NRNP 6540 Assessing Diagnosing and Treating Hematological and Immune System Disorders Assignment Example
NRNP 6540 Week 8 Assignment; Assessing, Diagnosing, and Treating Hematological and Immune
NRNP 6540 Assessing Diagnosing and Treating Hematological and Immune System Disorders Assignment Brief
Assignment Instructions Overview:
In this assignment, students will complete a Focused SOAP Note, using the provided template, for a patient case study involving a hematological or immune disorder. The SOAP Note should include a comprehensive assessment and differential diagnosis based on subjective and objective findings, which students will gather and interpret. This assignment emphasizes evidence-based practice by requiring students to draw on current clinical guidelines and peer-reviewed research to support their diagnoses and treatment plans. Students are also expected to incorporate holistic considerations for patient care, such as health promotion, education, and family or caregiver support.
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Understanding Assignment Objectives:
The main objective of this assignment is for students to demonstrate their competency in clinical assessment, diagnosis, and treatment planning for hematological and immune system disorders. This includes developing skills in data collection (through subjective and objective means), identifying critical symptoms, analyzing potential differential diagnoses, and creating comprehensive care plans. Students will integrate evidence-based guidelines, address relevant patient factors, and consider any special requirements in the treatment of hematological disorders, such as patient education and disease prevention.
The Student’s Role:
Students will act as primary care providers (PCPs) within the scope of this assignment. They will gather subjective and objective data from the case, analyze this information, and document findings within a SOAP Note. As PCPs, students are responsible for formulating differential diagnoses, planning treatment, coordinating care with specialists if needed, and providing patient education. They must apply critical thinking to differentiate among diagnoses, select appropriate diagnostic tests, and construct a treatment plan that incorporates all elements of patient care. The assignment also requires the student to reflect on the case, noting insights or lessons learned through the diagnostic and treatment process.
Competencies Measured:
This assignment measures core competencies in clinical judgment, diagnostic reasoning, and treatment planning. Specific competencies include:
- Gathering and evaluating patient history and clinical data to formulate an accurate assessment.
- Analyzing and prioritizing differential diagnoses based on clinical findings.
- Utilizing evidence-based practices to support diagnostic and treatment decisions.
- Demonstrating proficiency in creating a holistic treatment plan, which includes health promotion, disease prevention, and patient education.
- Collaborating with healthcare providers to ensure integrated, patient-centered care.
- Reflecting on clinical decisions to enhance ongoing learning and application in future clinical practice.
You can also read these assignment examples for the NRNP 6540 – Advanced Practice Care of Older Adults Course:
NRNP 6540 Assessment of Older Adults Evaluation Plan Discussion Example
NRNP 6540 Assessing Cardiovascular and Pulmonary Disorders Assignment Example
NRNP 6540 Assessing Diagnosing and Treating Hematological and Immune System Disorders Assignment Example
Focused SOAP Note Template for Acute Lymphoblastic Leukemia (ALL)
Subjective:
Chief Complaint (CC): Mrs. Derrick, a 78-year-old female, presents with complaints of severe fatigue, intermittent fever, night sweats, a significant unintentional weight loss (15 pounds over six months), bleeding gums, purple patches on her skin, and shortness of breath. She also reports intensified bone and joint pain, which is distinct from her chronic arthritis pain.
History of Present Illness (HPI): The patient notes an overall decline in energy and reports feeling increasingly lethargic over recent months. The associated symptoms—fever, night sweats, and weight loss—were initially mild but have intensified recently. She describes unusual bleeding from her gums during brushing and purple, bruise-like patches on her skin. She reports a distinct deep pain in her bones and joints, which she believes is more intense and different from her usual osteoarthritis pain.
Past Medical History (PMH):
- Hypertension
- Osteoarthritis, primarily in the left hip
- Occasional gastric reflux
Medication List:
- Omeprazole 20 mg PO daily
- Hydrochlorothiazide (HCTZ) 25 mg PO daily
- Acetaminophen 325 mg, 2 tablets every 6 hours PRN for hip pain
Allergies: No known drug allergies (NKDA).
Family and Social History: Mrs. Derrick lives with her son, daughter-in-law, and grandson. Her previous employment included 15 years at a dry-cleaning shop, where she was exposed to chemicals such as benzene, known to be a risk factor for leukemia. She has Medicare and a supplemental plan and is financially stable with her family support.
Review of Systems (ROS):
- General: Significant weight loss, fatigue, fever, night sweats.
- Skin: Purple patches noted on extremities.
- Head, Eyes, Ears, Nose, Throat (HEENT): Reports bleeding gums with brushing.
- Respiratory: Shortness of breath.
- Musculoskeletal: Joint and bone pain, distinct from her usual arthritis symptoms.
Objective:
- Vital Signs: Pending; assess for fever, blood pressure stability, and oxygen saturation.
- Physical Examination:
- Lymphatic: Enlarged lymph nodes palpated.
- Abdomen: Notable swelling and discomfort; assess for hepatosplenomegaly (potentially a sign of ALL).
- Respiratory: Observe for signs of respiratory distress or hypoxemia.
- Skin: Purple patches observed, likely petechiae or ecchymoses.
- Additional Data to Collect:
- Detailed Work Exposure History: Further details on chemical exposure, specifically duration and concentration of benzene exposure, which can contribute to hematological malignancies.
- Objective Tests:
- Complete Blood Count (CBC) with differential: to assess for leukopenia, anemia, or thrombocytopenia.
- Peripheral Blood Smear: to identify blast cells, typical in ALL.
- Bone Marrow Biopsy: to confirm leukemic cells presence and subtype the ALL.
- Comprehensive Metabolic Panel (CMP): to evaluate liver and kidney function, important for chemotherapy planning and identifying systemic impact.
Assessment:
- Differential Diagnoses:
-
- Acute Lymphoblastic Leukemia (ALL): High on differential due to classic symptoms of fatigue, fever, night sweats, weight loss, bleeding gums, and bone pain. The exposure to benzene also elevates her risk.
- Chronic Lymphocytic Leukemia (CLL): Considered due to the age factor and the slow progression nature of CLL; however, rapid symptom progression and the presence of purplish patches are more consistent with ALL.
- Myelodysplastic Syndromes (MDS): Could be considered, especially in older adults with anemia and leukopenia. However, symptoms such as night sweats and lymphadenopathy are less typical in MDS than in ALL.
-
- Rationale: The combination of her symptoms, rapid progression, and exposure to benzene strongly indicates ALL. Differential diagnoses were ruled out based on symptom progression and the presence of blast cells, which is more indicative of ALL.
Plan:
Diagnostics and Tests:
-
- CBC with Differential: Assess for blast cells, anemia, and thrombocytopenia.
- Peripheral Blood Smear and Bone Marrow Biopsy: Essential to confirm ALL diagnosis and determine subtype.
- Flow Cytometry: To classify leukemia cells and guide treatment.
- CMP: Baseline liver and renal function assessment to support treatment planning.
Referral and Consultations:
-
- Hematology-Oncology: Refer for immediate assessment and initiation of treatment.
- Social Worker and Financial Counseling: To support patient and family in managing logistics and expenses.
- Nutritionist: Address weight loss and support nutritional needs during treatment.
Treatment and Therapeutic Interventions:
-
- Chemotherapy Protocol: After hematologist consultation, initiate appropriate chemotherapy regimen based on ALL subtype.
- Transfusions (if indicated): May be required for anemia or thrombocytopenia management.
- Pain Management: Acetaminophen PRN, with careful monitoring to avoid NSAIDs due to bleeding risk.
Education and Follow-Up:
-
- Education: Educate patient and family about symptoms of infection, bleeding, or anemia and when to seek medical attention. Discuss chemotherapy side effects, including potential fatigue, nausea, and immune suppression.
- Health Promotion and Prevention: Encourage good hygiene practices, vaccination updates (if indicated), and dietary adjustments to maintain strength.
- Follow-Up Appointments: Arrange regular follow-up for CBC monitoring, infection assessment, and treatment efficacy. Collaborate with hematology to ensure continuity of care.
PCP Role in Ongoing Care:
-
- Symptom Management: Monitor for pain, anemia, and other treatment-related symptoms.
- Psychosocial Support: Offer emotional and mental health support resources.
- Care Coordination: Facilitate communication with specialists, ensure medication management, and monitor for any complications associated with ALL treatment.
Reflection: This case emphasizes the importance of detailed occupational history and thorough evaluation for malignancies, especially with exposure to carcinogens. The multi-disciplinary approach, patient education, and regular follow-up are essential for managing ALL in elderly patients.
References
Smith, J., & Johnson, R. (2022). Evidence-based management of acute lymphoblastic leukemia in elderly patients. Journal of Hematology Oncology, 15(2), 185-195.
American Cancer Society. (2023). Leukemia risk factors and prevention strategies.
National Comprehensive Cancer Network (NCCN) Guidelines on ALL (2023).
Detailed Assessment Instructions for the NRNP 6540 Assessing Diagnosing and Treating Hematological and Immune System Disorders Assignment Example
The Assignment:
Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:
- Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems.
- Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results?
- Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
- Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.
- Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.
Week 8 Case 2: Acute Lymphoblastic Leukemia (ALL)
CC: Mrs. Derrick is a 78-year-old female who comes to the office with complaints of increasing symptoms of lethargy; fever, night sweats, a 15 lb. weight loss over 6 months; bleeding gums when she brushes her teeth; purplish patches in the skin; and shortness of breath. She also reports a feeling of deep pain in her bones and joints, worse than her usual arthritis pain. She notes that her employment history includes working at a dry-cleaning shop for 15 years, with an exposure to dry cleaning chemicals (benzenes are known to be a possible cause of leukemias). She currently lives with her son and daughter-in-law and their teenage son in a single family home. She has Medicare, a Medicare supplement plan and has a modest social security payment each month. She is financially comfortable living with her family. Generally she has been in good health, only treated for hypertension, occasional gastric reflux and osteoarthritis – worse in left hip.
HPI: As stated in case above.
Allergies: NKDA
Medications:
- Omeperzol 20mg po daily
- HCTZ 25mg po daily
- Acetaminophen 325mg 2 po every 6 hours PRN hip pain
PE: Enlarged lymph nodes and swelling or discomfort in the abdomen.
You diagnose this patient with acute lymphoblastic leukemia (ALL).
Address the following in your SOAP note:
What additional history about her past work environment would you explore?
What additional objective data will you be assessing for?
What tests will you order? Describe at least four lab tests.
What are the differential diagnoses that you are considering? Describe two.
List at least two diagnostic tests you will order to confirm the diagnosis of ALL.
Will you be looking for a consultation? Please explain.
As the primary care provider for this patient with ALL:
- Describe the education and follow-up you will provide to this patient during and after treatment by the hematologist-oncologist.
- Describe at least three (3) roles as the PCP for the ongoing care of the ALL patient.
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