NRNP 6550 – Advanced Practice Care of Adults in Acute Care Settings II Course Guide, Assignments & Examples

NRNP 6550 – Advanced Practice Care of Adults in Acute Care Settings II Course Guide, Assignments & Examples

NRNP 6550 – Advanced Practice Care of Adults in Acute Care Settings II (3 credits)

The complex assessment and care of patients in the hospital setting will require advanced practice nurses to obtain the specialized skills necessary to provide quality care for patients in these acute care settings. This course is designed to prepare students to provide care for acutely ill and critically ill patients. Students in this course will be introduced to the role of the advanced practice nurse, while gaining confidence in caring for acutely ill patients. Through course assignments and clinical practice in the acute care setting they will plan, implement and evaluate care for critically ill patients. Students will also increase their knowledge of pharmacologic management of hospitalized patients, while applying knowledge gained through previous coursework.

Prerequisites

• NRNP 6540
• NRNP 6566

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NRNP 6550 wk 1-5 concepts-updated

NRNP 6550

Week 1 to 5 Key Concepts

Week 1- Medicological, Health Promotion, Psychosocial considerations

1. Identify and describe the three levels of prevention. Be able to provide examples
2. Identify health screenings that are recommended by agea. Cancers such as prostate and breast, LDL screening, osteoporosis, HTN, DM
3. Identify recommendations for administration of pertussis, tetanus, and pneumococcal vaccinesa. Know the contraindications of vaccines
4. Distinguish between live, attenuated, and inactivated vaccines
5. Know the treatment of different psych disorders-depression, insomnia, anxiety, alcohol disordera. Be familiar with CAGE assessment b. Drugs to be avoided in bipolar disorder
6. Know the adverse reactions of different psych meds-SSRI’s, NSRI’s, TCA, etc.
7. BE familiar with suicide screenings and predictors

Week 2 -EENT considerations

1. Common symptoms, diagnostics, and treatment of EENT disorders a. Epiglottis, pharyngitis, rhinosinusitis, otitis medias
2. Be able to identify angioedema and treatment modalities
3. Know signs and symptoms as well as treatment for Bells Palsy
4. Management of corneal abrasions5. Symptoms of eye disorders such as retinal detachment

Week 3 and 4-Cardiological disorders

1. Differentiate between STEMI, NSTEMI, and angina. Include symptoms, diagnostics, and treatment. Know the side effects, dosing, and interactions of all medications
2. Be familiar with PCI guidelines
3. Describe the use of TPA in treatment of ACS. Know the contraindications of TPA a. Be familiar with different stents
4. Describe Prinzmentas angina and how it is treated
5. Be familiar with the ATP 3 cholesterol treatment guidelines. Include medication, monitoring, dosing recommendations and treatment goals.
6. Signs and symptoms of cardiac tamponade and treatment for it.
7. Physical exam findings, diagnostics, and treatment for a. Mitral regurgitationb. Mitral stenosisc. Aortic regurgitationd. Aortic stenosis
8. Signs, symptoms, diagnostics, and treatment for endocarditis. Be familiar with the Duke criteria
9. Signs, symptoms, diagnostics, and treatment for pericarditis
10. Signs, symptoms, diagnostics, and treatment for cardiomyopathy. Distinguish between the threetypes of cardiomyopathies.
11. Signs, symptoms, diagnostics, and treatment for myocarditis
12. Signs, symptoms, diagnostics, and treatment for heart failure
13. Know about Virchow’s triad
14. Know contraindications for fibrinolytic therapy and when it is used in the setting of ACS
15. Be familiar of acute limb ischemiaa. Signs, symptoms, diagnosis, treatment

Week 5 Respiratory Part I

1. Signs, symptoms, diagnostics, and treatment for pulmonary embolism.
2. Be able to identify pneumonia, atelectasis, pulmonary edema
3. Interpret pulmonary function test and identify level of compromise for obstructive or restrictive disease
4. Describe the four phases of ARDS. Discuss prevention and treatment strategies
5. Signs, symptoms, diagnostics, and treatment for tuberculosis
6. Signs, symptoms, diagnostics, and treatment for pleural effusion
7. Signs, symptoms, diagnostics, and treatment of COPD-mainstay of treatmenta. Action of different class of meds-Beta2 agonists, mucolytics, anticholinergics b. Lung volume changes
8. Be sure to know dosing, side effects, and interactions of all medications indicated for treatment of listed conditions
9. Signs, symptoms, diagnostics, and treatment for asthma. Know the stepwise approach to treatment. Describe how monitoring with PEF works.
10. Identify the treatment plan for an acute asthma exacerbation
11. Signs, symptoms, diagnostics, and treatment for pneumonia. Distinguish between HAP and CAP including diagnostic criteria and treatment

NRNP 6550 iHuman Case Study Assignments Week 2 – 11

NRNP 6550 Week 2 i-Human Case Study Elisa Henderick

NRNP 6550 Week 3 i-Human Case Study Cindy Wagoner

NRNP 6550 Week 4 i-Human Case Study Ariela Hernandez

NRNP 6550 Week 5 i-Human Case Study Alvin Stafford

NRNP 6550 Week 6 i-Human Case Study Tom Bradford

NRNP 6550 Week 7 i-Human Case Study Walter Sobchak

NRNP 6550 Week 8 i-Human Case Study Erin Bradley

NRNP 6550 Week 9 i-Human Case Study Betty Burns

NRNP 6550 Week 10 i-Human Case Study Samantha A. Higgins

NRNP 6550 Week 11 i-Human Case Study Charlie Harris

NRNP 6550 Week 1 Discussion Including Response; Medicolegal Impacts on Health Promotion

Vaccination can prevent the emergence and spread of disease. It is no surprise that it is a supported public health promotion issue. Many of the diseases targeted by vaccines are childhood diseases that impact the young; hence vaccination can prevent infants, children, and teens from potentially harmful diseases that can even be deadly.

But immunizations are not just for children. Protection from some childhood vaccines can wear off over time. Adults may also be at risk for vaccine-preventable disease due to age, job, lifestyle, travel, or other health conditions.

For this Discussion, review the immunization recommendations for patients across the lifespan. Reflect on how these recommendations might differ for patients who are immunocompromised or on immunosuppressive therapy. Consider how patient factors, such as age group and gender, might affect which immunizations are recommended by nurse practitioners for their patients.

• Review the Learning Resources on medicolegal and health promotion considerations.
• Reflect on how medicolegal recommendations may impact health promotion strategies for the advanced practice nurse.

Write a post comparison of the differences in immunizations that are recommended for patients ages 11–24, 25–64, and 65 years of age and older. Then, explain how these immunizations might impact patients who are immunocompromised or on immunosuppressive therapy. Be specific and provide examples by age group and gender.  With 3 APA style citations

NRNP 6550 Week 1- Medicological and Health Promotion

Describe what elements are included when identifying a billing code.

1. Identify and describe the three levels of prevention.  Be able to provide examples
2. Identify health screenings that are recommended by age
   1. Cancers such as prostate and breast, LDL screening, osteoporosis
3. Identify recommendations for administration of pertussis, tetanus, and pneumococcal vaccines
4. Distinguish between live, attenuated, and inactivated vaccines

Week 1: Medicolegal and Health Promotion

The story of humankind contains many impressive accomplishments. Yet, in order to turn the page on any advancement, it is often necessary to address its impact, including any ethical or legal considerations that must be addressed.

This is certainly true of health accomplishments. Medical professionals continue to learn new ways to address both existing and emerging health concerns. With each achievement comes the need to address the extent to which regulation and/or ethics impacts behavior, informs decision-making, and guides health promotion activities.

This week, you examine this impact. You analyze medicolegal impacts on health promotion by comparing differences in immunizations for differing age populations and consider the impact on immunocompromised patients. You also identify concepts related to medicolegal recommendations and health promotion initiatives.

Learning Objectives

Students will:

• Compare immunization recommendations for patients across the lifespan
• Analyze the effects of immunizations on immunocompromised or immunosuppressed patients
• Analyze the effects of patient factors on immunization recommendations

Discussion: Medicolegal Impacts on Health Promotion

Vaccination can prevent the emergence and spread of disease. It is no surprise that it is a supported public health promotion issue. Many of the diseases targeted by vaccines are childhood diseases that impact the young; hence vaccination can prevent infants, children, and teens from potentially harmful diseases that can even be deadly.  

But immunizations are not just for children. Protection from some childhood vaccines can wear off over time. Adults may also be at risk for vaccine-preventable disease due to age, job, lifestyle, travel, or other health conditions.

For this Discussion, review the immunization recommendations for patients across the lifespan. Reflect on how these recommendations might differ for patients who are immunocompromised or on immunosuppressive therapy. Consider how patient factors, such as age group and gender, might affect which immunizations are recommended by nurse practitioners for their patients.

To Prepare:

• Review the Learning Resources on medicolegal and health promotion considerations.
• Reflect on how medicolegal recommendations may impact health promotion strategies for the advanced practice nurse.

By Day 3

Post a comparison of the differences in immunizations that are recommended for patients ages 11–24, 25–64, and 65 years of age and older. Then, explain how these immunizations might impact patients who are immunocompromised or on immunosuppressive therapy. Be specific and provide examples by age group and gender.  

By Day 6

Respond to at least two of your colleagues on two different days and expand upon your colleagues’ posts by recommending which immunizations should be recommended to address immunocompromised or immune suppressed patients and explain why. 

You can Check an Example on NRNP 6550 Week 1 Medicolegal Impacts on Health Promotion Discussion to guide you with writing your nursing paper.

Learning Resources

Required Readings (click to expand/reduce)

Barkley, T. W., Jr., & Myers, C. M. (2020). Practice considerations for the adult-gerontology acute care nurse practitioner (3rd ed.). Barkley & Associates.

• Chapter 87, “Guidelines for Health Promotion and Screening” 
• Chapter 88, “Major Causes of Mortality in the United States” 
• Chapter 89, Immunization Recommendations” 

American Academy of Professional Coders. (2020). What is CPT?

https://www.aapc.com/resources/medical-coding/cpt.aspx

American Academy of Professional Coders. (2018). 2018 procedure desk reference.

https://static.aapc.com/aapc/images/booksamples/Sample_2018_PDR_AAPC.pdf?fbclid=IwAR1tmBzS-Ii6RfIG5J-WQmnbisO750wvWAiPWVgLtyQoVk1N0D9izE-H4UA

American Association of Nurse Practitioners. (2020a). Multistate reimbursement alliance (MSRA): Enhancing NP support for insurance credentialing, contracting and reimbursement.

https://www.aanp.org/practice/business-practice-management/reimbursement

American Association of Nurse Practitioners. (2020b). Practice information by state: What you need to know about NP practice in your state. http://www.aanp.org/legislation-regulation/state-legislation-regulation/state-practice-environment

American Nurses Credentialing Center. (n.d.). Adult-gerontology acute care nurse practitioner certification (AGACNP-BC).

https://www.nursingworld.org/our-certifications/adult-gerontology-acute-care-nurse-practitioner/

Kleinsinger, F. (2018). The unmet challenge of medication nonadherence. The Permanente Journal. https://doi.org/10.7812/tpp/18-033

National Center for Health Statistics. (2020). International classification of diseases, tenth revision, clinical modification (ICD-10-CM). Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/icd/icd10cm.htm

Document: iHuman Directions and Required Management Template (Word document)

Throughout this course, you will be required to complete case study Assignments with i-Human Patients. This manual provides guidance on accessing and using these simulations. It is HIGHLY recommended that you explore the manual’s various training resources in preparation for the upcoming Assignments. 

Required Media (click to expand/reduce)

Rubric Detail see for grading details 

Select Grid View or List View to change the rubric’s layout.

Name: NRNP_6550_Week1_Discussion_Rubric

	Excellent Point range: 90–100		Fair Point range: 70–79	Poor Point range: 0–69
Main Posting: Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.	40 (40%) – 44 (44%) Thoroughly responds to the discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least 3 current credible sources.		31 (31%) – 34 (34%) Responds to some of the discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with fewer than 2 credible references.	0 (0%) – 30 (30%) Does not respond to the discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only 1 or no credible references.
Main Posting: Writing	6 (6%) – 6 (6%) Written clearly and concisely. Contains no grammatical or spelling errors. Further adheres to current APA manual writing rules and style.		4 (4%) – 4 (4%) Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors.	0 (0%) – 3 (3%) Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Posting: Timely and full participation	9 (9%) – 10 (10%) Meets requirements for timely, full, and active participation. Posts main discussion by due date.		7 (7%) – 7 (7%) Posts main discussion by due date.	0 (0%) – 6 (6%) Does not meet requirements for full participation. Does not post main discussion by due date.
First Response: Post to colleague’s main post that is reflective and justified with credible sources.	9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.		7 (7%) – 7 (7%) Response is on topic, may have some depth.	0 (0%) – 6 (6%) Response may not be on topic, lacks depth.
First Response: Writing	6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in Standard, Edited English.		4 (4%) – 4 (4%) Response posed in the discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited.	0 (0%) – 3 (3%) Responses posted in the discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited.
First Response: Timely and full participation	5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date.		3 (3%) – 3 (3%) Posts by due date.	0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date.
Second Response: Post to colleague’s main post that is reflective and justified with credible sources.	9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.		7 (7%) – 7 (7%) Response is on topic, may have some depth.	0 (0%) – 6 (6%) Response may not be on topic, lacks depth.
Second Response: Writing	6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in Standard, Edited English.		4 (4%) – 4 (4%) Response posed in the discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited.	0 (0%) – 3 (3%) Responses posted in the discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited.
Second Response: Timely and full participation	5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date.		3 (3%) – 3 (3%) Posts by due date.	0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date.
Total Points: 100

Name: NRNP_6550_Week1_Discussion_Rubric

NRNP 6550 Week 1 Course Acknowledgement Quiz

1. Question: How many patients must I provide direct care to and log in Meditrek this quarter?
2. Question: How many clinical hours must I complete this quarter?
3. Question: Do I need to document all patients I see
4. Question: I must complete my assignments on a patient that I have seen in clinical with my preceptor this quarter.
5. Question: How long does my instructor have to grade my assignments after the due date?
6. Question: Where do I find my instructor’s feedback on assignments?
7. Question: How often should I check the announcements, email and doc sharing?
8. Question: Do I need to log all of my patients, even if I have already logged the minimum number required?
9. Question: How long do I have to log my clinical hours and patients in Meditrek after seeing them?
10. Question: When is the earliest I can finish clinical without special permission?
11. Question: I can see patients age
12. Question: Who do I contact if I my preceptor can’t locate his/her Meditrek login?
13. Question: Who do I contact about a grade I don’t agree with?
14. Question: Are assignment re-dos or extra credit allowed in the NP program?
15. Question: I cannot use my textbook as a resource or other patient centered websites such as
16. Question: Are Grand Rounds mandatory to attend?
17. Question: Can I watch a recording of Grand Rounds later?
18. Question: My midterm and final evaluation must be complete by my approved preceptor and no one else.
19. Question: I can ONLY complete my practicum hours with my approved preceptor. I may NOT rotate among preceptor in the practice.
20. Question: The midterm video call MUST be completed with my approved preceptor and no one else. The office manager cannot relay information. The preceptor must complete the call with my clinical faculty.
21. Question: When is my midterm preceptor call due?
22. Question: What needs to be completed in Meditrek by the end of week 10? 80% of patient log and 80% of the clinical hours.
23. Question: If I enter my patient logs and time logs in Meditrek more than 48 hours after clinical, I will not receive the weekly points allocated for those assignments
24. Question: I have read the NP program Practicum Manual and will abide by the requirements to successfully complete this program.
25. Question: I am responsible for everything I post on social media.
26. Question: I understand the appropriate chain of command in the College of Nursing.
27. Question: I acknowledge reading the syllabus and understand the course requirements to successfully pass the class.

NRNP 6550 Week 2 i-Human Case Study Elisa Henderick

Description

For this Case Study Assignment, you will analyze an i-Human simulation case study about an adult patient with a cardiovascular condition. Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and create an appropriate treatment plan for the patient.

Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with cardiovascular conditions.

• Access i-Human from this week’s Learning Resources and review this week’s i-Human case study. Based on the provided patient information, think about the health history you would need to collect from the patient.
• Consider what physical exams and diagnostic tests would be appropriate to 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 that may be considered in a differential diagnosis for the patient.
• Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
• Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with cardiovascular conditions.

Elisa Henderick i-Human case performance overview

Henderick

The following table summarizes your performance on each section of the case, whether you completed that section or not.

Time spent: 1hr 46min 1sec

Status: Submitted

Case Section	Status	Your Score	Time spent	Performance Details
Total Score		32%
History	Done	34%	8hr 21min 26sec	60 questions asked, 20 correct, 39 missed relative to the case’s list
Physical exams	Done	96%	17hr 47min 33sec	66 exams performed, 21 correct, 0 partially correct, 1 missed relative to the case’s list
Key findings organization	Done		8min 55sec	23 findings listed; 25 listed by the case
Problem statement	Done		16min 2sec	137 words long; the case’s was 165 words
Differentials	Done	71%	2min 52sec	5 items in the DDx, 5 correct, 2 missed relative to the case’s list
Differentials ranking	Done	100% (lead/alt score) 100% (must not miss score)	7min 2sec
Tests	Done	100%	41min 43sec	7 correct tests ordered, 0 extraneous, 0 missed relative to the case’s list
Diagnosis	Done	0%	1min 35sec
Management plan	Done		3hr 47min 34sec	635 words long; the case’s was 677 words
Exercises	Done	100% (of scored items only)	20min 55sec	9 of 9 correct (of scored items only)

History Notecard 

Use this worksheet to organize your thoughts before developing a differential diagnosis list.

1. Indicate key symptoms (Sx) you have identified from the history. Start with the patient’s reason(s) for the encounter and add additional symptoms obtained from further questioning.
2. Characterize the attributes of each symptom using “OLDCARTS”. Capture the details in the appropriate column and row.
3. Review your findings and consider possible diagnoses that may correlate with these symptoms. (Remember to consider the patient’s age and risk factors.) Use your ideas to help guide your physical examination in the next section of the case.

 

HPI	Sx =	Sx =	Sx =	Sx =	Sx =	Sx =
Onset
Location
Duration
Characteristics
Aggravating
Relieving
Timing / Treatments
Severity

Problem Statement

Elisa Henderick, a 16-year-old female, has lost 20 pounds gradually over the past six months due to excessive exercise, food obsession, and self-perceived overeating despite being significantly underweight (BMI 15.7). Additional general health issues include secondary amenorrhea and a recent metatarsal stress fracture. Periods of restriction are alternated with episodes of binge-eating and self-induced vomiting (two times per week on average), as well as the usage of laxatives for “constipation”. She reports tiredness and a mild loss of interest in her usual tasks. Striking for straight A’s, parent’s divorce one year ago, and social phobias related to other people’s views of her weight are psychosocial stressors. Physical findings are significant for orthostatic hypotension, dry skin and scalp hair, lanugo body hair, calluses of the dorsal aspect of the right hand, mild angular stomatitis, and bilateral parotid enlargement.

Management Plan

PLANNING

• Primary Diagnosis: Anorexia Nervosa (binge-eating/purging, type: mild)
• Status/Condition: Fair
• Code Status:
• Allergies: NKDA
• Admit to Unit: Psychiatric Unit
• Activity Level: Moderate
• Diet: Oral Nutrition
• IVF:
• Critical Drips:
• Respiratory:

• Pulse Oximetry monitoring daily.
• Medications:
• Fluoxetine (Prozac) 10 mg QD
• Midodrine 2 mg PO QD for orthostatic hypotension.
• Zofran 24 mg QD PRN nausea
• Multivitamin 1 co QD for 7 days
• Vitamin B1 (thiamine) 50 mg PO QD for 7 days Nursing Orders:
• Obtain weight BIW
• Obtain vital signs q 4 hours daily: o BP (lying and standing) o Pulse (lying and standing) o Temperature o Respiratory Rate
• Monitor potassium levels. Notify physician if potassium < 3 mmol/L.
• Monitor fluid balance.
• Document initial daily energy intake at initiation of refeeding, progression in intake and maximum number of daily calories consumed, and macronutrient distribution.
• Monitor and recognize refeeding syndrome.
• Monitor mental state.
• Monitor compensatory behaviors, purging in toilets after a meal.
• Chart physical activity and level of work. Follow Up Lab tests:
• Electrolytes and phosphate daily for 3 days. Diagnostic testing:
• Bone Density Scan Consults:
• Consult dentist for dental optimization outcomes.
• Consult for a nutritional rehabilitation program.

Patient Education and Health Promotion:

To ensure that the patient and the parent understands the medical rationale for nutrition meal plan guidance, patient education should be offered. Parents may need to take the lead on meal preparation and consumption after discharge. Patient is engaged in severe limiting or purging habits, thus, needs to discontinue exercising until the patient builds a healthy relationship with food. The primary line of treatment for children and adolescents with anorexia nervosa is family counseling, according to the National Institute for Health and Care Excellence. For those with anorexia nervosa, therapy may be recommended either directly one-on-one or in a family setting. Cognitive behavioral therapy is a specific sort of treatment that is frequently provided to patients. It aids people in realizing that their thought patterns may be incorrect or skewed, which enables them to gradually alter their belief systems (Chand et al., 2022). Although the reasons of hypermetabolism are not fully understood, weight gain is made challenging by an increase in metabolism after refeeding. To achieve minimal weight gain objectives, patients might need at least 2200 calories per day. Although the impact may linger for months, metabolism gradually stabilizes (Reese, 2022). Physical symptoms frequently go away before psychological ones during recovery, which might take a while. Discharge planning and required follow-up care: An important element to support recovery from AN has been identified as multidisciplinary approaches, which include nutritional, psychological, physical, and psychiatric interventions for patients with anorexia nervosa. These approaches should be used throughout the continuum of care, from inpatient to outpatient modalities (Proulx- Cabana et al., 2021). Patient assessed as physically stable by medical team. Consistently completing suggested full meal plan. Depending on openness and engagement in therapy, temperament discharge ranges from fair to good. Relapse is common; thus, treatments should be followed by a long period of relapse preventive therapy. Following weight restoration, relapse prevention therapy should involve at least a year of monthly outpatient consultations with nutritional and psychiatric doctors.

References

Chand, S. P., Kuckel, D. P., & Huecker, M. R. (2022). Cognitive behavior therapy. In StatPearls. StatPearls Publishing. pubmed.ncbi.nlm.nih/29261869/

Neale, J., & Hudson, L. D. (2020). Anorexia nervosa in adolescents. British Journal of Hospital Medicine (London, England : 2005), 81(6), 1-8. doi/10.12968/hmed.2020.

Proulx-Cabana, S., Taddeo, D., Jamoulle, O., Frappier, J. Y., Tremblay-Racine, F., & Stheneur, C. (2021). Initial inpatient management of adolescents and young adults admitted with severe malnutrition due to anorexia nervosa: protocol for a systematic review. Journal of eating disorders, 9(1), 36. doi/10.1186/s40337-021- 00389-

Reese, J. M. (2022). Assessment and treatment of eating disorders in adolescents. Contemporary PEDS Journal, (39)4. contemporarypediatrics/view/assessment-and-treatment-of-eating-disorders-in-adolescents

Electronic Health Record

History of Present Illness

Category	Data entered by Rosemarie Jean-Baptiste
Reason for Encounter	Recent weight loss reported by family.
History of present illness	16-year-old Caucasian female presents with her mother for evaluation related to concerns pertaining intentional weight loss of 30 lb that began a year ago. E.H. has lost 20 pounds gradually over the past six months due to excessive exercise, food obsession, and self-perceived overeating despite being significantly underweight (BMI 15.7). Additional general health issues include secondary amenorrhea and a recent metatarsal stress fracture. Periods of restriction are alternated with episodes of binge-eating and self-induced vomiting (two times per week on average), as well as the usage of laxatives for “constipation”. She reports tiredness and a mild loss of interest in her usual tasks. Striking for straight A’s, parent’s divorce one year ago, and social phobias related to other people’s views of her weight are psychosocial stressors. Physical findings are significant for orthostatic hypotension, dry skin and scalp hair, lanugo body hair, calluses of the dorsal aspect of the right hand, mild angular stomatitis, secondary sexual development (Tanner stage 4) and bilateral parotid enlargement.

 

Past Medical History

Category	Data entered by Rosemarie Jean-Baptiste
Past Medical History	Denies hospitalization history. Reports recent foot metatarsal stress fracture.
Hospitalizations / Surgeries	No past surgery reported.

Medications

Category	Data entered by Rosemarie Jean-Baptiste
Medications	Ibuprofen Laxatives

 Allergies

Category	Data entered by Rosemarie Jean-Baptiste
Allergies	NKDA

 Preventive Health

Category	Data entered by Rosemarie Jean-Baptiste
Preventive health

 Family History

Category	Data entered by Rosemarie Jean-Baptiste
Family History	Parents divorced a year ago. Unremarkable psychiatric history other than cousin with eating disorder.

 Social History

Category	Data entered by Rosemarie Jean-Baptiste
Social History	Junior high school student athlete. Works out in regular gym class. Lives between both parents’ homes. Shares time with both separated parents. Denies alcohol intake and use of recreational drug. Skips breakfast on a typical day, avoids carbohydrate and fats and sometimes engages in binge eating at midnight. Sleeps at least 4-5 hours a day.

Review of Systems

Category	Data entered by Rosemarie Jean-Baptiste
General	Admits an intensional 20-lbs weight loss in the last six months. Reports feeling of tiredness. Denies fever, chills, night sweats, rigors, illness, and pain.
Integumentary / Breast	Denies problems with an itchy scalp, skin changes, moles, hair thinning and brittling of nails.
HEENT / Neck	Denies headache, double/blurry vision, ear pain, hearing problems, sinus problems, sore throat or swallowing difficulty.
Cardiovascular	Reports fainting episode once. Denies palpitation and chest pain.
Respiratory	Denies SOB, chest pain, wheezing, and cough.
Gastrointestinal	Admits self-induced vomiting and constipation. No diarrhea, and abdominal pain reported.
Genitourinary	Denies dysuria, frequency, and hematuria. Irregular menses. Not sexually active.
Musculoskeletal	Denies muscle aches, weakness, cramps, joint pain, redness and swelling.
Allergic / Immunologic	Up to date recommended immunizations.
Endocrine	Denies heat or cold intolerance and excessive thirst/hunger, and sweating.
Hematologic / Lymphatic	Denies bleeding, bruising, and swelling.
Neurologic	Fainted once during volleyball game, attribute to heat. Denies headache, dizziness, ataxia, numbness or tingling in the extremities.
Psychiatric	Reports social anxiety related to perceptions of her weight. Denies depression.

 Physical Exams

Category	Data entered by Rosemarie Jean-Baptiste
General	A/Ox4 well-groomed and dressed appropriately. BMI-for-age at the 1st percentile for 16 years old.
Skin	Warm and dry. Abrasions and calluses on dorsa of right hand. Dry scalp with thin hair.
HEENT / Neck	NC/AT, fine thin hair/lanugo, PERRLA, clear and intact TM, clear oralpharynx. Bilateral parotid enlargement, thyroid size and consistency WNL, no cervical lymphadenopathy.
Cardiovascular	Bradycardic. No murmur or gallops noted. No increase in JVP. PMI nondisplaced. Orthostatic hypotension. Borderline sinus bradycardia, rate 60. T-wave flattening, ST depression, and QT prolongation.
Chest / Respiratory	Clear to auscultation bilaterally.
Abdomen	Lean, non-distended. Hyperactive BSx4 quads. Non-tender, no ogranomegaly, no mass noted. No tympany or shifting dullness. Appropriate girth for age and gender.
Genitourinary / Rectal	Normal external genitalia No masses or tenderness Normal pelvic exam
Musculoskeletal / Osteopathic Structural Examination	Reduced muscle bulk for height and age. No assymetry or deformity of the back. No tenderness or spasm of the paraspinal muscles. No localized tenderness of the spinous processes or pelvic structure.
Neurologic	Alert and oriented. Normal cranial nerves. Sensation intact for fine touch, crude touch, pain, temperature, vibration and position sense.
Psychiatric	Appearance- Thin emaciated female, dressed in loose clothing. Appears mildly fidgety during the examination. Rough skin and thin hair. Abrasions and calluses are present on the dorsa of the right hand. Good rapport was established during the course of the interview; though reluctant during the initial part of the interview, she was more cooperative with the later part. Speech- Spontaneous, normal rate, tone, and flow. Mood – Mild dysphoria Affect – Reactive Thought Form – Logical and goal oriented. Thought Content – Overvalued ideas on her weight. Even though she I preoccupied with fear of being fat, she did not exhibit any obsessions. No hallucinations or delusions present. No suicidal ideation or homicidal ideation. Insights/Judgment – Does not recognize weight loss to be a problem, but is willing to engage in treatment. Abstract Thinking – Good Memory – Immediate, recent, and remote memory
Lymphatic	No regional lymphadenopathy.

NRNP 6550 Week 3 i-Human Case Study Cindy Wagoner

NRNP 6550 Week 2

Description

For this Case Study Assignment, you will analyze an i-Human simulation case study about an adult patient with a cardiovascular condition. Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and create an appropriate treatment plan for the patient.

Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with cardiovascular conditions.

• Access i-Human from this week’s Learning Resources and review this week’s i-Human case study. Based on the provided patient information, think about the health history you would need to collect from the patient.
• Consider what physical exams and diagnostic tests would be appropriate to 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 that may be considered in a differential diagnosis for the patient.
• Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
• Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with cardiovascular conditions.

Performance Overview for Rosemarie Jean-Baptiste on case Ashley Baker

The following table summarizes your performance on each section of the case, whether you completed that section or not.

Time spent: 1hr 51min 1sec Status: Submitted

Case Section	Status	Your Score	Time spent	Performance Details
Total Score		32%
History	Done	37%	23min 26sec	90 questions asked, 8 correct, 14 missed relative to the case’s list
Physical exams	Done	71%	47min 33sec	50 exams performed, 11 correct, 1 partially correct, 1 missed relative to the case’s list
Key findings organization	Done		55sec	8 findings listed; 7 listed by the case
Problem statement	Done		6min 2sec	42 words long; the case’s was 57 words
Differentials	Done	40%	2min 52sec	4 items in the DDx, 2 correct, 3 missed relative to the case’s list
Differentials ranking	Done	100% (lead/alt score) 40% (must not miss score)	1min 2sec
Tests	Done	100%	4min 43sec	4 correct tests ordered, 0 extraneous, 0 missed relative to the case’s list
Diagnosis	Done	0%	55sec
Management plan	Done		7min 34sec	35 words long; the case’s was 219 words
Exercises	Done	86% (of scored items only)	2min 15sec	0 of 1 correct (of scored items only) 1 partially correct

Attempt: 2801245            Report generated on 6/24/2023, 8:05:53 PM America/Denver

History Notecard by Rosemarie Jean-Baptiste on case Ashley Baker

Use this worksheet to organize your thoughts before developing a differential diagnosis list.

4. Indicate key symptoms (Sx) you have identified from the history. Start with the patient’s reason(s) for the encounter and add additional symptoms obtained from further questioning.
5. Characterize the attributes of each symptom using “OLDCARTS”. Capture the details in the appropriate column and row.
6. Review your findings and consider possible diagnoses that may correlate with these symptoms. (Remember to consider the patient’s age and risk factors.) Use your ideas to help guide your physical examination in the next section of the case.

 

HPI	Sx =	Sx =	Sx =	Sx =	Sx =	Sx =
Onset
Location
Duration
Characteristics
Aggravating
Relieving
Timing / Treatments
Severity

 

Attempt: 2801245            Report generated on 6/24/2023, 8:05:53 PM America/Denver

Problem Statement by Rosemarie Jean-Baptiste on case Ashley Baker

AB is a 23-year-old female who comes to the clinic today with complaints of chills, headaches, cervical erythematosus, and sore throat. the physical examination shows that AB experiencing a fever of 101.5 degrees F. that comes and goes along with the headaches.

Attempt: 2801245            Report generated on 6/24/2023, 8:05:53 PM America/Denver

Management Plan by Rosemarie Jean-Baptiste on case Ashley Baker

This is AB, a 23-year-old female with a history of mononucleosis who comes in with acute pharyngitis associated with a fever of 101.5 F, headaches, cervical tenderness, and mild to moderate enlarged tonsilar without deviation.

Attempt: 2801245            Report generated on 6/24/2023, 8:05:53 PM America/Denver

Electronic Health Record by Rosemarie Jean-Baptiste on case Ashley Baker

History of Present Illness

Category	Data entered by Rosemarie Jean-Baptiste
Reason for Encounter
History of present illness

 Past Medical History

Category	Data entered by Rosemarie Jean-Baptiste
Past Medical History
Hospitalizations / Surgeries

 Medications

Category	Data entered by Rosemarie Jean-Baptiste
Medications

 Allergies

Category	Data entered by Rosemarie Jean-Baptiste
Allergies

 Preventive Health

Category	Data entered by Rosemarie Jean-Baptiste
Preventive health

 Family History

Category	Data entered by Rosemarie Jean-Baptiste
Family History

 Social History

Category	Data entered by Rosemarie Jean-Baptiste
Social History

Review of Systems

Category	Data entered by Rosemarie Jean-Baptiste
General
Integumentary / Breast
HEENT / Neck
Cardiovascular
Respiratory
Gastrointestinal
Genitourinary
Musculoskeletal
Allergic / Immunologic
Endocrine
Hematologic / Lymphatic
Neurologic
Psychiatric

 Physical Exams

Category	Data entered by Rosemarie Jean-Baptiste
General
Skin
HEENT / Neck
Cardiovascular
Chest / Respiratory
Abdomen
Genitourinary / Rectal
Musculoskeletal / Osteopathic Structural Examination
Neurologic
Psychiatric
Lymphatic

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