room air showed a PaO2 of 84 and PaCo2 of 39. Current ABG is

 

  • FIO2 0.21      Hb 11.5
  • pH 7.47
  • pCO2 32
  • pO2 57
  • HCO3 23
  • SaO2 83%

Case #7

Mr. B is a 65-year-old male brought to the ER with moderate respiratory distress. He smokes 2 packs of cigarettes daily X 45 years. He has severe COPD. Stated he was doing pretty good until two days ago when he developed a cough and dyspnea. ABGs results:

  • FIO2 0.21      Hb 17
  • pH 7.36      Na 140
  • pCO2 60      K 4.2
  • pO2 35      Cl 91
  • HCO3 33      CO2 35
  • SaO2 51%

Case #8 (Continuation of #7)

Mr. B does well on your regimen, but six hours later he is much less alert, falls asleep easily and responds only when vigorously stimulated. You repeat his ABGs:

 

  • pH 7.10
  • pCO2 80
  • pO2 40
  • HCO3 24
  • SaO2 64%

To prepare:

  • Select and review 1 of the 8 case studies provided. Analyze the patient information.
  • Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
  • Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
  • Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.

Post on or before Day 3 the case you selected along with a discussion of the pertinent differential diagnoses and a leading diagnosis. Present treatment strategies and a management plan for the patient. Please state appropriate dosages for any recommended pharmacologic interventions and/or provide specific orders for nonpharmacologic treatments. Finally, discuss age specific strategies for educating patients and families on the respiratory disorder and the management plan.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days who selected a different case study than you. Share additional insights or alternative perspectives.

NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

Assignment 1: Assessing, Diagnosing, and Treating Conditions of the Respiratory System

Many respiratory conditions have common symptoms and are often the result of underlying health disorders. Therefore, to ensure proper diagnosis, it is essential for advanced practice nurses to perform comprehensive assessments when patients present with respiratory complaints. For this Assignment, as you examine this week’s i-Human patient case study, consider how you might evaluate and treat patients presenting with respiratory conditions.

To prepare:

  • Review this week’s Learning Resources. Consider how to assess, diagnose, and treat conditions of the eye, ear, nose, and throat.
  • Review this week’s i-Human case studies. Based on the patient information provided, think about the health history you would need to collect from the patient
  • Consider what physical exams and diagnostic tests would be appropriate to help you gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
  • Identify three to five possible conditions to consider in a differential diagnosis for the patient.
  • Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
  • Reflect on a treatment plan for the patient that includes health promotion and patient education strategies.

To complete:

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Patients Case Player Student Manual in the Week 1 Learning Resources.

By Day 7

This Assignment is due.

Assignment 2: Midterm Practicum Evaluation

By Day 7

Submit your Midterm Practicum Evaluation to Meditrek.

Assignment 3: Board Vitals

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

  • Respiratory System

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NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

NURS 6550 Week 6: Conditions of the Gastrointestinal System

Gastrointestinal conditions can be challenging to treat in acute care settings, because many clinical manifestations may seem mild or nonspecific and yet cause significant pain and complications for patients. Consider Melinda Ridgely, who went to a hospital because of severe stomach pain. Although she believed she had appendicitis, a series of tests revealed that she had Crohn’s disease. Unfortunately, her initial treatment regimen did not relieve her pain, and her provider had to work closely with her to develop an alternative treatment plan (University of Maryland Medical Center, 2013). When you are diagnosing and treating gastrointestinal conditions such as Melinda’s, it is important to recognize that not every patient will present in the same way or respond in the same way to treatments.

This week, as you examine the clinical presentations of gastrointestinal conditions in acute care settings, you will explore strategies for assessing, diagnosing, and treating patients with gastrointestinal conditions.

Learning Objectives

By the end of this week, students will:

  • Evaluate patients with gastrointestinal conditions
  • Develop differential diagnoses for patients with gastrointestinal conditions
  • Develop treatment plans for patients with gastrointestinal conditions
  • Assess knowledge of patient evaluation, diagnosis, and treatment in acute care settings

When patients present with symptoms related to gastrointestinal conditions, it is important for advanced practice nurses to perform thorough physical examinations and focus on shared patient information, especially regarding symptoms, diet, lifestyle, and medication use. Even mild gastrointestinal symptoms can be caused by serious health conditions with potentially life-threatening consequences. For this Assignment, as you examine this week’s i-Human patient case study, consider how you might evaluate and treat patients who present with gastrointestinal conditions.

To prepare:

  • Review this week’s Learning Resources. Consider how to assess, diagnose, and treat conditions of the gastrointestinal system.
  • Review this week’s i-Human case studies. Based on the patient information provided, think about the health history you would need to collect from the patient
  • Consider what physical exams and diagnostic tests would be appropriate to help you gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
  • Identify three to five possible conditions to consider in a differential diagnosis for the patient.
  • Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
  • Reflect on a treatment plan for the patient that includes health promotion and patient education strategies.

To complete:

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Patients Case Player Student Manual in the Week 1 Learning Resources.

By Day 7

This Assignment is due.

Exam: Midterm Exam

This exam covers topics related to assessing, diagnosing, and treating the following:

  • Psychosocial health conditions
  • Conditions of the eye, ear, nose, and throat
  • Conditions of the cardiovascular system
  • Conditions of the respiratory system

By Day 7

Complete the Midterm Exam.

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NURS 6550 Week 7: Conditions of the Genitourinary, Gynecologic, and Renal Systems and Acid/Base Disorders

Genitourinary, gynecologic, renal, and acid/base conditions may present unique challenges for providers in acute care settings, because presentations of these conditions can vary significantly. Variations occur not just between young adults and older adults but also between females and males. Because of embarrassment or sensitivity, patients also sometimes wait to seek treatment for symptoms of these conditions until they become so severe that health outcomes are poor or even potentially life-threatening. The potential for these conditions to exert a serious impact on patients’ physical and emotional well-being makes it essential for advanced practice nurses to establish trusting relationships with patients. Such trust will help to ensure timely diagnosis and treatment.

This week, you will discuss the effectiveness of health promotion and patient education interactions. Then, as you study patient presentations of genitourinary, gynecologic, renal, and acid/base conditions in acute care settings, you will examine strategies for assessing, diagnosing, and treating patients with these conditions.

Learning Objectives

By the end of this week, students will:

  • Evaluate patient interactions in relation to health promotion and patient education
  • Evaluate patients with conditions of the genitourinary, gynecologic, and renal systems and acid/base disorders
  • Develop differential diagnoses for patients with conditions of the genitourinary, gynecologic, and renal systems and acid/base disorders
  • Develop treatment plans for patients with conditions of the genitourinary, gynecologic, and renal systems and acid/base disorders

Common emergency department complaints are vaginal bleeding, and STIs. An understanding of the differential diagnoses that might occur with pregnant and non-pregnant women is important to grasp. Advanced clinical skills that the Acute Care Nurse Practitioner must be familiar with include the auscultation of fetal heart tones, basic fetal heart monitoring, pelvic exams, and delivery of fetal demise or precipitous deliveries of viable fetuses. Pregnancy can alter the diagnostic possibilities of a patient with acute abdominal pain and change the clinical findings. Advanced pregnancy can make it even more difficult.

The Centers for Disease Control and Prevention estimates that there are 19 million new cases of sexually transmitted infections every year in the United States. STIs may present serious health implications for infected patients—especially for those who are unaware of their health condition. Studies show that women are not only at greater risk of contracting these infections, but they also tend to have more severe health problems resulting from infections than men. As an advanced practice nurse, you must educate female patients and emphasize the importance of prevention and STI testing for all women regardless of marital status, race, ethnicity, or socioeconomic status.

Case Study 1

A 19-year-old Asian American female comes into the urgent care clinic. She is complaining of severe abdominal pain, that radiates to her back. She is having a moderate amount of vaginal bleeding. She has a past medical history of PID and has used an IUD in the past. Her vitals are T 37.7, P 116, RR 18, BP 88/50.

Case Study 2

A 31-year-old African American female is brought into the ER with vaginal hemorrhage. She is unsure of her last menstrual period. States she is sexually active and does not use protection. On exam there are large clots noted in the vaginal vault, with possible tissue. Vital signs are T 37, P 134, RR 26, BP 180/110.

Case Study 3

A 21-year-old nulligravida comes to the ER, concerned about vague lower abdominal pain for two days associated with a yellowish, nonodorous, vaginal discharge. Past history reveals regular menstrual periods and no previous surgeries or significant medical problems. Her last menstrual period was normal and ended two days ago. She had a similar episode about eight months ago for which she did not seek care because of lack of health insurance. She is currently sexually active with one partner and has had two partners in the past year. She is not using any type of contraception. On physical exam you note a temperature of 38º C, a regular pulse of 100, and a BP of 110/65. Her abdomen is diffusely tender in both lower quadrants. Pelvic exam reveals a yellowish cervical discharge with cervical motion tenderness and a tender fullness in both adnexa.

To prepare

  • Review and select one of the three provided case studies. Reflect on the patient information.
  • Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
  • Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
  • Consider strategies for educating patients on the treatment and management of the gynecological condition you identified as your primary diagnosis.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Provide a minimum of three possible diagnoses, and list them from highest priority to lowest priority. Explain which is the most likely diagnosis for the patient and why. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patient.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in both of the ways listed below. Respond to colleagues who selected different case studies than you did.

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NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

NURS 6550 Week 8: Conditions of the Endocrine System and Infections

Consider Patrick Hanley, a 67-year-old patient with diabetes. Patrick unknowingly fractured his heel, and diabetic peripheral neuropathy prevented him from feeling any pain. This untreated fracture led to a sore on his heel, which eventually became an infected open wound. The infection spread to the bone, creating the potential for sepsis (PA Foot and Ankle Associates, n.d.). Like Patrick, many patients with endocrine conditions and infections experience serious and sometimes life-threatening complications. In acute care settings, advanced practice nurses are responsible for treating patients with such conditions and preventing further illness.

This week, as you explore presentations of endocrine conditions and infections in acute care settings, you will examine strategies for assessing, diagnosing, and treating patients with endocrine conditions and infections.

Learning Objectives

By the end of this week, students will:

  • Evaluate patients with endocrine conditions and infections
  • Develop differential diagnoses for patients with endocrine conditions and infections
  • Develop treatment plans for patients with endocrine conditions and infections

To prepare:

    • Select and review one of the videos found on the Khan academy website using the links below:
    • Khan Academy. (n.d.). Types of diabetes. Retrieved fromhttps://www.khanacademy.org/science/health-and-medicine/endocrine-system-diseases/v/treating-type-i-diabetes/v/types-of-diabetes
    • Khan Academy. (n.d.). Infectious diseases. https://www.khanacademy.org/science/health-and-medicine/infectious-diseases
  • Take notes as you watch the video and then prepare a summary of what you learned.

By Day 3

Post the title of the video you selected and a summary of the video written in your own words of what you learned. NO references are required for this Discussion Board post.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days. Respond to colleagues who selected a different video than you did. Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or contrasting perspectives.

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NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I exam help

NURS 6550 Week 9: Conditions of the Skin and Musculoskeletal System

Patients with skin and musculoskeletal conditions often require extensive management to prevent pain, injury, and other complications. Consider Debra Garrison, who was diagnosed with rheumatoid arthritis and scleroderma. As a result of her conditions, she experienced chronic ulcers on her feet and ankles. Worried that she might lose the ability to walk, Debra communicated her concerns to her healthcare providers. Together they developed a plan of care that allowed her to manage the conditions effectively (UC Health, 2012). However, because not all patients are as proactive as Debra, it is important for you as an advanced practice nurse in acute care to actively engage patients and facilitate education and management discussions.

This week, you will discuss the role of the advanced practice nurse in multidisciplinary teams. Then, as you study presentations of skin and musculoskeletal conditions in acute care settings, you will explore strategies for assessing, diagnosing, and treating patients with these conditions.

Learning Objectives

By the end of this week, students will:

  • Analyze the role of advanced practice nurses in multidisciplinary teams
  • Evaluate patients with skin and musculoskeletal conditions
  • Develop differential diagnoses for patients with skin and musculoskeletal conditions
  • Develop treatment plans for patients with skin and musculoskeletal conditions

NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

Discussion: Nurse Practitioner Roles in Multidisciplinary Teams

Patient care requires collaboration and communication among members of the multidisciplinary care team. As an advanced practice nurse, you are an important member of this team of medical professionals. By facilitating collaboration among members of the care team, you can ensure that patients’ needs and concerns are met, care plans are individualized, and appropriate treatment and support are available. For this Discussion, you will consider the role you filled in multidisciplinary care in your clinical setting and how this experience might impact your future practice in acute care.

To prepare:

  • Reflect on your clinical experiences from this week that included multidisciplinary care.
  • Consider your role as the advanced practice nurse in these experiences. Think about how you contributed to and supported the multidisciplinary teams. Include why your role is important to the holistic care of patients.
  • Reflect on how these experiences will inform your future clinical practice in acute care settings.

By Day 3

Post a description of this week’s clinical experiences that included multidisciplinary care. Explain your role as the advanced practice nurse in these experiences. Include why your role is important to the holistic care of patients. Then, explain how these experiences will inform your future clinical practice in acute care settings.

Read a selection of your colleagues’ responses.

Respond to two colleagues by sharing additional insights or alternative perspectives.

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NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

NURS 6550 Week 10: Conditions of the Neurologic System, Pain, and Toxic Exposures

I wanted desperately to be “normal”—to provide for myself—but no combination of medications or lifestyle changes kept me out of the emergency room. I had to give everything I had to make it from one day to the next without another fall, another burn, more stitches, another chipped tooth.

—Valda, epilepsy patient

Like Valda, patients with neurologic conditions, pain, and toxic exposures often experience significant challenges. Many patients present to acute care settings with injuries resulting from their conditions and symptoms related to side effects of their countless medications. In your role as advanced practice nurse, you have the opportunity to treat and support these patients as they adapt to lifestyle changes and learn to manage their conditions.

This week, as you explore how neurologic conditions, pain, and toxic exposures may present in acute care settings, you will examine strategies for assessing, diagnosing, and treating patients with these conditions.

Learning Objectives

By the end of this week, students will:

  • Evaluate patients with neurologic conditions, pain, and toxic exposures
  • Develop differential diagnoses for patients with neurologic conditions, pain, and toxic exposures
  • Develop treatment plans for patients with neurologic conditions, pain, and toxic exposures

NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

Pain and other symptoms of neurologic conditions and toxic exposures often impact multiple body systems and can have life-threatening implications if not treated in a timely manner. These conditions also present significant concerns for patients and providers because they are among the leading causes of hospital readmissions. For all of these reasons, your role in the care and management of acute care patients is essential. For this Assignment, as you examine this week’s i-Human patient case study, you will consider how you might evaluate and treat patients who present with conditions of the neurologic system, pain, and toxic exposures.

To prepare:

  • Review this week’s Learning Resources. Consider how to assess, diagnose, and treat conditions of the neurologic system, pain, and toxic exposures.
  • Review this week’s i-Human case studies. Based on the patient information provided, think about the health history you would need to collect from the patient.
  • Consider what physical exams and diagnostic tests would be appropriate to help you gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
  • Identify three to five possible conditions to consider in a differential diagnosis for the patient.
  • Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
  • Reflect on a treatment plan for the patient that includes health promotion and patient education strategies.

To Complete:

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Patients Case Player Student Manual in the Week 1 Learning Resources.

By Day 7

This Assignment is due.

Assignment 2: Board Vitals

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

  • Neurologic Conditions
  • Pain
  • Toxic Exposures

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NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

NURS 6550 Week 11: Conditions of the Hematologic, Lymphatic, and Immune Systems

Conditions of the hematologic, lymphatic, and immune systems have their own unique risks, causes, and clinical presentations. Advanced practice nurses who care for patients with these conditions must treat not only the disease but also the whole patient. Consider Richard Fletcher, who was diagnosed with sickle cell disease, a genetic condition. Throughout his life, he experienced pain crises and complications that led to frequent hospitalizations and prevented him from completing school or holding a stable job (UPMA, 2014). As with many patients who have hematologic, lymphatic, and immune disorders, Richard’s entire life was altered by his condition. In your role as advanced practice nurse, you will have the opportunity to provide patients like Richard with comprehensive care that addresses much more than just the treatment and management of physical symptoms.

This week, you will participate in your final Clinical Conference and discuss “aha” moments of insight, inspiration, or realization. Then, as you explore how hematologic, lymphatic, and immune conditions may present in acute care settings, you will examine strategies for assessing, diagnosing, and treating patients with these conditions.

Learning Objectives

By the end of this week, students will:

  • Analyze the impact of clinical experiences on future clinical practice
  • Evaluate patients with hematologic, lymphatic, and immune conditions
  • Develop differential diagnoses for patients with hematologic, lymphatic, and immune conditions
  • Develop treatment plans for patients with hematologic, lymphatic, and immune conditions
  • Assess knowledge of patient evaluation, diagnosis, and treatment in acute care settings

NURS 6550: Advanced Practice Care of Adults in Acute Care Settings I

Assignment 1: Assessing, Diagnosing, and Treating Conditions of the Skin and Musculoskeletal System

Patients with hematologic, lymphatic, and immune conditions often present to acute care settings with multiple physical symptoms. The health implications of these conditions also cause many patients to experience emotional distress, which may lead to psychosocial health conditions. Thus, your role in the holistic care of patients is essential. For this Assignment, as you examine this week’s i-Human patient case study, consider how you might evaluate and treat patients who present with hematologic, lymphatic, and immune conditions.

To prepare:

  • Review this week’s i-Human case studies. Based on the patient information provided, think about the health history you would need to collect from the patient.
  • Consider what physical exams and diagnostic tests would be appropriate to help you gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
  • Identify three to five possible conditions to consider in a differential diagnosis for the patient.
  • Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
  • Reflect on a treatment plan for the patient that includes health promotion and patient education strategies.

To complete:

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Patients Case Player Student Manual in the Week 1 Learning Resources.

By Day 7

This Assignment is due.

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