NUR-502 Theoretical Foundations for Nursing Roles And Practice Course Assignments & Examples Study Guide

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NUR-502 Theoretical Foundations for Nursing Roles And Practice Course Assignments & Examples Study Guide

NUR-502 Theoretical Foundations for Nursing Roles And Practice Course Assignments & Examples Study GuideNUR-502 Theoretical Foundations for Nursing Roles and Practice Course Description

This course examines nursing as a profession and a discipline and the individual nurse’s role as a member of the profession. The theoretical foundations for nursing practice and roles are explored and applied. Emphasis is placed on developing scholarly writing and presentation skills. Critical thinking skills are refined as students discuss and synthesize the literature that guides nursing practice with a special emphasis on caring, diversity, and spirituality.

NUR 502 Theoretical Foundations for Nursing Roles and Practice

NUR 502 Grand Canyon Week 1 Discussion 1

What comparisons can be found between the GCU Mission and Domains/CON Mission and Program Competencies (for your selected specialty track, links located in the Course Materials) with the AACN’s Essentials for Master’s Education for Advanced Practice Nursing (link located in the Week 1 Topic Materials)? Explain your rational.

http://www.gcu.edu/About-Us/Mission-and-Vision.php
http://www.gcu.edu/College-of-Nursing-and-Health-Care-Professions.php

NUR 502 Grand Canyon Week 1 Discussion 2

Name one recommendation from the IOM Future of Nursing Report. What is its importance relative to Advanced Practice Nursing? Support your answer.

NUR 502 Grand Canyon Week 2 Discussion 1

Discuss several aspects of professional communication as it relates to the use of language in terms of form (e.g., clarity, accuracy) and content (culture and/or ethics). Cite the references you used to compose your response (from required readings).

NUR 502 Grand Canyon Week 2 Discussion 2

What is the role of the Advanced Professional Nurse in creating an ethical practice environment? Respond to this question, based on your selected APN role.

NUR 502 Grand Canyon Week 3 Discussion 1

Discuss the value of nursing theory to the profession of nursing. Identify one way in which you could use nursing theory to improve your practice (present or future role). Provide a reference for your response.

NUR 502 Grand Canyon Week 3 Discussion 2

Read the AACN documents for essentials of baccalaureate versus master’s education and identify the competencies that reflect use of theory and knowledge. Compare and contrast the competencies for baccalaureate and master’s level.

NUR 502 Grand Canyon Week 4 Discussion 1

Explain, in your own words, the difference between the three paradigms: human needs, interactive, and unitary process.

Which of these best fits your philosophy of nursing?

NUR 502 Grand Canyon Week 4 Discussion 2

Select one of the grand or middle-range nursing theories. How does the theory demonstrate evidence of the utilization of social, behavioral, or bioscience theories?

NUR 502 Grand Canyon Week 5 Discussion 1

All nursing theories are developed in space and time, and are not value free. Select one nursing theorist and explain the factors that influenced development of the theory (history, scientific paradigm, and personal experiences–mentoring, education, practice, other).
Provide reference(s) for your response.

NUR 502 Grand Canyon Week 5 Discussion 2

Select three theories and compare the definition of person/human being. Comment regarding which definition best fits with your own thinking.

NUR 502 Grand Canyon Week 6 Discussion 1

Choose one of the middle-range theories. How could you use this theory to direct care in a nursing unit if you were the manager? Share your results

NUR 502 Grand Canyon Week 6 Discussion 2

Choose one of the middle-range theories. What impact would this theory most likely have on your individual practice? Give specific examples.

NUR 502 Grand Canyon Week 7 Discussion 1

The influence of consequential ethics as an ethical framework (the greatest good for the greatest number) opposes the ethical principle of deontology (i.e., the rightness of an act itself determines what is right). Both of these impact the nursing profession. Modern social exchange theories are based on the principle of utility. Read the assumptions of social exchange theory and consider how these would affect the nurse-patient relationship, compared to how these impact the nurse within the health care environment. To what extent are all theories ethical? Is social exchange theory compatible with the values of the nursing profession?

NUR 502 Grand Canyon Week 7 Discussion 2

Which among the learning theories provided you with new information? How would you apply this in your practice?

NUR 502 Grand Canyon Week 8 Discussion 1

1- Individually, comment on at least three reports posted by other CLC teams by the end of Topic 8. Provide substantive comments that include a focus on the application of the theory as a framework for practice (general or specific, basic or advanced).

2- As a group, respond to all posts directed towards your CLC group’s posted report.

NUR 502 Grand Canyon Week 8 Discussion 2

Comment on the usefulness of Benner’s work in your present or future role. Provide several examples.

NUR 502 Week 1 Assignment

Master’s-Prepared Nurse Interview

Details:

Refer to the “Master’s Prepared Nurse Interview Guide_student” as you prepare this assignment.

Interview a nurse who is master’s-prepared in nursing and is using this education in a present position. Preferably, select someone who is in a position similar to your chosen specialty track. The purpose of the interview is for you to gain insight into the interplay among education, career path, and opportunities. Be certain to identify specific competencies that the MSN-prepared nurse gained, and is presently using, that reflect advanced education. Organize your interview around the topics below:

  1. Overview of the master’s-prepared nurse’s career
  2. Reason for seeking graduate education
  3. Description of present position and role
  4. Usefulness of graduate education for present role
  5. Pearls of wisdom he/she is willing to share

In 750-1,000 words, write the interview in a narrative format. Use the following guidelines:

  1. Within the paper’s introduction, explain your interview selection.
  2. Do not identify the individual by name.
  3. Use centered headings to separate parts of the interview.
  4. In the conclusion, identify one or more competencies from the interview that are consistent with GCUprogram competencies and/or AACN education essentials. In addition, provide a statement that reflects what you gained from the interview.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.

You can also read another study guide on nursing assignments for students from another post on NUR-504 Health Care Research Analysis and Utilization Course Assignments & Examples.

NUR 502 Week 2 Assignment

Professional Communication: Cultural Sensitivity

Details:

For this assignment, consult the “Professional Communication Cultural Sensitivity Guide.”

Write a paper of 1,000-1,250 words on a specific cultural group. Use the following guidelines:

  1. Select one article from a nursing journal focused on a cultural group.
  2. In the introduction, state your reason for selecting the cultural group.
  3. Summarize the key points of the article.
  4. Apply the new information to a practice situation that demonstrates cultural sensitivity in communication, reflecting the reading in chapter 25.
  5. Write a conclusion. 

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.

NUR 502 Week 3 Assignment

Collaborative Learning Community: Grand Nursing Theorist Assignment: CLC Group Project
Agreement

Details:

This is a CLC assignment.
For this group assignment, refer to the instructor for your group placement, then develop a CLC Group Project Agreement that addresses the following:

  1. Sets up schedule for communication.
  2. Provides contact information if needed.
  3. Clarifies process for conflict resolution.
  4. Clarifies roles for each member after reviewing the assignment details. 

APA format is not required, but solid academic writing is expected.

You are not required to submit this assignment to Turnitin, unless otherwise directed by your instructor. If so directed, refer to the Student Success Center for directions. Only Word documents can be submitted to Turnitin.

NUR 502 Week 4 Assignment 1

Collaborative Learning Community: Grand Nursing Theorist Assignment: Theorist Identification and Rationale

Details:

This is a CLC assignment.

The purpose of this assignment is to have a clear understanding of the elements of a theory and to apply a theory to practice. The CLC group must use a grand theory or a high-level mid-range theory.

The group will create a report for a practice committee at a health care institution. The objective is to convince your peers of the value of using a specific theory to guide practice and evaluate care.

Since the text does not provide adequate information on any one theory for the purpose of this assignment, further research through nursing theory websites (general and specific), as well as theory texts specific to individual theories, will be required.

Begin the assignment by identifying a theorist and providing the rationale for the group’s selection.

Prepare this assignment according to the APA guidelines found in the GCU APA Style Guide, located in the Student Success Center. An abstract is not required.

You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.

NUR 502 Week 4 Assignment 2

Benchmark Assignment: Application of Concept Analysis to Clinical Practice

Details:

Select a peer-reviewed concept analysis article of your choice and write a response of 1,000–1,250 words. Use the following guidelines:

  1. Include an introduction.
  2. Describe the method of analysis, using the article and chapter 3 of Theoretical Basis for Nursing.
  3. Describe the steps of process and the results for each step.
  4. Apply the concept to a practice situation.
  5. Include a conclusion.

Prepare this assignment according to APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.

NUR 502 Week 5 Assignment

Applying Theory to a Practice Problem: Part 1: Introduction and Problem of Practice

Details:

PURPOSE:
It is important to understand how research can help you in your everyday environment as a nurse. In this assignment, you will identify a practical problem that emerges from the evidence in the extant literature or professional practice.

DIRECTIONS:
Chose a problem that you are encountering in your practice or about which you have read in the current literature.

Write a paper (250 to 500 words) that describes a practical problem that emerges from the evidence in the extant literature or professional practice. The paper should do the following:

  1. Clearly describe the problem.
  2. Provide a rationale for the significance of this problem. The rationale must be supported by the current or seminal literature.

Prepare this assignment according to APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to Turnitin.

NUR 502 Week 6 Assignment

Applying Theory to a Practice Problem: Part 2:

Application of Middle-Range Theory to Problem

Details:

PURPOSE:
It is important to understand how middle-range theory can help you in your everyday environment as a nurse. In the previous assignment, you identified a practical problem that emerged from the evidence in the extant literature or professional practice. In this assignment, you will explore and apply middle-range theory to solve the specific problem that you identified in the previous assignment.

DIRECTIONS:
Consider the problem that you described in the previous assignment and the instructor feedback about that assignment.

Write a paper (1,000 to 1,500 words) that describes how middle-range theory can be applied to the identified problem. The paper should include the following:

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NRNP 6550 Week 1 Medicolegal Impacts on Health Promotion Discussion Example

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NRNP 6550 Week 1 Medicolegal Impacts on Health Promotion Discussion Example

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

NRNP 6550 Week 1: Medicolegal and Health Promotion Discussion Assignment Brief

Course: NRNP 6550 – Advanced Practice Care of Adults in Acute Care Settings II

Assignment Title: NRNP 6550 Week 1; Medicolegal Impacts on Health Promotion Discussion Assignment

Assignment Instructions Overview

This assignment focuses on analyzing the medicolegal impacts on health promotion, particularly through the lens of immunization recommendations across different age groups and for immunocompromised patients. Students will compare immunization recommendations, analyze their effects on immunocompromised or immunosuppressed patients, and examine how patient factors influence immunization recommendations.

Understanding Assignment Objectives

The primary objectives are to compare immunization recommendations for patients across various age groups, analyze the impact of these recommendations on immunocompromised patients, and understand how patient factors such as age and gender influence these recommendations. This understanding is crucial for ensuring that nurse practitioners provide tailored and effective health promotion strategies.

The Student’s Role

Students are expected to review the provided learning resources on medicolegal and health promotion considerations, reflect on the impact of these recommendations on health promotion strategies, and actively participate in discussions by posting their analysis and responding to their peers’ posts. This engagement will deepen their understanding of the complexities involved in immunization recommendations and their application in diverse patient populations.

Competencies Measured

The competencies measured include the ability to analyze immunization recommendations, understand their impact on different patient populations, and apply this knowledge in clinical practice. Students will also demonstrate critical thinking skills by comparing and contrasting immunization strategies and their implications for health promotion and disease prevention.

You Can Also Check Other Related Assessments for the NRNP 6550 – Advanced Practice Care of Adults in Acute Care Settings II Course:

 

NRNP 6550 Week 1 Medicolegal Impacts on Health Promotion Discussion Example

NRNP 6550 Week 1: Medicolegal and Health Promotion

Elements Included in Identifying a Billing Code

When identifying a billing code, several critical elements must be considered to ensure accurate and appropriate billing. These elements include patient information, which entails accurate details about the patient, including demographics and medical history (American Academy of Professional Coders, 2020). Diagnosis is another vital component, involving the specific medical condition or disease diagnosed, often identified using ICD-10 codes (National Center for Health Statistics, 2020). The services provided must be detailed, with descriptions of the medical services or procedures performed, identified using CPT (Current Procedural Terminology) codes (American Academy of Professional Coders, 2020). Additionally, the date of service must be accurately recorded, indicating the exact date when the service was provided. Provider information is also essential, including details about the healthcare provider and their National Provider Identifier (NPI). Finally, the location of service, which refers to the setting in which the service was provided, such as a hospital, clinic, or outpatient facility, must be included.

Levels of Prevention

Prevention in healthcare is categorized into three levels: primary, secondary, and tertiary prevention. Primary prevention focuses on preventing the onset of diseases or injuries before they occur. This level includes activities such as immunizations, lifestyle modifications (such as a healthy diet and regular exercise), and health education programs (Barkley & Myers, 2020). Secondary prevention aims at early detection and intervention to prevent the progression of disease. Examples include screening tests such as mammograms for breast cancer, colonoscopies for colorectal cancer, and LDL cholesterol screening to detect early signs of cardiovascular disease (Barkley & Myers, 2020). Tertiary prevention involves managing and reducing the impact of an ongoing illness or injury that has lasting effects. This includes rehabilitation programs for stroke patients, chronic disease management programs for diabetes, and support groups for mental health conditions (Barkley & Myers, 2020).

Recommended Health Screenings by Age

Health screenings are essential tools for early detection and prevention of diseases. For cancers such as prostate and breast cancer, specific screenings are recommended by age. Prostate cancer screenings, such as the PSA (Prostate-Specific Antigen) test, are recommended for men starting at age 50, or earlier for those at higher risk (Barkley & Myers, 2020). Breast cancer screenings, including mammograms, are recommended every 1-2 years for women aged 50-74. Regular cholesterol screenings (LDL) are recommended for adults starting at age 20 and should be repeated every 4-6 years (Barkley & Myers, 2020). For osteoporosis, bone density testing is recommended for women aged 65 and older, and for men aged 70 and older, or younger for those at high risk (Barkley & Myers, 2020).

Vaccine Recommendations

Vaccination recommendations are crucial for preventing various infectious diseases. For pertussis (Tdap), it is recommended that one dose be administered during each pregnancy, preferably during the early part of gestational weeks 27-36 (Centers for Disease Control and Prevention [CDC], 2020). Adults who have never received Tdap should get it once, followed by Td (tetanus, diphtheria) boosters every 10 years. Tetanus booster shots are recommended every 10 years. For pneumococcal vaccines, the PCV13 is recommended for all children under 5 years, adults 65 years or older, and people with certain medical conditions (CDC, 2020). The PPSV23 is recommended for all adults 65 years or older and for people aged 2 through 64 years with certain medical conditions (CDC, 2020).

Types of Vaccines

Vaccines are classified into several types based on their composition. Live, attenuated vaccines contain a version of the living microbe that has been weakened. Examples include the MMR (measles, mumps, rubella) vaccine and the varicella (chickenpox) vaccine (CDC, 2020). Inactivated vaccines contain the killed version of the germ that causes a disease. Examples include the polio vaccine and the hepatitis A vaccine (CDC, 2020). Subunit, recombinant, polysaccharide, and conjugate vaccines use specific pieces of the germ—like its protein, sugar, or capsid. Examples include the HPV vaccine and the meningococcal vaccine (CDC, 2020).

Discussion: Medicolegal Impacts on Health Promotion

Immunization Recommendations Across the Lifespan

When examining immunization schedules, it is evident that childhood vaccines are heavily emphasized. However, vaccinations are vital in preventing diseases across all age groups. The Centers for Disease Control and Prevention (CDC) recommend annual influenza vaccinations for all age groups (CDC, 2020). For patients aged 11-24, it is recommended that the tetanus, diphtheria, and pertussis (Tdap) vaccination be administered once between the ages of 11 and 12 years, with boosters every ten years thereafter (CDC, 2020). The meningococcal 2-dose series should be administered between 11-12 years of age and again at 16 years of age, with a catch-up vaccination between 13-15 years of age and a booster at 16-18 years of age (CDC, 2020). The human papillomavirus (HPV) vaccination is recommended between 11 and 12 years of age, with catch-up vaccinations for all teens through the age of 18 if not adequately vaccinated (CDC, 2020).

For adults aged 25-64, the influenza vaccine remains a yearly recommendation. Tdap should be administered once if not previously received, followed by Td boosters every ten years (CDC, 2020). Adults with no evidence of immunity to measles, mumps, and rubella (MMR) should receive one dose of the MMR vaccine. The varicella vaccination is recommended for adults without evidence of immunity to varicella and who have not received a varicella-containing vaccine (CDC, 2020).

For older adults aged 65 and above, the influenza vaccine continues to be recommended annually. Additionally, the pneumococcal vaccination (PPSV23) is recommended for all adults aged 65 years and older, with the PCV13 and PPSV23 considered for those with chronic medical or immunocompromising conditions (CDC, 2020). The shingles vaccination should be administered to those aged 50 years or older (CDC, 2020).

Impact on Immunocompromised Patients

Immunocompromised patients, including those with conditions such as HIV, require special consideration regarding vaccination. For children and adolescents aged 11-24 years, the HPV vaccine is safe and recommended for those with HIV (CDC, 2020). The meningococcal vaccine is crucial for individuals with complement deficiencies or asplenia (CDC, 2020). In the adult population aged 25-64 years, the inactivated influenza vaccine is recommended for immunocompromised patients to avoid the risk associated with live vaccines (CDC, 2020). Pneumococcal vaccines (both PCV13 and PPSV23) are essential for preventing pneumonia in those with chronic medical conditions or immunosuppression (CDC, 2020).

For older adults aged 65 years and older, pneumococcal vaccinations (PCV13 and PPSV23) are particularly important to protect against pneumococcal diseases, which can be severe in this population (CDC, 2020). The recombinant zoster vaccine (RZV) is preferred for shingles prevention in immunocompromised patients due to its non-live formulation, which is safer compared to live vaccines (CDC, 2020).

References

American Academy of Professional Coders. (2020). What is CPT? https://www.aapc.com/resources/medical-coding/cpt.aspx

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

Centers for Disease Control and Prevention (CDC). (2020). Recommended Vaccinations.

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

Detailed Assessment Instructions for the NRNP 6550 Week 1 Medicolegal Impacts on Health Promotion Discussion Assignment

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 also read another study guide on nursing assignments for students from another post on NUR-502 Theoretical Foundations for Nursing Roles And Practice Course Assignments & Examples.

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

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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 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.

  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

 

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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NRNP 6665 Ethical and Legal Foundations of PMHNP Care Discussion Paper Example

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NRNP 6665 Ethical and Legal Foundations of PMHNP Care Discussion Paper Example

NRNP 6665 Ethical and Legal Foundations of PMHNP Care Discussion AssignmentNRNP 6665 Ethical and Legal Foundations of PMHNP Care Discussion Assignment

NRNP 6665 Ethical and Legal Foundations of PMHNP Care Discussion Assignment Brief

Course: NRNP 6665 – Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I

Assignment Title: NRNP 6665 Ethical and Legal Foundations of PMHNP Care Discussion Assignment

Assignment Instructions Overview

In this discussion assignment, you will explore a topic that has significant ethical and legal implications for Psychiatric-Mental Health Nurse Practitioner (PMHNP) practice. The aim is to deepen your understanding of these issues and how they influence clinical decision-making for both adult and child/adolescent patients. You will conduct a literature review to identify key ethical and legal considerations related to your chosen topic, and discuss how these considerations apply in your state and to your clinical practice.

Understanding Assignment Objectives

The primary objectives of this assignment are to:

  • Analyze critical ethical and legal issues in psychiatric-mental health practice.
  • Understand the impact of cultural considerations on ethical and legal decision-making in advanced practice nursing.
  • Prepare for the nurse practitioner national certification examination by evaluating your knowledge and application of nurse practitioner principles.

The Student’s Role

As a student, your role is to critically examine a selected topic that intersects ethical and legal dimensions in PMHNP practice. You are expected to:

  • Select one of the provided ethical/legal topics.
  • Conduct a thorough literature review, locating four relevant scholarly or professional resources.
  • Summarize the ethical and legal issues for both adult and child/adolescent patients based on your selected topic.
  • Apply this information to your clinical practice, considering specific state regulations.
  • Participate in discussions with peers to share insights and cultural considerations related to the ethical and legal issues.

Competencies Measured

This assignment measures the following competencies:

  • Critical thinking and analytical skills in evaluating ethical and legal issues.
  • Research skills in identifying and synthesizing relevant scholarly resources.
  • Application of ethical and legal principles to clinical practice.
  • Communication skills in discussing and presenting findings.
  • Cultural competence in recognizing and integrating cultural considerations into ethical and legal decision-making.

You Can Also Check Other Related Assessments for the NRNP 6665 – Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I Course:

NRNP 6665 Comprehensive Integrated Psychiatric Assessment Discussion Assignment Example

NRNP 6665 Ethical and Legal Foundations of PMHNP Care Discussion Paper Example

Discussion: Ethical and Legal Foundations of PMHNP Care

Topic: Restraints

Ethical Considerations of Restraints for Adult Patients

Restraints in psychiatric settings present significant ethical dilemmas. Restraints, whether physical, chemical, or environmental, are typically employed as a last resort to prevent patients from harming themselves or others. However, the use of restraints conflicts with the ethical principle of autonomy, which emphasizes respect for patients’ self-governance. Ethical practice necessitates that restraints be used only when absolutely necessary and that their use is minimized and justified through evidence-based guidelines. Restraints must never be used for the convenience of caregivers or as a punitive measure. Instead, the decision to use restraints should involve thorough professional training, constant reassessment, and a commitment to discontinue their use as soon as it is safe to do so. This approach aligns with the ethical principles of beneficence and non-maleficence, ensuring that the benefits outweigh the risks and potential harm to patients (Salehi et al., 2019).

Legal Considerations for Restraints for Adult Patients

Legally, the use of restraints is heavily regulated to protect patients’ rights and ensure their safety. According to federal regulations, restraints should only be applied when necessary to prevent imminent harm and must be used in the least restrictive manner possible. The attending physician must be consulted promptly, and each restraint order must be reassessed and renewed within specific timeframes (every 4 hours for adults, expiring within 24 hours). Additionally, patients must be monitored continuously, and their rights, such as privacy and protection from abuse, must be upheld. Legal frameworks also mandate that patients and their families are informed about the use of restraints and involved in the decision-making process (Public Health, 2018).

Ethical Considerations of Restraints on Children/Adolescents

The use of restraints on children and adolescents in mental health settings introduces further ethical complexities. Children are particularly vulnerable, and restraints can cause long-lasting psychological trauma. Ethical considerations must include the potential physical and psychological harm and the impact on the therapeutic relationship. Providers must prioritize less restrictive interventions and ensure that any use of restraints is justified, well-documented, and continuously reassessed. The principle of beneficence must guide decisions, ensuring that the use of restraints is always in the best interest of the child or adolescent (Nielson et al., 2021).

Legal Considerations for Restraints on Children/Adolescents

Legally, the use of restraints on minors is subject to strict scrutiny. Federal and state laws aim to provide the highest level of protection for minors. Providers are required to inform parents or legal guardians immediately and obtain written acknowledgment of the restraint policy. The application of restraints must be closely monitored, and any use must be thoroughly documented and justified to prevent claims of improper detention or harm. Legal considerations also emphasize the importance of safeguarding the minor’s rights and ensuring that all actions taken are in their best interest (Neiman et al., 2016).

Application to Clinical Practice

In clinical practice, PMHNPs must navigate the complex interplay of ethical and legal considerations regarding the use of restraints. Understanding and adhering to ethical principles and legal regulations is crucial for ensuring patient safety and upholding professional standards. In my state, regulations closely mirror federal guidelines, emphasizing the protection of patients’ rights and the necessity of using the least restrictive interventions. Continuous education and training on the ethical and legal aspects of restraint use are essential for all healthcare providers to ensure that they can make informed and justifiable decisions in the best interests of their patients.

References

Neiman, E., Pelkey, E., & Holloway, M. (2016). An Analysis of Legal Issues-Child and Adolescent Behavioral Health, Part III: Patient Safety-Identifying and Addressing Legal Issues Involved When Treating Pediatric Patients with Behavioral Health Needs. Teaching Hospitals and In-House Counsel Practice Groups. Link

Nielson, S., Bray, L., Carter, B., & Kiernan, J. (2021). Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis. Journal of Child Health Care, 25(3), 342–367. https://doi.org/10.1177/1367493520937152

Public Health. (2018, October 1). Code of Federal Regulations. Link

Salehi, Z., Najafi Ghezeljeh, T., Hajibabaee, F., & Joolaee, S. (2019). Factors behind ethical dilemmas regarding physical restraint for critical care nurses. Nursing Ethics, 27(2), 598–608. https://doi.org/10.1177/0969733019858711

Detailed Assessment Instructions for the NRNP 6665 Ethical and Legal Foundations of PMHNP Care Discussion Assignment

Week 2: Ethical and Legal Foundations of PMHNP Care Across the Lifespan

In your role as a PMHNP, you will regularly encounter situations that require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidence-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their background or worldview. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action.

Learning Objectives

Students will:

  • Analyze salient ethical and legal issues in psychiatric-mental health practice
  • Analyze the impact of cultural considerations on ethical/legal decision making in advanced practice nursing
  • Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination*

*Assessed in Week 3 Assignment

Reminder: Keep Your Library of Advanced Practice Nursing Texts at Your Fingertips

Several textbooks are assigned in multiple courses in your program. That is, you will see reading assignments from the books assigned in the Learning Resources of more than one course. You should, however, keep all prior textbooks—not just the ones explicitly assigned—readily accessible. The expectation is that you will independently consult these prior textbooks to synthesize information needed to complete your final courses. This is your time to “put it all together” and to more fully embrace the advanced practice nursing role. Part of the responsibility of advanced practice is developing information literacy skills to know where to locate needed information for your clinical practice.

Discussion: Ethical and Legal Foundations of PMHNP Care

Advanced practice nursing in all specialties is guided by codes of ethics that put the care, rights, duty, health, and safety of the patient first and foremost. PMHNP practice is also guided by ethical codes specifically for psychiatry. These ethical codes are frameworks to guide clinical decision making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. Laws, on the other hand, dictate the requirements that must be followed. In this way, legal codes may be thought to represent the minimum standards of care, and ethics represent the highest goals for care.

Photo Credit: [Hero Images]/[Hero Images]/Getty Images

For this Discussion, you select a topic that has both legal and ethical implications for PMHNP practice and then perform a literature review on the topic. Your goal will be to identify the most salient legal and ethical facets of the issue for PMHNP practice, and also how these facets differ in the care of adult patients versus children. Keep in mind as you research your issue, that laws differ by state and your clinical practice will be dictated by the laws that govern your state.

TO PREPARE

  • Select one of the following ethical/legal topics:
    • Autonomy
    • Beneficence
    • Justice
    • Fidelity
    • Veracity
    • Involuntary hospitalization and due process of civil commitment
    • Informed assent/consent and capacity
    • Duty to warn
    • Restraints
    • HIPPA
    • Child and elder abuse reporting
    • Tort law
    • Negligence/malpractice
  • In the Walden library, locate a total of four scholarly, professional, or legal resources related to this topic. One should address ethical considerations related to this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal considerations related to this topic for adults, and one should be on legal considerations related to this topic for children/adolescents.

By Day 3 of Week 2

Briefly identify the topic you selected. Then, summarize the articles you selected, explaining the most salient ethical and legal issues related to the topic as they concern psychiatric-mental health practice for children/adolescents and for adults. Explain how this information could apply to your clinical practice, including specific implications for practice within your state. Attach the 4 PDFs of your articles.

Read a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond to at least two of your colleagues on 2 different days by sharing cultural considerations that may impact the legal or ethical issues present in their articles.

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

Learning Resources

Required Readings (click to expand/reduce)

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https://www.nursingworld.org/practice-policy/nursi…

American Psychological Association. (2017). Ethical principles of psychologists and diagnostic formulation. http://www.apa.org/ethics/code/

American Academy of Child & Adolescent Psychiatry. (2014). Code of ethics. https://www.aacap.org/App_Themes/AACAP/docs/about_…

American Psychiatric Nurses Association. (2020). APRN psychiatric-mental health nursing practice. https://www.apna.org/i4a/pages/index.cfm?pageID=38…

Anderson, S. L. (2012). Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents. American Academy of Child and Adolescent Psychiatry, 51(9). 957–974. https://www.jaacap.org/action/showPdf?pii=S0890-85…

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

  • Chapter 19, “Legal Issues in the Care and Treatment of Children with Mental Health Problems”

Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.

  • Chapter 1, “Preparing to Pass the Psychiatric-Mental Health Nurse Practitioner Certification Exam”

Ethical and Legal Foundations of PMHNP Care Submission and Grading Information

Ethical and Legal Foundations of PMHNP Care Grading Criteria

Post by Day 3 of Week 2 and Respond by Day 6 of Week 2

To Participate in this Discussion:

Week 2 Discussion

Name:  Ethical and Legal Foundations of PMHNP Care Discussion Rubric

Ethical and Legal Foundations of PMHNP Care Excellent

90–100

 Good

80–89

 Fair

70–79

 Poor

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 three current credible sources.

 35 (35%) – 39 (39%)

Responds to most of the Discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least three credible references.

 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.

Cited with fewer than two 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 one or no credible references.
Main Posting:

Writing

 6 (6%) – 6 (6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

 5 (5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

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.

 8 (8%) – 8 (8%)

Meets requirements for full 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.

 8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

 7 (7%) – 7 (7%)

Response is on topic and may have some depth.

 0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.
First Response:

Writing

 6 (6%) – 6 (6%)

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.

 5 (5%) – 5 (5%)

is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is 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.

 4 (4%) – 4 (4%)

Meets requirements for full 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.

 8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

 7 (7%) – 7 (7%)

Response is on topic and may have some depth.

 0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.
Second Response:
Writing		 6 (6%) – 6 (6%)

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.

 5 (5%) – 5 (5%)

is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is 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.

 4 (4%) – 4 (4%)

Meets requirements for full 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

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NRNP 6665 Comprehensive Integrated Psychiatric Assessment Discussion Example

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NRNP 6665 Comprehensive Integrated Psychiatric Assessment Discussion Example

NRNP 6665 Comprehensive Integrated Psychiatric Assessment Discussion AssignmentNRNP 6665 Comprehensive Integrated Psychiatric Assessment Discussion Assignment

NRNP 6665 Comprehensive Integrated Psychiatric Assessment Discussion Assignment Brief

Course: NRNP 6665 – Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I

Assignment Title: NRNP 6665 Comprehensive Integrated Psychiatric Assessment Discussion Assignment

Assignment Instructions Overview

This assignment involves a critical analysis of a comprehensive, integrated psychiatric assessment for an adolescent. You will review a provided video vignette and evaluate the assessment techniques used, identifying areas of strength and potential improvement. Additionally, you will discuss the importance of thorough psychiatric assessments for children/adolescents, suitable symptom rating scales, and treatment options specific to this population.

Understanding Assignment Objectives

The primary goal of this assignment is to enhance your understanding of psychiatric assessment techniques tailored for children and adolescents. By engaging in this exercise, you will develop the ability to critically evaluate clinical practices and apply appropriate diagnostic tools and treatment strategies for younger patients.

The Student’s Role

As a student, your role is to:

  • Review and analyze the provided video vignette.
  • Identify and critique the assessment methods demonstrated by the practitioner.
  • Discuss the significance of comprehensive psychiatric assessments for the pediatric population.
  • Propose relevant symptom rating scales and treatment options for children/adolescents.
  • Engage with peers by offering insights and alternative perspectives on their analyses.

Competencies Measured

This assignment measures the following competencies:

  • Ability to evaluate and critique psychiatric assessment techniques for children and adolescents.
  • Skill in recommending effective assessment questions for this demographic.
  • Understanding the importance of comprehensive psychiatric assessments in developing accurate diagnoses and treatment plans.
  • Knowledge of appropriate symptom rating scales for pediatric psychiatric assessments.
  • Identification of suitable psychiatric treatments for children and adolescents.
  • Comprehension of the vital role parents/guardians play in the assessment and treatment process of young patients.

You Can Also Check Other Related Assessments for the NRNP 6665 – Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I Course:

NRNP 6665 Ethical and Legal Foundations of PMHNP Care Discussion Assignment Example

NRNP 6665 Comprehensive Integrated Psychiatric Assessment Discussion Example

Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment

What did the practitioner do well? In what areas can the practitioner improve?

Practitioner Strengths:

  • Open-Ended Questions: The practitioner used open-ended questions, which facilitated detailed responses from the adolescent, Tony. This approach helped gather comprehensive information about Tony’s feelings and behaviors.
  • Exploring Emotions: The practitioner effectively explored Tony’s emotional state, including feelings of hopelessness and anger, which are crucial in assessing depression and anxiety.
  • Summarizing Statements: The practitioner summarized Tony’s statements, which validated his feelings and ensured understanding.

Areas for Improvement:

  • Confidentiality and Consent: The practitioner did not address confidentiality, privacy, and consent at the beginning of the session. It is essential to explain these aspects to establish trust and clarify the boundaries of the therapeutic relationship.
  • Family Involvement: There was no mention of involving Tony’s family or obtaining collateral information from them. Family input can provide additional context and support for the adolescent.
  • Environment: Creating a more child-friendly environment could make the session more comfortable for young patients. This could include having art on the walls or other engaging elements.

At this point in the clinical interview, do you have any compelling concerns? If so, what are they?

Yes, there are compelling concerns. Tony expressed feelings of anger, hopelessness, and a lack of interest in activities he used to enjoy, such as basketball and school. He also mentioned thoughts of not wanting to be alive. These symptoms are indicative of depression and possible suicidal ideation, which require immediate attention and intervention.

What would be your next question, and why?

The next question should be: “Can you tell me more about your thoughts of not wanting to be alive? Have you ever thought about how you might hurt yourself?” This question is crucial to assess the severity of Tony’s suicidal ideation and to determine the level of immediate risk.

Additional Discussion Points:

Explain why a thorough psychiatric assessment of a child/adolescent is important.

A thorough psychiatric assessment of a child or adolescent is essential because it allows for accurate diagnosis and effective treatment planning. Children and adolescents are at a developmental stage where mental health issues can significantly impact their growth, education, social relationships, and overall well-being. Early and precise assessment can prevent the progression of mental health disorders and improve long-term outcomes (Hilt & Nussbaum, 2016).

Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.

  • Pediatric Symptom Checklist (PSC): This is a brief screening questionnaire that helps identify psychosocial problems in children. It is widely used in primary care settings and has versions for different age groups.
  • Strengths and Difficulties Questionnaire (SDQ): This tool measures emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. It is suitable for children aged 4-17 and can be completed by parents, teachers, or the adolescents themselves.

Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.

  • Play Therapy: This form of therapy uses play to help children express their feelings and deal with psychological issues. It is particularly effective for younger children who may not have the verbal skills to articulate their emotions.
  • Family-Based Treatment (FBT): This approach involves the family in the treatment process, which is especially important for conditions like eating disorders. FBT empowers parents to support their child’s recovery, which may not be as relevant in adult treatments.

Explain the role parents/guardians play in assessment.

Parents and guardians play a critical role in the assessment process by providing historical context, observations of behavior, and information about the child’s development and family dynamics. Their involvement helps ensure a comprehensive understanding of the child’s issues and supports the implementation of treatment plans (Srinath et al., 2019).

References

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. Indian Journal of Psychiatry, 61(2), 158–175.

Graf, M., Lederman, S., Raphael, E., & Kafri, R. (2023). Home-based treatment for children and adolescents with acute mental health disorders: A literature review. Journal of Child and Adolescent Psychiatric Nursing, 36(2), 681-686.

Detailed Assessment Instructions for the NRNP 6665 Comprehensive Integrated Psychiatric Assessment Discussion Assignment

NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment

Photo Credit: Seventyfour / Adobe Stock

Many assessment principles are the same for children and adults; however, unlike with adults/older adults, where consent for participation in the assessment comes from the actual client, with children it is the parents or guardians who must make the decision for treatment. Issues of confidentiality, privacy, and consent must be addressed. When working with children, it is not only important to be able to connect with the pediatric patient, but also to be able to collaborate effectively with the caregivers, other family members, teachers, and school counselors/psychologists, all of whom will be able to provide important context and details to aid in your assessment and treatment plans.

Some children/adolescents may be more difficult to assess than adults, as they can be less psychologically minded. That is, they have less insights into themselves and their motivations than adults (although this is not universally true). The PMHNP must also take into consideration the child’s culture and environmental context. Additionally, with children/adolescents, there are lower rates of neurocognitive disorders superimposed on other clinical conditions, such as depression or anxiety, which create additional diagnostic challenges.

In this Discussion, you review and critique the techniques and methods of a mental health professional as the practitioner completes a comprehensive, integrated psychiatric assessment of an adolescent. You also identify rating scales and treatment options that are specifically appropriate for children/adolescents.

TO PREPARE

  • Review the Learning Resources and consider the insights they provide on comprehensive, integrated psychiatric assessment. Watch the Mental Status Examination B-6 and Simulation Scenario-Adolescent Risk Assessment videos.
  • Watch the YMH Boston Vignette 5 video and take notes; you will use this video as the basis for your Discussion post.

By Day 3 of Week 1

Based on the YMH Boston Vignette 5 video, post answers to the following questions:

  • What did the practitioner do well? In what areas can the practitioner improve?
  • At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
  • What would be your next question, and why?

Then, address the following. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.

  • Explain why a thorough psychiatric assessment of a child/adolescent is important.
  • Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
  • Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
  • Explain the role parents/guardians play in assessment.

Support your response with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Read a selection of your colleagues’ responses.

BY DAY 6 OF WEEK 1

Respond to at least two of your colleagues on 2 different days by offering additional insights or alternative perspectives on their analysis of the video, other rating scales that may be used with children, or other treatment options for children not yet mentioned. Be specific and provide a rationale with evidence.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 1 Discussion

Week 1: Child and Adolescent Assessment

All diagnoses, from infancy to adulthood, begin with an examination. While an organic basis for most medical disorders can be determined through the use of diagnostic testing, the field of psychiatry is different in that patients cannot be sent to the lab for blood tests to determine the degree of depression. Similarly, patients cannot be sent to the radiology department for a “scan” to determine the severity of their bipolar disorder. Instead, the field of psychiatry must use psychiatric assessments, such as the comprehensive integrated physical exam, diagnostic interviews, and questionnaires to make diagnoses. These tools must be specialized to address the needs of children and adolescents.

Diagnostic assessment of the child and adolescent is a specialized area of expertise. The PMHNP will often see children who have already been seen by a primary care provider. Many PCPs are comfortable handling attention-deficit/hyperactivity disorder (ADHD) and other straightforward childhood disorders. That means that the PMHNP will often treat the more complicated patients. This week, you explore psychiatric assessment techniques and tools for children and adolescents. You also examine the role of the parent/guardian in the assessment process for this patient population.

Learning Objectives

Students will:

  • Evaluate comprehensive integrated psychiatric assessment techniques for children and adolescents
  • Recommend assessment questions for child and adolescent patients
  • Explain the importance of thorough psychiatric assessment for children and adolescents
  • Identify rating scales that are appropriate for child/adolescent psychiatric assessment
  • Identify psychiatric treatments appropriate for children and adolescents
  • Explain the role of the parent/guardian in child/adolescent psychiatric assessment

Optional Discussion Forum: PMHNP Study Support Lounge

The PMHNP Study Support Lounge is offered throughout the course as a place of academic refuge where you can ask questions, offer insights, and interact with your peers. Your Instructor may also weigh in to provide global feedback to the group based on trends, common problems, and common strengths in student posts.

You are encouraged to provide constructive, helpful feedback to your peers. Advanced practice nurses always benefit from the feedback of others. Your Study Support Lounge posts may be procedural (“How do I attach a Kaltura video to a Discussion post?”), conceptual (“How does this relate to the other therapy approaches we have studied?”), or analytical (“What do these diagnostic results actually mean in the context of this specific patient case?”). Although not mandatory, this is an opportunity to interact and study together as you navigate the assignments, so you are highly encouraged to take part in this activity. Full participation in activities like this is a statistically significant predictor of success.

To Participate in this Optional Discussion:

  • PMHNP Study Support Lounge
  • Acknowledgment
  • Practicum Manual Acknowledgment

The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.

  • Field Experience: MSN Nurse Practitioner Practicum Manual

Click here and follow the instructions to confirm you have downloaded and read the entire MSN Nurse Practitioner Practicum Manual and will abide by the requirements described in order to successfully complete this program.

Learning Resources

Required Readings (click to expand/reduce)

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. Indian Journal of Psychiatry, 61(2), 158–175. http://doi.org/10.4103/psychiatry.IndianJPsychiatr…

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

  • Chapter 32, “Clinical assessment and diagnostic formulation”

Required Media (click to expand/reduce)

Symptom Media. (2014). Mental status exam B-6. [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/mental-status-exam-b-6/cite?context=channel:volume-2-new-releases-assessment-tools-mental-status-exam-series

Western Australian Clinical Training Network. (2016, August 4). Simulation scenario-adolescent risk assessment [Video]. YouTube. 

YMH Boston. (2013, May 22). Vignette 5 – Assessing for depression in a mental health appointment [Video]. YouTube. 

Recommended Reading (click to expand/reduce)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

  • Chapter 31, “Child Psychiatry”

NRNP 6665 Week 1 Assignment: Child and Adolescent Assessment Rubric

Name:  Assignment Rubric

Excellent Good Fair Poor
Summarize your interpretation of the frequency data provided in the output for respondent’s age, highest school grade completed, and family income from prior month. 32 (32%) – 35 (35%)

The response accurately and clearly explains, in detail, a summary of the frequency distributions for the variables presented.

The response accurately and clearly explains, in detail, the number of times the value occurs in the data.

The response accurately and clearly explains, in detail, the appearance of the data, the range of data values, and an explanation of extreme values in describing intervals that sufficiently provides an analysis that fully supports the categorization of each variable value.

The response includes relevant, specific, and appropriate examples that fully support the explanations provided for each of the areas described.

 28 (28%) – 31 (31%)

The response accurately summarizes the frequency distributions for the variables presented.

The response accurately explains the number of times the value occurs in the data.

The response accurately explains the appearance of the data, the range of data values, and explains extreme values in describing intervals that provides an analysis which supports the categorization of each variable value.

The response includes relevant, specific, and accurate examples that support the explanations provided for each of the areas described.

 25 (25%) – 27 (27%)

The response inaccurately or vaguely summarizes the frequency distributions for the variables presented.

The response inaccurately or vaguely explains the number of times the value occurs in the data.

The response inaccurately or vaguely explains the appearance of the data, the range of data values, and inaccurately or vaguely explains extreme values.

An analysis that may support the categorization of each variable value is inaccurate or vague.

The response includes inaccurate and irrelevant examples that may support the explanations provided for each of the areas described.

 0 (0%) – 24 (24%)

The response inaccurately and vaguely summarizes the frequency distributions for the variables presented, or it is missing.

The response inaccurately and vaguely explains the number of times the value occurs in the data, or it is missing.

The response inaccurately and vaguely explains the appearance of the data, the range of data values, and an explanation of extreme values, or it is missing.

An analysis that does not support the categorization of each variable values is provided, or it is missing.

The response includes inaccurate and vague examples that do not support the explanations provided for each of the areas described, or it is missing.
Summarize your interpretation of the descriptive statistics provided in the output for respondent’s age, highest school grade completed, race and ethnicity, currently employed, and family income from prior month. 45 (45%) – 50 (50%)

The response accurately and clearly summarizes in detail the interpretation of the descriptive statistics provided.

The response accurately and clearly evaluates in detail each of the variables presented, including an accurate and complete description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.

 40 (40%) – 44 (44%)

The response accurately summarizes the interpretation of the descriptive statistics provided.

The response accurately explains evaluates each of the variables presented, including an accurate description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.

 35 (35%) – 39 (39%)

The response inaccurately or vaguely summarizes the interpretation of the descriptive statistics provided.

The response inaccurately or vaguely evaluates each of the variables presented, including an inaccurate or vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data.

 0 (0%) – 34 (34%)

The response inaccurately and vaguely summarizes the interpretation of the descriptive statistics provided, or it is missing.

The response inaccurately and vaguely evaluates each of the variables presented, including an inaccurate and vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data, or it is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.		 5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

 4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

 3 (3%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

 0 (0%) – 2 (2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion was provided.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation		 5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

 4 (4%) – 4 (4%)

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

 3 (3%) – 3 (3%)

Contains several (3 or 4) grammar, spelling, and punctuation errors.

 0 (0%) – 2 (2%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

 4 (4%) – 4 (4%)

Contains a few (1 or 2) APA format errors.

 3 (3%) – 3 (3%)

Contains several (3 or 4) APA format errors.

 0 (0%) – 2 (2%)

Contains many (≥ 5) APA format errors.
Total Points: 100

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NRNP 6665 – Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I Course Guide, Assignments & Examples

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NRNP 6665 – Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I Course Guide, Assignments & Examples

NRNP 6665 - Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan INRNP 6665 – Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I (3 credits)

Working from a lifespan approach, this course brings together diagnosis and treatment planning in psychiatry. Topics include psychiatric assessment, application of diagnostic criteria, diagnostic formulation, differential diagnosis, psychopharmacology, and appropriate labs and diagnostics. The learner will select a combination of psychotherapeutic modalities coupled with psychopharmacologic approaches to treat common psychiatric mental health conditions across the lifespan. Legal and ethical considerations for working with clients across the lifespan will be addressed. Students build confidence as they continue to transition from the role of registered nurse to that of advanced practice nurse.

NRNP 6665 – Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I Program Summary

Program Overview

The Psychiatric Mental Health Nurse Practitioner (PMHNP) is an advanced practice registered nurse trained to provide a wide range of mental health services to patients and families in a variety of settings. PMHNPs diagnose, conduct therapy, and prescribe medications for patients who have psychiatric disorders, medical organic brain disorders, or substance abuse problems. They are licensed to provide emergency psychiatric services, conduct psychosocial and physical assessment of their patients, develop and manage treatment plans, and provide ongoing manage patient care. They may also serve as consultants or as educators for families and staff.

The PMHNP has a focus on making a psychiatric diagnosis, differentiates between medical disorders with psychiatric symptoms, and orders appropriate medications to treat various psychiatric disorders. A PMHNP can often practice autonomously, depending on state licensure laws.

 Course Description

This is the third of four practicum courses in the advanced practice psychiatric-mental health curriculum. Students will apply their knowledge of psychopathology, psychopharmacology, and psychiatric assessment to the diagnosis, treatment, and management of mental health disorders in children, adolescents, adults, and older adults. The focus of this course is on advanced nursing practice in mental health settings. 

 Credit & Practicum Hours

Quarter Credit Hours: 

  • Practicum Course (PRAC) – 2 credits:  See required practicum hours below.
  • Didactic Course (NRNP) – 3 credits:  Didactic course to be taken prior to or concurrently with PRAC.  

Practicum Hours:  

  • Students Enrolled Before Spring 2018:  This course requires a minimum of 144 practicum hours.    
  • Students Enrolled After Spring 2018:  This course requires a minimum of 160 practicum hours.

 Course Learning Outcomes

  • Assess advanced practice nursing skills for strengths and opportunities. 
  • Develop professional plans in advanced nursing practice for the practicum experience.
  • Apply advanced practice nursing assessment and diagnosis skills in mental health settings. 
  • Analyze cases involving advanced care of patients across the lifespan in mental health settings.
  • Formulate differential diagnoses for patients across the lifespan.
  • Formulate appropriate treatment plans include psychopharmacology and psychotherapeutic techniques.
  • Collaborate with multi-disciplinary teams to improve clinical practice in mental health settings. 
  • Develop skills to be a social change agent within your community.

 MSN Learning Outcomes

At the end of this program, students will be able to:

  1. Synthesize organizational/systems leadership for cost-effective specialist nursing practice that contributes to high-quality healthcare delivery, advancement of the nursing profession, and social change.
  2. Critique evidence-based literature drawing from diverse theoretical perspectives and pertinent research to guide decision making that demonstrates best practices for specialist nursing practice in a global society.
  3. Integratively assess, diagnose, plan, implement, and evaluate cost-effective healthcare strategies that reduce health disparities by patient/population advocacy for access to specialist nursing care.
  4. Demonstrate ability to effectively communicate using audience-specific oral, written, and information technology for professional delivery of specialist nursing care.
  5. Evaluate health needs of diverse populations for necessary teaching/coaching functions based on specialist nursing knowledge to restore/promote health and prevent illness/injury.
  6. Exhibit ongoing commitment to professional development and value of nursing theories/ethical principles (altruism, autonomy, human dignity, integrity, social justice) in accordance with ethically responsible, legally accountable, specialist nursing practice.
  7. Implement specialist nursing roles to promote quality improvement of patient-centered care in accordance with professional practice standards that transform health outcomes for diverse populations.

NRNP 6665 Complete Course Week 1 – 11

NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment

NRNP 6665 Week 2 Discussion: Ethical and Legal Foundations of PMHNP Care – Topic: Child and Elder Abuse Reporting

NRNP 6665 Week 2 Discussion: Ethical and Legal Foundations of PMHNP Care – Topic: Informed Consent

NRNP 6665 Week 2 Discussion: Ethical and Legal Foundations of PMHNP Care – Topic: Restraints

NRNP 6665 Week 3 Assignment 1: Prescribing for Children and Adolescents (ADHD)

NRNP 6665 Week 3 Assignment 2: National Certification Exam Plan

NRNP 6665 Week 3 Assignment 2: Study Plan

NRNP 6665 Week 4 Assignment: Assessing, Diagnosing, and Treating Adults with Mood Disorders

NRNP 6665 Week 5 Assignment: Patient Education for Children and Adolescents – Cyclothymia Blog

NRNP 6665 Week 5 Assignment: Patient Education for Children and Adolescents

NRNP 6665 Week 6 Midterm Exam (100% Correct Summer QTR)

NRNP 6665 Week 6 Midterm Exam Solutions

NRNP 6665 Week 6 Midterm Exam (Fall QTR)

NRNP 6665 Week 6 Midterm Drugs

NRNP 6665 Week 8 Assignment: Study Guide Forum – Intellectual Disability

NRNP 6665 Week 8 Assignment: Study Guide Forum – Pyromania

NRNP 6665 Week 8 Assignment: Study Guide Forum – Tic Disorder

NRNP 6665 Week 8 Assignment: Study Guide Forum – Vascular Dementia

NRNP 6665 Week 8 Assignment; Study Guide Forum – Stereotypic Movement

NRNP 6665 Week 9 Assignment: Controversy Associated with Dissociative Disorders

NURS 6665 Week 11 Final Exam (100% Correct Spring QTR)

NURS 6665 Week 11 Final Exam (100% Correct Summer QTR)

NRNP 6665-01 Week 11 Final Exam (100 out of 100 Points)

NRNP 6665: Across the Lifespan

Discussion Week 1

COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT

NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment

Photo Credit: Seventyfour / Adobe Stock

Many assessment principles are the same for children and adults; however, unlike with adults/older adults, where consent for participation in the assessment comes from the actual client, with children it is the parents or guardians who must make the decision for treatment. Issues of confidentiality, privacy, and consent must be addressed. When working with children, it is not only important to be able to connect with the pediatric patient, but also to be able to collaborate effectively with the caregivers, other family members, teachers, and school counselors/psychologists, all of whom will be able to provide important context and details to aid in your assessment and treatment plans.

Some children/adolescents may be more difficult to assess than adults, as they can be less psychologically minded. That is, they have less insights into themselves and their motivations than adults (although this is not universally true). The PMHNP must also take into consideration the child’s culture and environmental context. Additionally, with children/adolescents, there are lower rates of neurocognitive disorders superimposed on other clinical conditions, such as depression or anxiety, which create additional diagnostic challenges.

In this Discussion, you review and critique the techniques and methods of a mental health professional as the practitioner completes a comprehensive, integrated psychiatric assessment of an adolescent. You also identify rating scales and treatment options that are specifically appropriate for children/adolescents.

TO PREPARE

  • Review the Learning Resources and consider the insights they provide on comprehensive, integrated psychiatric assessment. Watch the Mental Status Examination B-6 and Simulation Scenario-Adolescent Risk Assessment videos.
  • Watch the YMH Boston Vignette 5 video and take notes; you will use this video as the basis for your Discussion post.

By Day 3 of Week 1

Based on the YMH Boston Vignette 5 video, post answers to the following questions:

  • What did the practitioner do well? In what areas can the practitioner improve?
  • At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
  • What would be your next question, and why?

Then, address the following. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.

  • Explain why a thorough psychiatric assessment of a child/adolescent is important.
  • Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
  • Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
  • Explain the role parents/guardians play in assessment.

Support your response with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Read a selection of your colleagues’ responses.

BY DAY 6 OF WEEK 1

Respond to at least two of your colleagues on 2 different days by offering additional insights or alternative perspectives on their analysis of the video, other rating scales that may be used with children, or other treatment options for children not yet mentioned. Be specific and provide a rationale with evidence.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 1 Discussion

Week 1: Child and Adolescent Assessment

All diagnoses, from infancy to adulthood, begin with an examination. While an organic basis for most medical disorders can be determined through the use of diagnostic testing, the field of psychiatry is different in that patients cannot be sent to the lab for blood tests to determine the degree of depression. Similarly, patients cannot be sent to the radiology department for a “scan” to determine the severity of their bipolar disorder. Instead, the field of psychiatry must use psychiatric assessments, such as the comprehensive integrated physical exam, diagnostic interviews, and questionnaires to make diagnoses. These tools must be specialized to address the needs of children and adolescents.

Diagnostic assessment of the child and adolescent is a specialized area of expertise. The PMHNP will often see children who have already been seen by a primary care provider. Many PCPs are comfortable handling attention-deficit/hyperactivity disorder (ADHD) and other straightforward childhood disorders. That means that the PMHNP will often treat the more complicated patients. This week, you explore psychiatric assessment techniques and tools for children and adolescents. You also examine the role of the parent/guardian in the assessment process for this patient population.

Learning Objectives

Students will:

  • Evaluate comprehensive integrated psychiatric assessment techniques for children and adolescents
  • Recommend assessment questions for child and adolescent patients
  • Explain the importance of thorough psychiatric assessment for children and adolescents
  • Identify rating scales that are appropriate for child/adolescent psychiatric assessment
  • Identify psychiatric treatments appropriate for children and adolescents
  • Explain the role of the parent/guardian in child/adolescent psychiatric assessment

Optional Discussion Forum: PMHNP Study Support Lounge

The PMHNP Study Support Lounge is offered throughout the course as a place of academic refuge where you can ask questions, offer insights, and interact with your peers. Your Instructor may also weigh in to provide global feedback to the group based on trends, common problems, and common strengths in student posts.

You are encouraged to provide constructive, helpful feedback to your peers. Advanced practice nurses always benefit from the feedback of others. Your Study Support Lounge posts may be procedural (“How do I attach a Kaltura video to a Discussion post?”), conceptual (“How does this relate to the other therapy approaches we have studied?”), or analytical (“What do these diagnostic results actually mean in the context of this specific patient case?”). Although not mandatory, this is an opportunity to interact and study together as you navigate the assignments, so you are highly encouraged to take part in this activity. Full participation in activities like this is a statistically significant predictor of success.

To Participate in this Optional Discussion:

  • PMHNP Study Support Lounge
  • Acknowledgment
  • Practicum Manual Acknowledgment

The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.

  • Field Experience: MSN Nurse Practitioner Practicum Manual

Click here and follow the instructions to confirm you have downloaded and read the entire MSN Nurse Practitioner Practicum Manual and will abide by the requirements described in order to successfully complete this program.

Learning Resources

Required Readings (click to expand/reduce)

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. Indian Journal of Psychiatry, 61(2), 158–175. http://doi.org/10.4103/psychiatry.IndianJPsychiatr…

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

  • Chapter 32, “Clinical assessment and diagnostic formulation”

Required Media (click to expand/reduce)

Symptom Media. (2014). Mental status exam B-6. [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/mental-status-exam-b-6/cite?context=channel:volume-2-new-releases-assessment-tools-mental-status-exam-series

Western Australian Clinical Training Network. (2016, August 4). Simulation scenario-adolescent risk assessment [Video]. YouTube. 

YMH Boston. (2013, May 22). Vignette 5 – Assessing for depression in a mental health appointment [Video]. YouTube. 

Recommended Reading (click to expand/reduce)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

  • Chapter 31, “Child Psychiatry”

NRNP 6665 Week 1 Assignment: Child and Adolescent Assessment Rubric

Name:  Assignment Rubric

Excellent Good Fair Poor
Summarize your interpretation of the frequency data provided in the output for respondent’s age, highest school grade completed, and family income from prior month. 32 (32%) – 35 (35%)

The response accurately and clearly explains, in detail, a summary of the frequency distributions for the variables presented.

The response accurately and clearly explains, in detail, the number of times the value occurs in the data.

The response accurately and clearly explains, in detail, the appearance of the data, the range of data values, and an explanation of extreme values in describing intervals that sufficiently provides an analysis that fully supports the categorization of each variable value.

The response includes relevant, specific, and appropriate examples that fully support the explanations provided for each of the areas described.

 28 (28%) – 31 (31%)

The response accurately summarizes the frequency distributions for the variables presented.

The response accurately explains the number of times the value occurs in the data.

The response accurately explains the appearance of the data, the range of data values, and explains extreme values in describing intervals that provides an analysis which supports the categorization of each variable value.

The response includes relevant, specific, and accurate examples that support the explanations provided for each of the areas described.

 25 (25%) – 27 (27%)

The response inaccurately or vaguely summarizes the frequency distributions for the variables presented.

The response inaccurately or vaguely explains the number of times the value occurs in the data.

The response inaccurately or vaguely explains the appearance of the data, the range of data values, and inaccurately or vaguely explains extreme values.

An analysis that may support the categorization of each variable value is inaccurate or vague.

The response includes inaccurate and irrelevant examples that may support the explanations provided for each of the areas described.

 0 (0%) – 24 (24%)

The response inaccurately and vaguely summarizes the frequency distributions for the variables presented, or it is missing.

The response inaccurately and vaguely explains the number of times the value occurs in the data, or it is missing.

The response inaccurately and vaguely explains the appearance of the data, the range of data values, and an explanation of extreme values, or it is missing.

An analysis that does not support the categorization of each variable values is provided, or it is missing.

The response includes inaccurate and vague examples that do not support the explanations provided for each of the areas described, or it is missing.
Summarize your interpretation of the descriptive statistics provided in the output for respondent’s age, highest school grade completed, race and ethnicity, currently employed, and family income from prior month. 45 (45%) – 50 (50%)

The response accurately and clearly summarizes in detail the interpretation of the descriptive statistics provided.

The response accurately and clearly evaluates in detail each of the variables presented, including an accurate and complete description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.

 40 (40%) – 44 (44%)

The response accurately summarizes the interpretation of the descriptive statistics provided.

The response accurately explains evaluates each of the variables presented, including an accurate description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.

 35 (35%) – 39 (39%)

The response inaccurately or vaguely summarizes the interpretation of the descriptive statistics provided.

The response inaccurately or vaguely evaluates each of the variables presented, including an inaccurate or vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data.

 0 (0%) – 34 (34%)

The response inaccurately and vaguely summarizes the interpretation of the descriptive statistics provided, or it is missing.

The response inaccurately and vaguely evaluates each of the variables presented, including an inaccurate and vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data, or it is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.		 5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

 4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

 3 (3%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

 0 (0%) – 2 (2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion was provided.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation		 5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

 4 (4%) – 4 (4%)

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

 3 (3%) – 3 (3%)

Contains several (3 or 4) grammar, spelling, and punctuation errors.

 0 (0%) – 2 (2%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

 4 (4%) – 4 (4%)

Contains a few (1 or 2) APA format errors.

 3 (3%) – 3 (3%)

Contains several (3 or 4) APA format errors.

 0 (0%) – 2 (2%)

Contains many (≥ 5) APA format errors.
Total Points: 100

Assignment: Practicum Journal Entry: Analyzing an Ethical Decision

In your role as a PMHNP, you will encounter several situations that will require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidenced-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their socio-demographic and ethnic/racial background. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action. For this Assignment, you review the literature and discover the various ethical dilemmas PMHNPs encounter and how these issues are typically addressed in your state.

Learning Objectives

Students will:

  • Analyze salient ethical issues in psychiatric mental health practice
  • Compare ethical dilemmas with state health laws and regulations
  • Analyze ethical decision-making processes

To prepare:

  • Review literature for moral/ethical issues encountered by a PMHNP.
  • Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment.

Write a 2-page paper in which you do the following:

  • Summarize the moral/ethical issue in the article (no more than 1 paragraph).
  • Describe the moral and ethical dilemmas surrounding the issue.
  • Analyze the ethical issue and compare them to the state health laws and regulations in your state.
  • Outline the process of ethical decision making you would use to address this ethical dilemma.

Note: Be sure to use the Practicum Journal Template, located in this week’s Learning Resources.

By Day 7 of Week 4

Submit your Assignment.

Making Connections

This week, you explored in depth the elements of the comprehensive integrated psychiatric assessment and diagnostic process.

Next week, you explore the many different psychiatric assessment tools and begin to explore treatment options. You also begin developing your resume and portfolio.

Looking Ahead 1: Didactic Assignments

  • Week 3: You will work in a group to develop a “Parent Guide,” which will serve as a teaching tool for parents with children who have been diagnosed with a specific mental health disorder.
  • Week 5: You will assess one of the clients in your practicum who you do not think is adequately progressing according to expected clinical outcomes. Comprehensive Integrated Psychiatric Assessment Discussion
  • Week 6: You will use one of your adult clients who had a psychiatric emergency as an example as you compare how you would assess a child or adolescent client who had a psychiatric emergency.
  • Week 7: You will work in a group to develop a “Parent Guide,” which will serve as a teaching tool for parents with children who have been diagnosed with a specific mental health disorder.
  • Week 10: You will work in a group to develop a “Parent Guide,” which will serve as a teaching tool for parents with children who have been diagnosed with a specific mental health disorder. Comprehensive Integrated Psychiatric Assessment Discussion

Looking Ahead 2: Practicum Assignments

Each week, you will complete practicum-related assignments. It is highly recommended that you review the practicum assignments for Weeks 2–11 before Day 7 of Week 1. This will give you time to meet with your preceptor so that you can fulfill the requirements of each practicum assignment.

  • Week 2: You begin working on your cover letter, resume, and portfolio. (Assignment to be submitted by Day 7 of Week 10.)
  • Week 3: You will complete a Decision Tree including the diagnosis and treatment of a pediatric client. (Assignment to be submitted by Day 7 of Week 4.)
  • Week 5: You will complete a Decision Tree including the diagnosis and treatment of a pediatric client. (Assignment to be submitted by Day 7 of Week 7.) Comprehensive Integrated Psychiatric Assessment Discussion
  • Week 6:  You will write a reflection on your practicum experiences involving group therapy sessions. (Assignment to be submitted by Day 7 of Week 7.)
  • Week 7: You will write a journal entry concerning voluntary and involuntary commitment. (Assignment to be submitted by Day 7 of Week 7.)
  • Week 9:  You will complete a Decision Tree including the diagnosis and treatment of a pediatric client. (Assignment to be submitted by Day 7 of Week 10.)
  • Week 10:  You will write about two clients you observed or counseled during a group therapy session for children and adolescents. (Assignment to be submitted by Day 7 of Week 10.)
  • Week 10: You will complete and submit your cover letter, resume, and portfolio. (Assignment to be submitted by Day 7 of Week 10.) Comprehensive Integrated Psychiatric Assessment Discussion

Refer to Weeks 2–10 for additional guidance.

Walden University – NRNP 6665 Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I

Walden University – PRAC – 6665 Week 1: Competencies of Advanced Nursing Practice

What do I have to do? When do I have to do it?
Review your Learning Resources. Days 1–7
Assignment 1: Practicum Site Information Submit Assignment 1 by Day 2.
Assignment 2: Clinical Skills Self-Assessment Submit Assignment 2 by Day 7.
Assignment 3: Clinical Hour and Patient Logs Track your clinical hours and patient encounters in
Meditrek throughout this practicum course. Each week,
your logs must be completed by Day 7.

Walden University – NRNP 6665 Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I

Introduction

Tell me and I forget, teach me and I may remember, involve me and I learn.
—Xun Kuang, Chinese Confucian philosopher

Welcome to your PMHNP Care Across the Lifespan I Practicum! The practicum experience is an experiential learning opportunity which allows you to gain and refine your clinical advanced nursing skills under the mentorship of a Preceptor. As you engage with patients in the practicum setting, your involvement will extend your learning about a variety of psychiatric and mental health care needs for patients across the lifespan.

Throughout the next 11 weeks, you will evaluate your skill development, reflect on patient encounters, and generate goals related to your growth as an advanced practice nurse. This week, you start by assessing your strengths and opportunities related to psychiatric-mental health nurse practitioner (PMHNP) clinical skills.

Learning Objectives

Students will:

  • Complete practicum site form
  • Assess clinical skills related to advanced psychiatric-mental health nursing practice
  • Develop measurable goals and objectives for the practicum experience
  • Describe clinical hours and patient encounters

Learning Resources

Walden University – NRNP 6665 Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan Required Readings

American Academy of Child and Adolescent Psychiatry. (2018). CPT code training module.

Walden University Field Experience. (2020a). Field experience: College of Nursing. 

Walden University Field Experience. (2020b). MSN nurse practitioner practicum manual.

Acknowledgment

Practicum Manual Acknowledgment

The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.

NRNP 6665 Week 2 Discussion: Ethical and Legal Foundations of PMHNP Care – Topic: Child and Elder Abuse Reporting

Week 2: Ethical and Legal Foundations of PMHNP Care Across the Lifespan

In your role as a PMHNP, you will regularly encounter situations that require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidence-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their background or worldview. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action.

Learning Objectives

Students will:

  • Analyze salient ethical and legal issues in psychiatric-mental health practice
  • Analyze the impact of cultural considerations on ethical/legal decision making in advanced practice nursing
  • Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination*

*Assessed in Week 3 Assignment

Reminder: Keep Your Library of Advanced Practice Nursing Texts at Your Fingertips

Several textbooks are assigned in multiple courses in your program. That is, you will see reading assignments from the books assigned in the Learning Resources of more than one course. You should, however, keep all prior textbooks—not just the ones explicitly assigned—readily accessible. The expectation is that you will independently consult these prior textbooks to synthesize information needed to complete your final courses. This is your time to “put it all together” and to more fully embrace the advanced practice nursing role. Part of the responsibility of advanced practice is developing information literacy skills to know where to locate needed information for your clinical practice.

Discussion: Ethical and Legal Foundations of PMHNP Care

Advanced practice nursing in all specialties is guided by codes of ethics that put the care, rights, duty, health, and safety of the patient first and foremost. PMHNP practice is also guided by ethical codes specifically for psychiatry. These ethical codes are frameworks to guide clinical decision making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. Laws, on the other hand, dictate the requirements that must be followed. In this way, legal codes may be thought to represent the minimum standards of care, and ethics represent the highest goals for care.

Photo Credit: [Hero Images]/[Hero Images]/Getty Images

For this Discussion, you select a topic that has both legal and ethical implications for PMHNP practice and then perform a literature review on the topic. Your goal will be to identify the most salient legal and ethical facets of the issue for PMHNP practice, and also how these facets differ in the care of adult patients versus children. Keep in mind as you research your issue, that laws differ by state and your clinical practice will be dictated by the laws that govern your state.

TO PREPARE

  • Select one of the following ethical/legal topics:
    • Autonomy
    • Beneficence
    • Justice
    • Fidelity
    • Veracity
    • Involuntary hospitalization and due process of civil commitment
    • Informed assent/consent and capacity
    • Duty to warn
    • Restraints
    • HIPPA
    • Child and elder abuse reporting
    • Tort law
    • Negligence/malpractice
  • In the Walden library, locate a total of four scholarly, professional, or legal resources related to this topic. One should address ethical considerations related to this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal considerations related to this topic for adults, and one should be on legal considerations related to this topic for children/adolescents.

By Day 3 of Week 2

Briefly identify the topic you selected. Then, summarize the articles you selected, explaining the most salient ethical and legal issues related to the topic as they concern psychiatric-mental health practice for children/adolescents and for adults. Explain how this information could apply to your clinical practice, including specific implications for practice within your state. Attach the 4 PDFs of your articles.

Read a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond to at least two of your colleagues on 2 different days by sharing cultural considerations that may impact the legal or ethical issues present in their articles.

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

Learning Resources

Required Readings (click to expand/reduce)

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https://www.nursingworld.org/practice-policy/nursi…

American Psychological Association. (2017). Ethical principles of psychologists and diagnostic formulation. http://www.apa.org/ethics/code/

American Academy of Child & Adolescent Psychiatry. (2014). Code of ethics. https://www.aacap.org/App_Themes/AACAP/docs/about_…

American Psychiatric Nurses Association. (2020). APRN psychiatric-mental health nursing practice. https://www.apna.org/i4a/pages/index.cfm?pageID=38…

Anderson, S. L. (2012). Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents. American Academy of Child and Adolescent Psychiatry, 51(9). 957–974. https://www.jaacap.org/action/showPdf?pii=S0890-85…

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

  • Chapter 19, “Legal Issues in the Care and Treatment of Children with Mental Health Problems”

Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.

  • Chapter 1, “Preparing to Pass the Psychiatric-Mental Health Nurse Practitioner Certification Exam”

Ethical and Legal Foundations of PMHNP Care Submission and Grading Information

Ethical and Legal Foundations of PMHNP Care Grading Criteria

Post by Day 3 of Week 2 and Respond by Day 6 of Week 2

To Participate in this Discussion:

Week 2 Discussion

Name:  Ethical and Legal Foundations of PMHNP Care Discussion Rubric

Ethical and Legal Foundations of PMHNP Care Excellent

90–100

 Good

80–89

 Fair

70–79

 Poor

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 three current credible sources.

 35 (35%) – 39 (39%)

Responds to most of the Discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least three credible references.

 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.

Cited with fewer than two 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 one or no credible references.
Main Posting:

Writing

 6 (6%) – 6 (6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

 5 (5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

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.

 8 (8%) – 8 (8%)

Meets requirements for full 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.

 8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

 7 (7%) – 7 (7%)

Response is on topic and may have some depth.

 0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.
First Response:

Writing

 6 (6%) – 6 (6%)

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.

 5 (5%) – 5 (5%)

is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is 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.

 4 (4%) – 4 (4%)

Meets requirements for full 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.

 8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

 7 (7%) – 7 (7%)

Response is on topic and may have some depth.

 0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.
Second Response:
Writing		 6 (6%) – 6 (6%)

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.

 5 (5%) – 5 (5%)

is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is 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.

 4 (4%) – 4 (4%)

Meets requirements for full 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

NRNP 6665 Week 3 Assignment 1: Prescribing for Children and Adolescents

Assignment 1: Prescribing for Children and Adolescents

Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.

—Agency for Healthcare Research and Quality

Photo Credit: Getty Images/Ingram Publishing

Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug?

For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.

Reference:

Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html

To Prepare

  • Your Instructor will assign a specific disorder for you to research for this Assignment.
  • Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.

The Assignment (1–2 pages)

  • Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
  • Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
  • Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
  • Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.

By Day 7 of Week 3

Submit your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK3Assgn1+last name+first initial.(extension)” as the name.
  • Click the Week 3 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 3 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn1+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 3 Assignment 1 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 3 Assignment 1 draft and review the originality report.

Submit Your Assignment by Day 7 of Week 3

To participate in this Assignment:

Week 3 Assignment 1

Name:  Assignment Rubric

Excellent Good Fair Poor
Summarize your interpretation of the frequency data provided in the output for respondent’s age, highest school grade completed, and family income from prior month. 32 (32%) – 35 (35%)

The response accurately and clearly explains, in detail, a summary of the frequency distributions for the variables presented.

The response accurately and clearly explains, in detail, the number of times the value occurs in the data.

The response accurately and clearly explains, in detail, the appearance of the data, the range of data values, and an explanation of extreme values in describing intervals that sufficiently provides an analysis that fully supports the categorization of each variable value.

The response includes relevant, specific, and appropriate examples that fully support the explanations provided for each of the areas described.

 28 (28%) – 31 (31%)

The response accurately summarizes the frequency distributions for the variables presented.

The response accurately explains the number of times the value occurs in the data.

The response accurately explains the appearance of the data, the range of data values, and explains extreme values in describing intervals that provides an analysis which supports the categorization of each variable value.

The response includes relevant, specific, and accurate examples that support the explanations provided for each of the areas described.

 25 (25%) – 27 (27%)

The response inaccurately or vaguely summarizes the frequency distributions for the variables presented.

The response inaccurately or vaguely explains the number of times the value occurs in the data.

The response inaccurately or vaguely explains the appearance of the data, the range of data values, and inaccurately or vaguely explains extreme values.

An analysis that may support the categorization of each variable value is inaccurate or vague.

The response includes inaccurate and irrelevant examples that may support the explanations provided for each of the areas described.

 0 (0%) – 24 (24%)

The response inaccurately and vaguely summarizes the frequency distributions for the variables presented, or it is missing.

The response inaccurately and vaguely explains the number of times the value occurs in the data, or it is missing.

The response inaccurately and vaguely explains the appearance of the data, the range of data values, and an explanation of extreme values, or it is missing.

An analysis that does not support the categorization of each variable values is provided, or it is missing.

The response includes inaccurate and vague examples that do not support the explanations provided for each of the areas described, or it is missing.
Summarize your interpretation of the descriptive statistics provided in the output for respondent’s age, highest school grade completed, race and ethnicity, currently employed, and family income from prior month. 45 (45%) – 50 (50%)

The response accurately and clearly summarizes in detail the interpretation of the descriptive statistics provided.

The response accurately and clearly evaluates in detail each of the variables presented, including an accurate and complete description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.

 40 (40%) – 44 (44%)

The response accurately summarizes the interpretation of the descriptive statistics provided.

The response accurately explains evaluates each of the variables presented, including an accurate description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.

 35 (35%) – 39 (39%)

The response inaccurately or vaguely summarizes the interpretation of the descriptive statistics provided.

The response inaccurately or vaguely evaluates each of the variables presented, including an inaccurate or vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data.

 0 (0%) – 34 (34%)

The response inaccurately and vaguely summarizes the interpretation of the descriptive statistics provided, or it is missing.

The response inaccurately and vaguely evaluates each of the variables presented, including an inaccurate and vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data, or it is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.		 5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

 4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

 3 (3%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

 0 (0%) – 2 (2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion was provided.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation		 5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

 4 (4%) – 4 (4%)

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

 3 (3%) – 3 (3%)

Contains several (3 or 4) grammar, spelling, and punctuation errors.

 0 (0%) – 2 (2%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

 4 (4%) – 4 (4%)

Contains a few (1 or 2) APA format errors.

 3 (3%) – 3 (3%)

Contains several (3 or 4) APA format errors.

 0 (0%) – 2 (2%)

Contains many (≥ 5) APA format errors.
Total Points: 100

Name:  Assignment Rubric

NRNP 6665 WU Wk 4 Mood Disorders in Adults Soap Psychiatric Notes Discussion

Walden University – NRNP 6665 Assignment: Assessing, Diagnosing, and Treating Adults With Mood Disorders

Description

-APA

SOAP Note Exemplar attached

-Follow Directions Below

-Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).

-Week 4: Mood Disorders in Adults

I am finally doing everything right. I stayed up all night studying for my final exams and even managed to clean out my closet and order a whole new bedroom from the internet. I know I will ace all my exams. Nothing can go wrong like they did a few months ago. I was so low and was sleeping all the time. I did not think I would ever be happy again, but now I know I can do anything.
—Jessica, age 22

Patients presenting with mood disorders may find that their moods impact their ability to function or that their moods are not consistent with their circumstances. Bipolar and related disorders are one category of mood disorders. They affect nearly 3% of the U.S. population each year (Depression and Bipolar Support Alliance, n.d.). Although being relatively rare in terms of lifetime prevalence, bipolar disorder is burdensome to the individual and health care system because of its early onset, severity, and chronic nature. The average age of onset is around 25 and it affects men and women equally.

The importance of evidence-based intervention for treatment in persons with mood disorders cannot be underestimated. Unstable moods can result in repeat chronic hospitalizations and profound life disruption. Mood disorders are a leading cause of disability worldwide and can contribute to suicide (World Health Organization, 2020). Practitioners should understand that developing a good rapport and relationship with the patient can make a significant difference in the course, symptom management, and stability of the patient.

This week, you will assess, diagnose, and develop appropriate treatment plans for adults presenting with mood disorders.

Reference:

Depression and Bipolar Support Alliance. (n.d.). Bipolar disorder statistics. https://www.dbsalliance.org/education/bipolar-disorder/bipolar-disorder-statistics/#

World Health Organization. (2020). Depression. https://www.who.int/news-room/fact-sheets/detail/depression

LEARNING OBJECTIVES

Students will:

  • Assess adults presenting with mood disorders
  • Develop differential diagnoses for adult patients with mood disorders
  • Develop appropriate treatment plans for adult patients with mood disorders
  • Advocate health promotion and patient education strategies for adult patients with mood disorders

Learning Resources

Required Readings (click to expand/reduce)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

  • Chapter 8, “Mood Disorders”

Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.

  • Chapter 11, “Mood Disorders”

Document: Focused SOAP Note Template

Document: Focused SOAP Note Exemplar

Required Media (click to expand/reduce)

CrashCourse. (2014, September 8). Depressive and bipolar disorders: Crash course psychology #30 [Video]. YouTube. https://youtu.be/ZwMlHkWKDwM https://www.youtube.com/watch?v=ZwMlHkWKDwM&t=1s

Walden University. (2021). Case study: Petunia Park. Walden University Blackboard. https://class.waldenu.eduAccessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

MEDICATION REVIEW

Review the FDA approved use of the following medicines related to treating mood disorders.

Depression Premenstrual dysphoric disorder Seasonal affective disorder (MDD with Seasonal Variation)
agomelatine
amitriptyline
amoxapine
aripiprazole
(adjunct)
brexpiprazole (adjunct)bupropion
citalopram
clomipramine
cyamemazine
desipramine
desvenlafaxine
dothiepindoxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
iloperidone
imipramine
isocarboxazid
ketamine
lithium (adjunct)
l-methylfolate (adjunct) 		 lofepramine
maprotiline
mianserin
milnacipran
mirtazapine
moclobemide
nefazodone
nortriptyline
paroxetine
phenelzine
protriptyline quetiapine (adjunct)
reboxetine
selegiline
sertindole
sertraline
sulpiride
tianeptine
tranylcypromine
trazodone
trimipramine
venlafaxine
vilazodone
vortioxetine		 citalopram
desvenlafaxine
duloxetin
eescitalopram
fluoxetin
eparoxetine
pepexev
sarafe,
sertraline
venlafaxine		 Bupropion HCL extended-release

 

Bipolar depression Bipolar disorder (mixed Mania/Depression Bipolar maintenance Mania
lithium (used with lurasidone)
lurasidone
olanzapine-fluoxetine combination (symbyax)
quetiapine
valproate (divalproex) (used with lurasidone)		 aripiprazole
asenapine
carbamazepine		 olanzapine
ziprasidone		 aripiprazole

lamotrigine
lithium
olanzapine

 aripiprazole
asenapine
carbamazepine
lithium
olanzapine
quetiapine
risperidonevalproate (divalproex)
ziprasidone

Assignment: Assessing, Diagnosing, and Treating Adults With Mood Disorders

Photo Credit: Monkey Business / Adobe Stock

It is important for the PMHNP to have a comprehensive understanding of mood disorders in order to assess and accurately formulate a diagnosis and treatment plan for patients presenting with these disorders. Mood disorders may be diagnosed when a patient’s emotional state meets the diagnostic criteria for severity, functional impact, and length of time. Those with a mood disorder may find that their emotions interfere with work, relationships, or other parts of their lives that impact daily functioning. Mood disorders may also lead to substance abuse or suicidal thoughts or behaviors, and although they are not likely to go away on their own, they can be managed with an effective treatment plan and understanding of how to manage symptoms.

In this Assignment you will assess, diagnose, and devise a treatment plan for a patient in a case study who is presenting with a mood disorder.

To Prepare

  • Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating mood disorders.
  • Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
  • Review the video, Case Study: Petunia Park. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.

The Assignment

Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomatology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
  • Objective: What observations did you make during the psychiatric assessment? 
  • Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
  • Reflection notes: What would you do differently with this client if you could conduct the session again? Discuss what your next intervention would be if you were able to follow up with this patient. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion, and disease prevention that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Requirements: use SOAP Examplar

NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template

Subjective:

CC (chief complaint):

HPI:

Substance Current Use:

Medical History:

  • Current Medications:
  • Allergies:
  • Reproductive Hx:

ROS:

  • GENERAL:
  • HEENT:
  • SKIN:
  • CARDIOVASCULAR:
  • RESPIRATORY:
  • GASTROINTESTINAL:
  • GENITOURINARY:
  • NEUROLOGICAL:
  • MUSCULOSKELETAL:
  • HEMATOLOGIC:
  • LYMPHATICS:
  • ENDOCRINOLOGIC:

Objective:

Diagnostic results:

Assessment:

Mental Status Examination:

Diagnostic Impression:

Reflections:

Case Formulation and Treatment Plan: 

 

References

 

By Day 7 of Week 4

Submit your Focused SOAP Note.

Submission Information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area ASSESSING, DIAGNOSING, AND TREATING ADULTS WITH MOOD DISORDERS Focused SOAP Note.

  1. To submit your completed assignment, save your Assignment as WK1Assgn+last name+first initial.(extension)” as the name.
  2.  Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
  3.  Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  4.  Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
  5.  If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  6.  Click on the Submit button to complete your submission

Grading Criteria

To access your rubric:

Week 4 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 4 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 4

To participate in this Assignment:

Week 4 Assignment

Petunia Park Case Study – NRNP 6665 Week 4 Assignment

Walden University Case Study: Petunia Park

Description

It is important for the PMHNP to have a comprehensive understanding of mood disorders in order to assess and accurately formulate a diagnosis and treatment plan for patients presenting with these disorders. Mood disorders may be diagnosed when a patient’s emotional state meets the diagnostic criteria for severity, functional impact, and length of time. Those with a mood disorder may find that their emotions interfere with work, relationships, or other parts of their lives that impact daily functioning. Mood disorders may also lead to substance abuse or suicidal thoughts or behaviors, and although they are not likely to go away on their own, they can be managed with an effective treatment plan and understanding of how to manage symptoms.

In this Assignment you will assess, diagnose, and devise a treatment plan for a patient in a case study who is presenting with a mood disorder.

  • Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating mood disorders.
  • Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
  • Review the video, Case Study: Petunia Park. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.
  • Consider patient diagnostics missing from the video: Provider Review outside of interview:Temp 98.2 Pulse 90 Respiration 18 B/P 138/88Laboratory Data Available: Urine drug and alcohol screen negative. CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)

Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomatology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
  • Objective: What observations did you make during the psychiatric assessment? 
  • Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
  • Reflection notes: Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion, and disease prevention that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

What’s Coming Up in Week 5?

Next week, you will explore mood and anxiety disorders in children and adolescents and the unique
approaches to assessment and treatment of these disorders in this population compared to treating
them in adults. In next week’s Assignment, you will prepare patient education materials for an assigned
disorder in which you will explain signs and symptoms, pharmacological and nonpharmacological
treatments, and community resources.

Midterm Exam

Photo Credit: [Vergeles_Andrey]/[iStock / Getty Images Plus]/Getty Images

You should also begin studying for your midterm exam, which is completed in Week 6. This will be a 100-
question, multiple-choice exam covering all topics in Week 1 through Week 6 of the course. The exams
in your MSN program are designed to test your knowledge in preparation for your certification exam and to simulate the certification exam environment. Accordingly, no outside resources, including books,
notes, websites, or any other type of resource, may be used to help you complete the exams in your
courses.

Next Week

To go to the next week:

Week 5

Learning Resources

Required Readings (click to expand/reduce)

Sadock, B. J., Sadock, V. A., &amp; Ruiz, P. (2015). Kaplan &amp; Sadock’s synopsis of psychiatry (11th ed.).
Wolters Kluwer.
 Chapter 8, “Mood Disorders”
Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
 Chapter 11, “Mood Disorders”

Document: Focused SOAP Note Template

Document: Focused SOAP Note Exemplar

Required Media (click to expand/reduce)

CrashCourse. (2014, September 8). Depressive and bipolar disorders: Crash course psychology #30
[Video]. YouTube. https://youtu.be/ZwMlHkWKDwM

Walden University. (2021). Case study: Petunia Park. Walden University Blackboard.
https://class.waldenu.edu
Accessible player
Medication Review
Review the FDA approved use of the following medicines related to treating mood disorders.

Week 5: Mood and Anxiety Disorders in Children and Adolescents

Patient Education for Children and Adolescents NRNP 6665 Week 5

Week 5: At A Glance

Mood and Anxiety Disorders In Children And Adolescents

Introduction

School and going out with my friends used to be fun, but not anymore. Mom keeps telling me just to go out and have fun, but I don’t see the point of trying. All my friends are better than I am. I keep having these headaches and just feel worthless. I used to get As and Bs in school, but not anymore. I can’t concentrate at school. I would rather be at home sleeping.

—Madison, age 16

Mood and anxiety disorders can be particularly challenging to address in childhood and adolescence for many reasons. Children may not be able to fully express or understand their feelings and behaviors. Parents may misattribute or not recognize signs and symptoms. The symptoms of disorders also vary when present in children as opposed to adults. The PMHNP needs to know how to diagnose these conditions and must understand the importance of integrating medication management strategies with both individual and family therapy to optimize treatment outcomes.

Learning Objectives

Students will:

  • Explain signs and symptoms of mood and anxiety disorders in children and adolescents
  • Explain the pathophysiology of mood and anxiety disorders in children and adolescents
  • Explain diagnosis and treatment methods for mood and anxiety disorders in children and adolescents
  • Develop patient education materials for mood and anxiety disorders in children and adolescents

Please choose one of these disorders below for week 5 Assignment depending on last name

Group 1. Last name starting with letter A through L

Anxiety Disorder
Disruptive Mood Dysregulation Disorder

Group 2. Last name starting with letter M through Z

Major Depressive Disorder
Bipolar Disorder
Disruptive Mood Dysregulation Disorder
Remember you have to research treatments for children/adolescents with these disorders. In regard to the community resources and referrals, do not just name them, but describe the services they provide.

Points to keep in mind:

You need a title page and a reference page. All assignments should follow APA guidelines. Please refer to your APA manual or the writing center at the university. Points will be deducted automatically for late submissions, unless received prior approval from the professor. Read your Turnitin report and revise your work if needed. Read the assignment instructions and the rubric carefully and ensure you all questions were answered before submitting.

Do not worry if you have more than 500 words.

PATIENT EDUCATION FOR CHILDREN AND ADOLESCENTS

Patient education is an effective tool in supporting compliance and treatment for a diagnosis. It is important to consider effective ways to educate patients and their families about a diagnosis—such as coaching, brochures, or videos—and to recognize that the efficacy of any materials may differ based on the needs and learning preferences of a particular patient. Because patients or their families may be overwhelmed with a new diagnosis, it is important that materials provided by the practitioner clearly outline the information that patients need to know.

For this Assignment, you will pretend that you are a contributing writer to a health blog. You are tasked with explaining important information about an assigned mental health disorder in language appropriate for child/adolescent patients and/or their caregivers.

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

To Prepare

  • By Day 1, your Instructor will assign a mood or anxiety disorder diagnosis for you to use for this Assignment.
  • Research signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.

The Assignment

In a 300- to 500-word blog post written for a patient and/or caregiver audience, explain signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.
Although you are not required to respond to colleagues, collegial discussion is welcome.

By Day 7 of Week 5

Submit your Assignment.

Submission Information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as WK5Assgn+last name+first initial.
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

Learning Resources

Required Readings

  • Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental healthLinks to an external site.. American Psychiatric Association Publishing.
    • Chapter 3, “Common Clinical Concerns”
    • Chapter 7, “A Brief Version of DSM-5″
    • Chapter 8, “A stepwise approach to Differential Diagnosis”
    • Chapter 10, “Selected DSM-5 Assessment Measures”
    • Chapter 11, “Rating Scales and Alternative Diagnostic Systems”Links to an external site.
  • Shoemaker, S. J., Wolf, M. S., & Brach, C. (2014). The patient education materials assessment tool (PEMAT) and user’s guideLinks to an external site.. Agency for Healthcare Research and Quality. https://www.ahrq.gov/sites/default/files/publications/files/pemat_guide.pdfLinks to an external site.
  • Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
    • Chapter 60, “Anxiety Disorders”
    • Chapter 61, “Obsessive Compulsive Disorder”
    • Chapter 62, “Bipolar Disorder in Childhood”
    • Chapter 63, “Depressive Disorders in Childhood and Adolescence”

Required Media

Medication  Review

Review the FDA-approved use of the following medicines related to treating mood and anxiety disorders in children and adolescents.

Bipolar depression Bipolar disorder
lurasidone (age 10–17)
olanzapine-fluoxetine combination (age 10–17)		 aripiprazole (age 10–17)
asenapine  (for mania or mixed episodes, age 10–17)
lithium (for mania, age 12–17)olanzapine (age 13–17)
quetiapine (age 10–17)
risperidone (age 10–17)

 

Generalized anxiety disorder Depression
duloxetine (age 7–17) escitalopram (age 12–17)
fluoxetine (age 8–17)

 

Obsessive-compulsive disorder
clomipramine (age 10–17)
fluoxetine (age 7–17)
fluvoxamine (age 8–17)
sertraline (age 6–17)

Depression in Children and Adolescents Sample Paper

Depression in children is multifactorial in origin. It results from interactions between both environmental factors and biological vulnerabilities. Heritability is the leading risk factor for mental illness.  The interaction between genes and environmental factors further contributes to this risk. Genes-environmental interaction increases the susceptibility to environmental stress.

Psychosocial factors can also increase the risk of developing depression, such as in the case of stressful life events which precede depressive symptoms in children and adolescents (Bremner et al., 2020). Cognitive factors can also contribute to the development of depression. Depressed children and adolescents have memory and attentional bias. These children tend to recall more negative words.

Also, children who underestimate their competence are more likely to have depressive symptoms. Children who have had depression before are also likely to underestimate their competence. Other factors that may contribute to the development of depression include substance and alcohol abuse, other mental illnesses, and comorbidities such as diabetes, epilepsy, and obesity.

The signs and symptoms of depression in children include pessimism and hopelessness about the future, a lack of interest in activities they previously enjoyed, feeling sad and irritable, criticism of themselves, difficulties in concentration in school, lack of energy, and problems with sleeping. Children may also experience symptoms such as stomach aches and headaches. There can be an increase or decrease in appetite. Weight changes can also be noticed, such as a remarkable weight gain or weight loss when not dieting. As Charles and Fazeli (2017) note, morbid thoughts may progress to suicidal ideations or suicide attempts.

Diagnosis of depression is made with the presence of at least five of the above symptoms with a change in function within 2 weeks. These symptoms should be accompanied by a depressed mood and should not be explained by another medical condition (Forman-Hoffman & Viswanathan, 2018).

Treatment of depression in children and adolescents targets recovery and returning to the premorbid level of functioning. Treatment involves the use of both pharmacological and nonpharmacological methods (Leichsenring et al., 2021).

Pharmacological methods involve the use of antidepressant medications. The most commonly used antidepressants are selective serotonin reuptake inhibitors (SSRIs). These drugs are fluoxetine, citalopram, sertraline, and escitalopram. Fluoxetine and escitalopram are FDA approved for the treatment of depression in children and adolescents (Leichsenring et al., 2021). Children on antidepressants should, however, be monitored for risk of suicide. This is one of the major side effects of antidepressants.

Nonpharmacological methods include the use of psychosocial interventions which involve both the children and the parents. Psychosocial interventions are used in the case of mild to moderate depression. It entails using psychoeducation, including education about illness, nutrition, and the importance of good sleep.

Patients should be encouraged to exercise for at least 30 minutes daily. Cognitive-behavioral therapy is also used to help patients identify cognitive distortions, learn problem-solving skills, and modify behaviors predisposing them to depressive symptoms (Oar et al., 2017). Interpersonal therapy is used to help individuals learn interpersonal problem-solving skills.

Parents should contact a healthcare provider if they observe changes in mood and functioning of the child. Mental health nurses and pediatricians should ensure they promote mental health and increase awareness to decrease the stigma associated with mental illness. Depression in children and adolescents is a treatable condition.

Treatment in an outpatient setting is recommended. Treatment should involve an interprofessional team comprising a mental health nurse, a pediatrician, a psychiatrist, a case manager, and a psychotherapist. In severe cases of depression, the management of patients in an inpatient setting is recommended (Leichsenring et al., 2021).

Patient Education for Children and Adolescents NRNP 6665 Week 5 References

Bremner, J. D., Moazzami, K., Wittbrodt, M. T., Nye, J. A., Lima, B. B., Gillespie, C. F., Rapaport, M. H., Pearce, B. D., Shah, A. J., & Vaccarino, V. (2020). Diet, Stress and Mental Health. Nutrients, 12(8), 2428. https://doi.org/10.3390/nu12082428

Charles, J., & Fazeli, M. (2017). Depression in children. Australian Family Physician, 46(12), 901–907.

Forman-Hoffman, V. L., & Viswanathan, M. (2018). Screening for Depression in Pediatric Primary Care. Current Psychiatry Reports, 20(8), 62. https://doi.org/10.1007/s11920-018-0926-7

Leichsenring, F., Luyten, P., Abbass, A., Rabung, S., & Steinert, C. (2021). Treatment of depression in children and adolescents. The Lancet. Psychiatry, 8(2), 96–97. https://doi.org/10.1016/S2215-0366(20)30492-2

Oar, E. L., Johnco, C., & Ollendick, T. H. (2017). Cognitive Behavioral Therapy for Anxiety and Depression in Children and Adolescents. The Psychiatric Clinics of North America, 40(4), 661–674. https://doi.org/10.1016/j.psc.2017.08.002

Patient Education for Children and Adolescents NRNP 6665 Week 5 Rubric

NRNP_6665_Week5_Assignment_Rubric

NRNP_6665_Week5_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning Outcome In a 300- to 500-word blog post written for a patient and/or caregiver audience: • Explain signs and symptoms for the assigned diagnosis in children and adolescents.

 

 
 

30 to >26.0 pts

Excellent

The response accurately and concisely explains signs and symptoms of the assigned diagnosis in language and tone that are engaging and appropriate for a patient/ caregiver audience.

  

26 to >23.0 pts

Good

The response accurately explains signs and symptoms of the assigned diagnosis in language and tone appropriate for a patient/ caregiver audience.

  

23 to >20.0 pts

Fair

The response somewhat vaguely or inaccurately explains signs and symptoms of the assigned diagnosis. Language and tone are mostly appropriate for a patient/ caregiver audience.

  

20 to >0 pts

Poor

The response vaguely or inaccurately explains signs and symptoms of the assigned diagnosis. Language and tone are not appropriate for a patient/ caregiver audience. Or the response is missing.
30 pts
This criterion is linked to a Learning Outcome· Explain pharmacological and nonpharmacological treatments for children and adolescents with the diagnosis.

 

 
 

30 to >26.0 pts

Excellent

The response accurately and concisely explains pharmacological and nonpharmacological treatments in language and tone that are engaging and appropriate for a patient/ caregiver audience.

  

26 to >23.0 pts

Good

The response accurately explains pharmacological and nonpharmacological treatments in language and tone that are appropriate for a patient/ caregiver audience.

  

23 to >20.0 pts

Fair

The response somewhat vaguely or inaccurately explains pharmacological and nonpharmacological treatments. Language and tone are mostly appropriate for a patient/caregiver audience.

  

20 to >0 pts

Poor

The response vaguely or inaccurately explains pharmacological and non pharmacological treatments. Language and tone are not appropriate for a patient/ caregiver audience. Or the response is missing.
30 pts
This criterion is linked to a Learning Outcome· Explain appropriate community resources and referrals for the assigned diagnosis.

 

 
 

25 to >22.0 pts

Excellent

The response accurately and concisely explains appropriate community resources and referrals for the assigned diagnosis in language and tone that are engaging and appropriate for a patient/ caregiver audience.

  

22 to >19.0 pts

Good

The response accurately explains appropriate community resources and referrals for the assigned diagnosis in language and tone that are appropriate for a patient/ caregiver audience.

  

19 to >17.0 pts

Fair

The response somewhat vaguely or inaccurately explains community resources and referrals for the assigned diagnosis. Language and tone are mostly appropriate for a patient/ caregiver audience.

  

17 to >0 pts

Poor

The response vaguely or inaccurately explains community resources and referrals for the assigned diagnosis. Language and tone are not appropriate for a patient/ caregiver audience. Or the response is missing.
25 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

 

 
 

5 to >4.0 pts

Excellent

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

  

4 to >3.5 pts

Good

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

  

3.5 to >3.0 pts

Fair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

  

3 to >0 pts

Poor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time. No purpose statement, introduction, or conclusion were provided.
5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation

 

 
 

5 to >4.0 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors

  

4 to >3.5 pts

Good

Contains one or two grammar, spelling, and punctuation errors

  

3.5 to >3.0 pts

Fair

Contains several (three or four) grammar, spelling, and punctuation errors

  

3 to >0 pts

Poor

Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/narrative in-text citations, and reference list.

 

 
 

5 to >4.0 pts

Excellent

Uses correct APA format with no errors

  

4 to >3.5 pts

Good

Contains one or two APA format errors

  

3.5 to >3.0 pts

Fair

Contains several (three or four) APA format errors

  

3 to >0 pts

Poor

Contains many (five or more) APA format errors
5 pts
Total Points: 100

NRNP 6665 Week 8 Assignment: Study Guide Forum

Week 8: Create a Study Guide : My Assigned Topic is: TIC DISORDERS

Description

My Assigned topic is : TIC DISORDERS

-Create a study guide, in outline form with references, for your assigned disorder. Incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcard

Content areas of importance you should address, but are not limited to, are:

• Signs and symptoms according to the DSM-5

• Differential diagnoses

• Incidence

• Development and course

• Prognosis

• Considerations related to culture, gender, age

• Pharmacological treatments, including any side effects

• Nonpharmacological treatments

• Diagnostics and labs

• Comorbidities

• Legal and ethical considerations

• Pertinent patient education considerations

 .
Support your guide with references to the DSM-5 and at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines. Be sure they are current (no more than 5 years old).

Week 8 Assignment: Neurodevelopmental Disorders

This week, during Week 8, you will begin exploring disorders that occur early in the life course and use this knowledge to create a study guide for a neurodevelopmental disorder. You will be assigned a specific disorder for you to research for this Assignment. See assigned topic below: Also review assignment instruction under Week 8 Tab.

To Prepare

  • Your Instructor will assign you to a specific neurodevelopmental disorder from the DSM-5.
  • Research your assigned disorder using the Walden Library. Then, develop an organizational scheme for the important information about the disorder.

The Assignment

  • Create a study guide for your assigned disorder. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the DSM-5 but also supported by at least three other scholarly resources.

Areas of importance you should address, but are not limited to, are:

  • Signs and symptoms according to the DSM-5
  • Differential diagnoses
  • Incidence
  • Development and course
  • Prognosis
  • Considerations related to culture, gender, age
  • Pharmacological treatments, including any side effects
  • Nonpharmacological treatments
  • Diagnostics and labs
  • Comorbidities
  • Legal and ethical considerations
  • Pertinent patient education considerations

Assignment: Study Guide Forum

Abnormal brain development or damage at an early age can lead to neurodevelopmental disorders. Within this group of disorders, some are resolvable with appropriate and timely interventions, either pharmacological or nonpharmacological, while other disorders are chronic and need to be managed throughout the lifespan.

For this Assignment, you will develop a study guide for an assigned disorder and share it with your colleagues. In sum, these study guides will be a powerful tool in preparing for your certification exam.

Photo Credit: Getty Images/iStockphoto

TO PREPARE

  • Your Instructor will assign you to a specific neurodevelopmental disorder from the DSM-5.
  • Research your assigned disorder using the Walden Library. Then, develop an organizational scheme for the important information about the disorder.

THE ASSIGNMENT

Create a study guide for your assigned disorder. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the DSM-5 but also supported by at least three other scholarly resources.

Areas of importance you should address, but are not limited to, are:

  • Signs and symptoms according to the DSM-5
  • Differential diagnoses
  • Incidence
  • Development and course
  • Prognosis
  • Considerations related to culture, gender, age
  • Pharmacological treatments, including any side effects
  • Nonpharmacological treatments
  • Diagnostics and labs
  • Comorbidities
  • Legal and ethical considerations
  • Pertinent patient education considerations

Learning Resources

Required Readings (click to expand/reduce)

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

  • Chapter 51, “Autism Spectrum Disorder”
  • Chapter 55, “ADHD and Hyperkinetic Disorder”

Utah State University. (n.d.). Creating study guides. https://www.usu.edu/academic-support/test/creating…

Walden University. (2020). Success strategies: Self-paced interactive tutorials. https://academicguides.waldenu.edu/academic-skills…

Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.

  • Chapter 13, “Child/Adolescent Neurodevelopmental Disorders”

Required Media (click to expand/reduce)

Dillon, K. (2019, March 23). DSM-5 neurodevelopmental disorders. [Video]. YouTube. https://www.youtube.com/watch?v=Ydr9s_UwACo

The National Center for Learning Disabilities. (2013, February 20). What is ADHD? [Video]. YouTube. 

Osmosis. (2017, October 17). Autism – causes, symptoms, diagnosis, treatment, pathology [Video]. YouTube. 

NRNP 6665 Week 9 Assignment: Controversy Associated with Dissociative Disorders

Week 9: Assignment: Controversy Associated with Dissociative Disorders

Have you ever been driving and realized you don’t remember the last few minutes of driving? Or have you gotten so wrapped up in a book or movie that you lose some awareness of your surroundings? These are examples of common and very mild dissociation, or a disconnect or lack of continuity between thoughts, feelings, actions, and sense of self.

There are three major dissociative disorders defined in the  DSM-5-TR:

    1. Dissociative identity disorder,
    2. dissociative amnesia, and
    3. depersonalization-derealization disorder.

Dissociative disorders may be associated with traumatic events in order to help manage difficult memories or experiences. Patients with these types of disorders are likely to also exhibit symptoms of a variety of other dysfunctions, such as depression, alcoholism, or self-harm and may also be more susceptible to personality, sleeping, and eating disorders.

This week, you will analyze issues related to the diagnosis and treatment of dissociative disorders as well as associated legal and ethical considerations.

The  DSM-5-TR is a diagnostic tool. It has evolved over the decades, as have the classifications and criteria within its pages. It is used not just for diagnosis, however, but also for billing, access to services, and legal cases. Not all practitioners are in agreement with the content and structure of the  DSM-5-TR, and dissociative disorders are one such area. These disorders can be difficult to distinguish and diagnose. There is also controversy in the field over the legitimacy of certain dissociative disorders, such as dissociative identity disorder, which was formerly called multiple personality disorder.

In this Assignment, you will examine the controversy surrounding dissociative disorders. You will also explore clinical, ethical, and legal considerations pertinent to working with patients with these disorders.

To Prepare

  • Review this week’s Learning Resources on dissociative disorders.
  • Use the Walden Library to investigate the controversy regarding dissociative disorders. Locate at least three scholarly articles that you can use to support your Assignment.

The Assignment Instructions (2–3 Pages)

  • Explain the controversy that surrounds dissociative disorders.
  • Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.
  • Explain strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.
  • Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important.
  • APA 7
  • At least four scholarly references

BY DAY 7 OF WEEK 9

Submit your Assignment

SUBMISSION INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as WK9Assgn+last name+first initial.
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

https://youtu.be/XF2zeOdE5GY

https://youtu.be/Iz03M9pwhs0

https://www.youtube.com/watch?v=zqTP0CP9aDk

image1.png

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Rubric

NRNP_6665_Week9_Assignment_Rubric

NRNP_6665_Week9_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeIn 2–3 pages, address the following:• Explain the controversy that surrounds dissociative disorders.
15 to >13.0 pts

Excellent

The response includes an accurate and concise explanation of the controversy within the field related to dissociative disorders.

 13 to >11.0 pts

Good

The response includes an accurate explanation of the controversy within the field related to dissociative disorders.

 11 to >10.0 pts

Fair

The response includes a somewhat vague or inaccurate explanation of the controversy within the field related to dissociative disorders.

 10 to >0 pts

Poor

The response includes a vague or inaccurate explanation of the controversy within the field related to dissociative disorders. Or the response is missing.
15 pts
This criterion is linked to a Learning Outcome• Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.
25 to >22.0 pts

Excellent

The response includes a thorough and well-organized explanation of the student’s professional beliefs about dissociative disorders. Rationale demonstrates critical thinking and is strongly supported with three scholarly references.

 22 to >19.0 pts

Good

The response includes a well-organized explanation of the student’s professional beliefs about dissociative disorders. Rationale is clear and appropriately supported with three scholarly references.

 19 to >17.0 pts

Fair

The response includes a somewhat vague explanation of the student’s professional beliefs about dissociative disorders. Rationale is somewhat unclear and references either provide weak support for the rationale or are not scholarly/current.

 17 to >0 pts

Poor

The response includes a vague explanation of the student’s professional beliefs about dissociative disorders. Rationale is unclear and references are inappropriate. Or the response is missing.
25 pts
This criterion is linked to a Learning Outcome• Explain strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.
30 to >26.0 pts

Excellent

The response includes an accurate and concise explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.

 26 to >23.0 pts

Good

The response includes an accurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.

 23 to >20.0 pts

Fair

The response includes a somewhat vague or incomplete explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.

 20 to >0 pts

Poor

The response includes a vague or inaccurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder. Or the response is missing.
30 pts
This criterion is linked to a Learning Outcome• Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important.
15 to >13.0 pts

Excellent

The response includes an accurate and concise explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important.

 13 to >11.0 pts

Good

The response includes an accurate explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important.

 11 to >10.0 pts

Fair

The response includes a somewhat vague or incomplete explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important.

 10 to >0 pts

Poor

The response includes a vague and inaccurate explanation of ethical and legal considerations related to dissociative disorders that are important to clinical practice and why they are important. Or, response is missing.
15 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 to >4.0 pts

Excellent

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

 4 to >3.5 pts

Good

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

 3.5 to >3.0 pts

Fair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

 3 to >0 pts

Poor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5 to >4.0 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors

 4 to >3.5 pts

Good

Contains one or two grammar, spelling, and punctuation errors

 3.5 to >3.0 pts

Fair

Contains three or four grammar, spelling, and punctuation errors

 3 to >0 pts

Poor

Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
5 to >4.0 pts

Excellent

Uses correct APA format with no errors

 4 to >3.5 pts

Good

Contains one or two APA format errors

 3.5 to >3.0 pts

Fair

Contains three or four APA format errors

 3 to >0 pts

Poor

Contains many (five or more) APA format errors
5 pts
Total Points: 100

LEARNING RESOURCES

Required Readings

  • Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
    • Chapter 11, “Dissociative Disorders”

Required Media

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NRNP 6540 Psychosocial Disorders Assessing Diagnosing and Treating Dementia Delirium and Depression Assignment Example

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NRNP 6540 Psychosocial Disorders Assessing Diagnosing and Treating Dementia Delirium and Depression Assignment Example

NRNP 6540 Psychosocial Disorders Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression AssignmentNRNP 6540 Psychosocial Disorders Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression Assignment

NRNP 6540 Psychosocial Disorders Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression Assignment Brief

Course: NRNP 6540 – Advanced Practice Care of Older Adults

Assignment Title: NRNP 6540 Psychosocial Disorders Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression Assignment

Assignment Instructions Overview

This assignment focuses on assessing, diagnosing, and treating dementia, delirium, and depression in geriatric patients. It requires completion of a SOAP (subjective, objective, assessment, and plan) note based on a provided case study.

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Understanding Assignment Objectives

You will evaluate a geriatric patient presenting with symptoms of dementia, delirium, or depression, develop differential diagnoses, and create treatment plans inclusive of diagnostic testing and therapeutic interventions.

The Student’s Role

As an advanced practice nurse, your role involves accurately documenting patient history, conducting thorough physical assessments, and interpreting diagnostic results to formulate effective treatment plans.

Competencies Measured

This assignment assesses your ability to:

  • Evaluate geriatric patients for psychosocial disorders.
  • Develop differential diagnoses based on clinical findings.
  • Design comprehensive treatment plans aligned with evidence-based guidelines.
  • Demonstrate effective communication skills through documentation.

You Can Also Check Other Related Assessments for the NRNP 6540 – Advanced Practice Care of Older Adults Course:

NRNP 6540 Assessment of Older Adults Evaluation Plan Discussion Example

NRNP 6540 Psychosocial Disorders Assessing Diagnosing and Treating Dementia Delirium and Depression Assignment Example

NRNP 6540 Assessing Cardiovascular and Pulmonary Disorders Assignment Example

NRNP 6540 Assessing Diagnosing and Treating Abdominal Urological and Gynecological Disorders Assignment Example

NRNP 6540 Assessing Diagnosing and Treating Hematological and Immune System Disorders Assignment Example

NRNP 6540 Psychosocial Disorders Assessing Diagnosing and Treating Dementia Delirium and Depression Assignment Example

Patient Information:

Ms. P, 70-year-old female, Caucasian

Subjective:

Chief Complaint (CC):

Increased confusion, agitation, and restlessness.

History of Present Illness (HPI):

Ms. P is a 70-year-old female with a known history of dementia, managed with Aricept (Donepezil) 10 mg daily. She presented with acute confusion, more than usual, and increased agitation and restlessness over the past two days. Two days ago, she became more disoriented and yesterday, she could not remember where she was in her own home. Her son, Jared, reports these changes began after her HCTZ dosage was increased to 50 mg three days ago. No falls, traumas, changes in diet or routine, dysuria, fever, nausea, or vomiting reported. Last MMSE score was 18/30, which remained unchanged today.

Current Medications:

  • Multivitamin daily
  • Losartan 50 mg daily
  • HCTZ 50 mg daily (recently increased)
  • Fish Oil 1 tablet daily
  • Glyburide 5 mg daily
  • Metformin 500 mg BID
  • Donepezil 10 mg daily
  • Alendronate 70 mg orally once a week

Allergies:

  • Atorvastatin (angioedema)

Past Medical History (PMHx):

  • Hypertension
  • Diabetes
  • Osteoporosis
  • Chronic allergic rhinitis

Review of Systems (ROS):

  • General: No weight loss, fever, chills, weakness, or fatigue.
  • Head: No headache or trauma.
  • Eyes: No visual loss, blurred vision, or double vision.
  • Ears, Nose, Throat (ENT): No hearing loss, sneezing, congestion, or sore throat.
  • Cardiovascular: No chest pain, pressure, discomfort, or palpitations.
  • Respiratory: No shortness of breath, cough, or sputum.
  • Gastrointestinal: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood in stool.
  • Genitourinary: No dysuria. LMP: N/A.
  • Neurological: Increased confusion and agitation. No dizziness, syncope, paralysis, or ataxia.
  • Musculoskeletal: No muscle pain or joint stiffness. Some balance issues but no falls.
  • Psychiatric: No history of depression or anxiety. No suicidal ideation.
  • Endocrinologic: No sweating, cold or heat intolerance. No polyuria or polydipsia.
  • Reproductive: Not pregnant, not sexually active.
  • Allergies: No history of asthma, hives, eczema, or rhinitis.

Objective:

Vital Signs:

  • Temperature: 98.1°F
  • Blood Pressure: 120/64 mmHg
  • Heart Rate: 72 bpm
  • Respiratory Rate: 20 bpm

Physical Exam:

  • General: Alert but easily distracted.
  • Head: Normocephalic, atraumatic.
  • Eyes: PERRLA (pupils equal, round, reactive to light and accommodation), no nystagmus.
  • ENT: Oral mucosa moist, no lesions.
  • Neck: Supple, no lymphadenopathy.
  • Cardiovascular: Regular rate and rhythm, no murmurs or gallops.
  • Respiratory: Clear to auscultation bilaterally.
  • Abdomen: Soft, non-tender, no hepatosplenomegaly.
  • Musculoskeletal: No joint swelling or deformities. Balance issues noted.
  • Neurological: Alert but disoriented to place and time, speech clear but tangential.
  • Psychiatric: No visual or auditory hallucinations, denies suicidal ideation.

Diagnostic Results:

  • CXR: No cardiopulmonary findings. WNL.
  • CT Head: Diffuse cerebral atrophy.
  • MMSE: 18/30, indicating moderate dementia.
  • Hemoglobin A1C: 7.2%
  • Basic Metabolic Panel:
    • Glucose: 90 mg/dL
    • Sodium: 130 mmol/L (low)
    • Potassium: 3.4 mmol/L (low)
    • Chloride: 104 mmol/L
    • CO2: 29 mmol/L
    • Calcium: 9.0 mg/dL
    • BUN: 20 mg/dL
    • Creatinine: 1.00 mg/dL
    • eGFR: 77 mL/min/1.73m2

Assessment:

Primary Diagnosis:

  1. Delirium – Acute onset of confusion, agitation, and restlessness in a patient with baseline dementia, likely precipitated by a medication change (increased HCTZ).

Differential Diagnoses:

  1. Worsening Dementia – Progressive confusion and disorientation typical of dementia; however, acute exacerbation suggests an additional factor.
  2. Electrolyte Imbalance (Hyponatremia and Hypokalemia) – Low sodium and potassium levels could contribute to confusion and agitation.

Plan:

Diagnostics:

  • Repeat electrolytes in 48 hours to monitor for further changes.
  • Consider urinalysis to rule out UTI, which could exacerbate confusion.

Medications:

  • Review and potentially adjust HCTZ dosage considering recent increase and onset of symptoms.
  • Consider switching HCTZ to an alternative antihypertensive not listed on the Beers Criteria for elderly patients.

Therapeutic Interventions:

  • Hydration to correct potential dehydration contributing to electrolyte imbalance.
  • Cognitive stimulation activities tailored to dementia patients.

Referrals:

  • Referral to a neurologist for further evaluation of dementia progression.
  • Referral to a dietitian to assess and manage nutritional needs impacting blood glucose and electrolytes.

Education:

  • Educate son on signs of delirium versus dementia exacerbation and importance of medication adherence and monitoring.

Follow-Up:

  • Follow-up visit in one week to reassess symptoms and evaluate lab results.
  • Immediate follow-up if symptoms worsen.

Health Promotion and Disease Prevention:

  • Encourage a balanced diet to manage diabetes and blood pressure.
  • Regular physical activity to improve balance and overall health.
  • Ensure home safety modifications to prevent falls.

Reflection:

This case highlights the importance of monitoring medication changes and their impact on elderly patients, particularly those with dementia. The overlap of symptoms between dementia, delirium, and other medical conditions necessitates a comprehensive and multidisciplinary approach to patient care.

References

American Geriatrics Society. (2019). Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society, 67(4), 674-694.

Inouye, S. K., Westendorp, R. G. J., & Saczynski, J. S. (2014). Delirium in elderly people. Lancet, 383(9920), 911-922.

Marcum, Z. A., & Hanlon, J. T. (2012). Commentary on the New American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The American Journal of Geriatric Pharmacotherapy, 10(2), 151-159.

Detailed Assessment Instructions for the NRNP 6540 Psychosocial Disorders Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression Assignment

Week 2: Psychosocial Disorders

In so many countries, to be old is shameful; to be mentally ill as well as old is doubly shameful. In so many countries, people with elderly relatives who are also mentally ill are ashamed and try to hide what they see as a disgrace on the family.

—Dr. Nori Graham, Psychiatrist and Honorary Vice President of Alzheimer’s Disease International

In this quote, Dr. Graham is expressing her observations and experiences in her work with numerous international organizations. Many patients and their families experience feelings of anxiety and shame upon receiving a diagnosis of dementia, delirium, or depression. Among caregivers, 36% report having tried to hide the dementia diagnosis of their family member (Alzheimer’s Disease International, 2019). As an advanced practice nurse providing care to patients presenting with dementia, delirium, and depression, it is critically important to consider the impact of these disorders on patients, caregivers, and their families. A thorough understanding of the health implications of these disorders, as well as each patient’s personal concerns, will aid you in making effective treatment and management decisions.

This week, you explore geriatric patient presentations of dementia, delirium, and depression. You also examine assessment, diagnosis, and treatment for these disorders and complete a SOAP (subjective, objective, assessment, and plan) note.

Reference:
Alzheimer’s Disease International. (2019). World Alzheimer report 2019: Attitudes to dementia. Author. https://www.alz.co.uk/research/world-report-2019

Learning Objectives

Students will:

  • Evaluate patients presenting with symptoms of dementia, delirium, or depression
  • Develop differential diagnoses for patients with psychosocial disorders
  • Develop appropriate treatment plans, including diagnostics and laboratory orders, for patients with psychosocial disorders 

Assignment: Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression

Photo Credit: Getty Images

With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as an advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care. 

To prepare:

  • Review the case study provided by your Instructor. Reflect on the way the patient presented in the case, including whether the patient might be presenting with dementia, delirium, or depression.
  • Reflect on the patient’s symptoms and aspects of disorders that may be present. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?
  • Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
  • Access the Focused SOAP Note Template in this week’s Resources.

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? How would you interpret and address the results of the Mini-Mental State Examination (MMSE)?
  • 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 healthcare 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. 

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

By Day 7

Learning Resources

 

Rubric Detail Tutor needs to FOLLOW

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

Name: NRNP_6540_Week2_Assignment_Rubric

 

  Excellent Fair Poor
Create documentation in the Focused SOAP Note Template about the patient in the case study to which you were assigned.

In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Current medications, checked against Beers Criteria
• Allergies
• Patient medical history (PMHx)
• Review of systems

 9 (9%) – 10 (10%)

The response throughly and accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

 7 (7%) – 7 (7%)

The response describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. A cross-check of medications against the Beers Criteria has been completed but alternatives may be missing.

 0 (0%) – 6 (6%)

The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has not been completed. Or, subjective documentation is missing.
In the Objective section, provide:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses		 9 (9%) – 10 (10%)

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

 7 (7%) – 7 (7%)

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

 0 (0%) – 6 (6%)

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
In the Assessment section, provide:
• At least three (3) differentials with supporting evidence. Explain what rules each differential in or out, and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.		 23 (23%) – 25 (25%)

The response lists in order of priority at least three distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the conditions selected.

 18 (18%) – 19 (19%)

The response lists three possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.

 0 (0%) – 17 (17%)

The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.
In the Plan section, provide:
• A detailed treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits.
• A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors.
• Reflections on the case describing insights or lessons learned.		 27 (27%) – 30 (30%)

The response thoroughly and accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. A thorough and accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate strong critical thinking and synthesis of ideas.

 21 (21%) – 23 (23%)

The response somewhat vaguely or inaccurately outlines a treatment plan for the patient. The discussion on health promotion and disease prevention related to the case is somewhat vague or contains innaccuracies. Reflections on the case demonstrate adequate understanding of course topics.

 0 (0%) – 20 (20%)

The response does not address all diagnoses or is missing elements of the treatment plan. The discussion on health promotion and disease prevention related to the case is vague, innaccurate, or missing. Reflections on the case are vague or missing.
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. 9 (9%) – 10 (10%)

The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents the latest in standards of care and provides strong justification for treatment decisions.

 . 7 (7%) – 7 (7%)

Three evidence-based resources are provided to support treatment decisions, but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan.

 0 (0%) – 6 (6%)

Two or fewer resources are provided to support treatment decisions. The resources may not be current or evidence-based, or do not support the treatment plan.
Written Expression and Formatting—Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.		 5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

 3 (3%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

 0 (0%) – 2 (2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and proper punctuation		 5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

 3 (3%) – 3 (3%)

Contains several (three or four) grammar, spelling, and punctuation errors.

 0 (0%) – 2 (2%)

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

 3 (3%) – 3 (3%)

Contains several (three or four) APA format errors.

 0 (0%) – 2 (2%)

Contains many (≥ five) APA format errors.
Total Points: 100

Name: NRNP_6540_Week2_Assignment_Rubric

 

Week 2: Psychosocial CASE SCENARIO

Week 2 Case 1: Dementia

HPI: Ms. Peters is a 70-year-old female who is brought to your office by her son with reports of acute confusion (more than usual) and some agitation and restlessness. She has a known history of dementia, managed with Aricept 10 mg. daily. Her son, Jared, reports that 2 days ago she began to become more confused than usual and very easily agitated. He reports that yesterday, she couldn’t remember where she was in her own home. She had a doctor’s appointment 3 days ago and her HCTZ (hydrochlorothiazide) was increased to 50 mg. due to increased bp’s.

Ms. Peter’s last Mini-Mental State Exam (MMSE) score was 18/30. The assessment was repeated, and the score remained unchanged.

Ms. Peters and her son denies her having any falls or contributing traumas recently. She denies any changes in diet or routine regimens. No reported dysuria, no fever, nausea, or vomiting.

Note: Be sure to review the MMSE and how to interpret results (Mental State Assessment Tests). Make sure you document the patient’s score in your SOAP note document. Also review the Geriatric Depression Assessment (Geriatric Depression Scale [GDS]).

Ms. Peters is a 70-year-old female who is alert but easily distracted, at times, during today’s clinical interview. Her eye contact is fair. Speech is clear and coherent but tangential at times. She makes no unusual motor movements and demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She is alert but disoriented to place and time. She denies any falls, denies any pain. Her son does say she has had some “stumbling” and balance issues but no reported falls.

All other Review of System and Physical Exam findings are negative other than stated.

Vital Signs: 98.1 120/64 HR-72 20

PMH: Hypertension, Diabetes, Osteoporosis, Chronic Allergic Rhinitis

Allergies: Atorvastatin

Medications:

  • Multivitamin daily
  • Losartan 50mg daily
  • HCTZ 50mg daily
  • Fish Oil 1 tablet daily
  • Glyburide 5mg daily
  • Metformin 500mg BID
  • Donepezil 10mg daily
  • Alendronate 70mg orally once a week

Social History: As stated in Case Study

ROS: As stated in Case study

Diagnostics/Assessments done:

  1. CXR—no cardiopulmonary findings. WNL
  2. CT head—diffuse Cerebral Atrophy
  3. MMSE—Ms. Peters scored 18 out of 30 with primary deficits in orientation, registration, attention and calculation, and recall at a previous visit. At today’s visit, there is no change. The score suggests moderate dementia.
  4. Hemoglobin A1C7.2%
  5. Basic Metabolic Panel as shown below
TEST RESULT REFERENCE RANGE
GLUCOSE 90 65–99
SODIUM 130 135–146
POTASSIUM 3.4 3.5–5.3
CHLORIDE 104 98–110
CARBON DIOXIDE 29 19–30
CALCIUM 9.0 8.6–10.3
BUN 20 7–25
CREATININE 1.00 0.70–1.25
GLOMERULAR FILTRATION RATE (eGFR) 77 >or=60 mL/min/1.73m2

Focused SOAP Note Template

Patient Information:

Initials, Age, Sex, Race

S (subjective)

CC (chief complaint): a BRIEF statement identifying why the patient is here, stated in the patient’s own words (for instance “headache,” NOT “bad headache for 3 days”).

HPI (history of present illness): This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:

  • Location: Head
  • Onset: 3 days ago
  • Character: Pounding, pressure around the eyes and temples
  • Associated signs and symptoms: Nausea, vomiting, photophobia, phonophobia
  • Timing: After being on the computer all day at work
  • Exacerbating/relieving factors: Light bothers eyes; Aleve makes it tolerable but not completely better
  • Severity: 7/10 pain scale

Current Medications: Include dosage, frequency, length of time used, and reason for use; also include over the counter (OTC) or homeopathic products.

Allergies: Include medication, food, and environmental allergies separately, including a description of what the allergy is (i.e., angioedema, anaphylaxis, etc.). This will help determine a true reaction versus intolerance.

PMHx: Include immunization status (note date of last tetanus for all adults), past major illnesses, and surgeries. Depending on the CC, more info is sometimes needed.

Soc and Substance Hx: Include occupation and major hobbies, family status, tobacco and alcohol use (previous and current use), and any other pertinent data. Always add some health promo question here, such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

Fam Hx: Illnesses with possible genetic predisposition, contagious, or chronic illnesses. Reason for death of any deceased first-degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

Surgical Hx: Prior surgical procedures.

Mental Hx: Diagnosis and treatment. Current concerns (anxiety and/or depression). History of self-harm practices and/or suicidal or homicidal ideation.

Violence Hx: Concern or issues about safety (personal, home, community, sexual (current and historical).

Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse (oral, anal, vaginal, other, any sexual concerns).

ROS (review of symptoms): Cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows:

  • General:
  • Head:
  • EENT (eyes, ears, nose, and throat):
  • Etc.:

Note: You should list these in bullet format, and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT:

  • Eyes: No visual loss, blurred vision, double vision or yellow sclerae.
  • Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination. Last menstrual period (LMP), MM/DD/YYYY.

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC: No anemia, bleeding or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

REPRODUCTIVE: Not pregnant and no recent pregnancy. No reports of vaginal or penile discharge. Not sexually active.

ALLERGIES: No history of asthma, hives, eczema or rhinitis.

O (objective)

Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format (i.e., General: Head: EENT: etc.).

Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

A (assessment)

Differential diagnoses: List a minimum of three differential diagnoses. Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence-based guidelines.

P (plan)

Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner.

Also included in this section is the reflection. Reflect on this case, and discuss what you learned, including any “aha” moments or connections you made.

Also include in your reflection, a discussion related to health promotion and disease prevention taking into consideration patient factors (such as, age, ethnic group, etc.), PMH, and other risk factors (e.g., socio-economic, cultural background, etc.).

References

You are required to include 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 to use correct APA 7th edition formatting.

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NRNP 6540 Assessment of Older Adults Evaluation Plan Discussion Example

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NRNP 6540 Assessment of Older Adults Evaluation Plan Discussion Example

NRNP 6540 Assessment of Older Adults Evaluation Plan Discussion AssignmentNRNP 6540 Assessment of Older Adults Evaluation Plan Discussion Assignment

NRNP 6540 Assessment of Older Adults Evaluation Plan Discussion Assignment Brief

Course: NRNP 6540 – Advanced Practice Care of Older Adults

Assignment Title: NRNP 6540 Assessment of Older Adults Evaluation Plan Discussion Assignment

Assignment Instructions Overview

This assignment involves creating an evaluation plan for an elderly patient based on a case study provided by the instructor. The focus is on assessing the patient’s health and functional ability to determine if their needs are being met. Students are required to use comprehensive geriatric assessments to identify age-related changes that may interfere with the patient’s functional status.

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Understanding Assignment Objectives

The primary objective of this assignment is to develop a detailed evaluation plan for an elderly patient. Students must:

  • Assess the patient’s health and functional stability.
  • Identify appropriate assessment tools to evaluate wellness and functional ability.
  • Consider factors such as the setting of the evaluation, involvement of other professionals or family members, and potential challenges like language barriers or cognitive impairment.
  • Determine immunization requirements relevant to the patient’s health promotion and disease prevention.

The Student’s Role

Students will assume the role of a nurse practitioner responsible for evaluating the health and functional status of an elderly patient. This involves:

  • Reviewing the provided case study thoroughly.
  • Developing an evaluation plan that includes specific assessment tools.
  • Justifying the choice of assessment tools and considering their validation for the patient population.
  • Addressing potential issues during the assessment, such as cognitive impairment or sensory deprivation.
  • Recommending necessary immunizations for health promotion and disease prevention.

Competencies Measured

This assignment measures several key competencies essential for advanced practice nurse practitioners, including:

  • Clinical reasoning and decision-making skills.
  • Ability to conduct comprehensive geriatric assessments.
  • Proficiency in using validated assessment tools for elderly patients.
  • Understanding of immunization requirements for older adults.
  • Communication skills, particularly in explaining the evaluation plan and addressing potential challenges.

You Can Also Check Other Related Assessments for the NRNP 6540 – Advanced Practice Care of Older Adults Course:

NRNP 6540 Assessment of Older Adults Evaluation Plan Discussion Example

NRNP 6540 Psychosocial Disorders Assessing Diagnosing and Treating Dementia Delirium and Depression Assignment Example

NRNP 6540 Assessing Cardiovascular and Pulmonary Disorders Assignment Example

NRNP 6540 Assessing Diagnosing and Treating Abdominal Urological and Gynecological Disorders Assignment Example

NRNP 6540 Assessing Diagnosing and Treating Hematological and Immune System Disorders Assignment Example

NRNP 6540 Assessment of Older Adults Evaluation Plan Discussion Example

As individuals age, they are more likely to develop various chronic health conditions that can significantly impact their quality of life. Advanced practice nurse practitioners (APNPs) frequently interact with elderly patients, and it is crucial to evaluate and address these conditions to maintain the patients’ functional ability. Common age-related health issues include obstructive sleep apnea (OSA), hypertension, chronic anemia, restless leg syndrome, osteoporosis, and cognitive impairment. Comprehensive assessments are essential to identify and manage these conditions effectively.

Case Study Overview

Mr. Raymond Young, a 92-year-old retired college professor, presents a case that exemplifies the complexity of caring for elderly patients. Despite his advanced age and several chronic health issues, Mr. Young is able to perform all basic activities of daily living independently. His medical history includes obstructive sleep apnea, hypertension managed with lifestyle modifications, mild chronic anemia, restless leg syndrome, and osteoporosis. He has also experienced falls and has reported instances of getting lost while driving to familiar locations. These issues suggest potential underlying problems related to immobility, sensory deprivation, and cognitive dysfunction that require thorough evaluation.

Evaluation Plan

Developing an evaluation plan for Mr. Young involves several critical steps. First, the assessment should be conducted in a setting that ensures the patient’s comfort and safety, such as his home or a familiar clinical environment. Involving family members, particularly his wife, in the evaluation process can provide additional insights into his daily functioning and any changes observed over time. Collaboration with other healthcare professionals, including a geriatrician, neurologist, and physical therapist, may also be necessary to provide a comprehensive evaluation.

Assessment Tools

Several assessment tools are appropriate for evaluating Mr. Young’s cognitive function, mobility, and overall health status. The Mini-Mental State Examination (MMSE) is a widely used tool for assessing cognitive function in older adults. It evaluates attention, orientation, memory, registration, recall, calculation, language, and visuospatial skills through a series of 30 questions (Arevalo-Rodriguez et al., 2021). Given Mr. Young’s history of cognitive impairment, the MMSE is suitable for monitoring any progression of cognitive decline. However, it is important to note that while the MMSE is validated for use in older adults, it may have limitations in patients with varying educational backgrounds or language barriers (Arevalo-Rodriguez et al., 2021).

The Comprehensive Geriatric Assessment (CGA) is another essential tool, incorporating multiple scales to evaluate various aspects of an elderly patient’s health. This multidisciplinary instrument includes the Berg Balance Scale to assess balance, the Falls Efficacy Scale to evaluate the fear of falling, and the Timed Up and Go Test to measure mobility (Appeadu & Bordoni, 2023). Given Mr. Young’s history of falls, these assessments can help identify specific risk factors and guide interventions to prevent future incidents.

For evaluating Mr. Young’s driving competency, performance-based road tests and driving simulation studies can be utilized. These tests assess the coordination of cognitive and physical tasks required for safe driving. Additionally, psychometric evaluations, such as the MMSE, can provide insights into cognitive functions relevant to driving (Toups et al., 2022).

Addressing Potential Issues

Several factors might present challenges during Mr. Young’s assessment. Cognitive impairment could affect his ability to recall past events accurately, which may hinder the history-taking process. Ensuring that questions are clear and straightforward can help mitigate this issue. Additionally, his educational background and any language barriers should be considered when administering cognitive tests to ensure accurate results. Cultural competency is crucial, as cultural beliefs and practices can influence how symptoms are perceived and reported by the patient (Khanna & Metgud, 2020).

Immunization Requirements

Vaccinations play a vital role in promoting health and preventing disease among older adults. Mr. Young should receive recommended vaccines to protect against common infections that can have severe consequences in the elderly. These include the annual influenza vaccine, pneumococcal vaccine, tetanus, and polio vaccines (Michel & Frangos, 2022). Ensuring that Mr. Young is up-to-date with his immunizations can help prevent infections that may exacerbate his existing health conditions.

Conclusion

A comprehensive and multidisciplinary approach is essential for evaluating and managing the health of elderly patients like Mr. Young. Utilizing appropriate assessment tools and considering potential issues related to cognitive function, educational background, and cultural factors can enhance the accuracy of the evaluation. Additionally, maintaining up-to-date immunizations is crucial for promoting overall health and preventing disease in older adults.

References

Appeadu, M., & Bordoni, B. (2023, June 4). Falls and Fall Prevention in the Elderly. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560761/

Arevalo-Rodriguez, I., Smailagic, N., Roqué-Figuls, M., Ciapponi, A., Sanchez-Perez, E., Giannakou, A., Pedraza, O. L., Bonfill Cosp, X., & Cullum, S. (2021). Mini-Mental State Examination (MMSE) for the Early Detection of Dementia in People with Mild Cognitive Impairment (MCI). Cochrane Database of Systematic Reviews, 2021(7). https://doi.org/10.1002/14651858.cd010783.pub3

Khanna, A., & Metgud, C. (2020). Prevalence of cognitive impairment in elderly population residing in an urban area of Belagavi. Journal of Family Medicine and Primary Care, 9(6), 2699. https://doi.org/10.4103/jfmpc.jfmpc_240_20

Michel, J.-P., & Frangos, E. (2022). The Implications of Vaccines in Older Populations. Vaccines, 10(3), 431. https://doi.org/10.3390/vaccines10030431

Toups, R., Chirles, T. J., Ehsani, J. P., Michael, J. P., Bernstein, J. P. K., Calamia, M., Parsons, T. D., Carr, D. B., & Keller, J. N. (2022). Driving Performance in Older Adults: Current Measures, Findings, and Implications for Roadway Safety. Innovation in Aging, 6(1), igab051. https://doi.org/10.1093/geroni/igab051

Detailed Assessment Instructions for the NRNP 6540 Assessment of Older Adults Evaluation Plan Discussion Assignment

NRNP 6540 Raymond Young Week 1 Assessment of Older Adults Instructions

As patients age, they are more likely to develop health issues. While some of these health issues are normal changes due to aging, some of them are abnormal and require further evaluation. Consider a 92-year-old patient who has been diagnosed with several disorders, including obstructive sleep apnea, hypertension, mild chronic anemia, restless leg syndrome, and osteoporosis. Despite these disorders, he can independently perform all basic activities of daily living, walk a quarter mile without difficulty, and pass functional and cognitive assessments. However, he did report that he fell a few times and had lost his way while driving to a familiar location (Carr & Ott, 2010).

As an advanced practice nurse caring for geriatric patients, you will likely encounter patients like this. While he can pass the basic assessments, the report of falls and confusion might indicate underlying issues of immobility, sensory deprivation, and/or cognitive dysfunction that require further attention. To identify these potential underlying issues and distinguish between normal and abnormal changes due to aging, healthcare providers use a variety of assessments. These assessments are a key tool in the care of geriatric patients.

This week, you examine assessment tools and evaluation plans used to assess geriatric patients presenting with potential issues of immobility, sensory deprivation, and cognitive dysfunction.

Reference:
Carr, D. B., & Ott, B. R. (2010). The older adult driver with cognitive impairment: “It’s a very frustrating life.” Journal of the American Medical Association, 303(16), 1632–1641. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915446/

NRNP 6540 Raymond Young Week 1 Assessment of Older Adults Learning Objectives

Students will:

  • Analyze assessment tools used to assess older adults
  • Design evaluation plans for patients with immobility, sensory deprivation, and/or cognitive dysfunction
  • Identify immunization requirements related to health promotion and disease prevention for older adults

Learning Resources

Required Readings (click to expand/reduce)

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Changes with aging. In Advanced practice nursing in the care of older adults (2nd ed., pp. 2–5). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Health promotion. In Advanced practice nursing in the care of older adults (2nd ed., pp. 6–18). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Exercise in older adults. In Advanced practice nursing in the care of older adults (2nd ed., pp. 19–24). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Comprehensive geriatric assessment. In Advanced practice nursing in the care of older adults (2nd ed., pp. 26–33). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Symptoms and syndromes. In Advanced practice nursing in the care of older adults (2nd ed., pp. 34–94). F. A. Davis.

Centers for Disease Control and Prevention. (2020). Recommended adult immunization schedule for ages 19 years or older. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf

Coll, P. P., Costello, V. W., Kuchel, G. A., Bartley, J., & McElhaney, J. E. (2019). The prevention of infections in older adults: Vaccination. Journal of the American Geriatrics Society, 68(1), 207–214. https://doi.org/10.1111/jgs.16205

Hartford Institute for Geriatric Nursing. (2020). General assessment series. In Try This: Series. Author. https://consultgeri.org/try-this/general-assessment

U.S. Preventive Services Task Force. (n.d.). Information for health professionals. Retrieved June 8, 2020 from https://www.uspreventiveservicestaskforce.org/uspstf/information-health-professionals

U.S. Preventive Services Task Force. (2019). Appendix III. USPSTF LitWatch process. https://www.uspreventiveservicestaskforce.org/uspstf/procedure-manual-appendix-iii-uspstf-litwatch-process

Recommended Reading (click to expand/reduce)

Goldberg, C. (2019). Role of physical exam, general observation, skin screening and vital signs. https://meded.ucsd.edu/clinicalmed/assets/docs/Vital%20Signs%20and%20Introduction%20to%20the%20Exam.pdf

Recommended Media (click to expand/reduce)

Engage-IL (Producer). (2017m). Geriatric health promotion and disease prevention [Video]. https://engageil.com/modules/geriatric-health-promotion-and-disease-prevention/

Note: View the Geriatric Health Promotion and Disease Prevention video module available in this free course. If you choose to view the Engage-IL media, you will need to create a free account at the Engage-IL website. 

Engage-IL (Producer). (2017w). The process of aging [Video]. https://engageil.com/modules/the-process-of-aging/

Note: View the Process of Aging video module available in this free course.

Discussion: Evaluation Plan

As geriatric patients age, their health and functional stability may decline resulting in the inability to perform basic activities of daily living. In your role as a nurse practitioner, you must assess whether the needs of these aging patients are being met. Comprehensive geriatric assessments are used to determine whether these patients have developed or are at risk of developing age-related changes that interfere with their functional status. Since the health status and living situation of older adult patients often differ, there are a variety of assessment tools that can be used to evaluate wellness and functional ability. For this Discussion, you will consider which assessment tools would be appropriate for a patient in a case scenario.

Photo Credit: LIGHTFIELD STUDIOS / Adobe Stock

To prepare:

  • Review this week’s Learning Resources, considering how assessment tools are used to evaluate patients.
  • Your Instructor will assign a case study to use for this Discussion. Review the case study and, based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.
  • Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments such as language, education, prosthetics, missing limbs, etc.
  • Consider immunization requirements that may be needed for this patient.

By Day 3

Post an explanation of your evaluation plan for the patient in the case study provided, and explain which type of assessment tool you might use for the patient. Explain whether the assessment tool was validated for use with this patient’s specific patient population and whether this poses issues. Include additional factors that might present issues when performing assessments, such as language, education, prosthetics, etc. Also explain the immunization requirements related to health promotion and disease prevention for the patient.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in one or more of the following ways:

  • Suggest alternative assessment tools and explain why these tools might be appropriate for your colleagues’ patients.
  • Recommend strategies for mitigating issues related to use of the assessment tools your colleagues discussed.
  • Explain other health promotion considerations for patients in this population or with related issues.

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

NRNP 6540 Raymond Young Week 1 Assessment of Older Adults Rubric Detail

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

Name: NRNP_6540_Week1_Discussion_Rubric

Grid View

List View

Excellent

Point range: 90–100       Good

Point range: 80–89         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.

35 (35%) – 39 (39%)

Responds to most of the discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least 3 credible references.

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.

5 (5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

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.

8 (8%) – 8 (8%)

Posts main discussion by due date.

Meets requirements for full participation.

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.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

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.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is 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.

4 (4%) – 4 (4%)

Meets requirements for full 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.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

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.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is 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.

4 (4%) – 4 (4%)

Meets requirements for full 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_6540_Week1_Discussion_Rubric

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NRNP 6540 – Advanced Practice Care of Older Adults Course Guide, Assignments & Examples

,

NRNP 6540 – Advanced Practice Care of Older Adults Course Guide, Assignments & Examples

NRNP 6540 - Advanced Practice Care of Older AdultsNRNP 6540 – Advanced Practice Care of Older Adults (3 credits)

NRNP 6540 – Advanced Practice Care of Older Adults Course Description

In this course, students focus on the complex healthcare and management needs of older adults by advanced nurse practitioners in acute and primary care settings. Students learn to plan, implement, and evaluate therapeutic regimens of older adults through the application of knowledge in multiple settings. Additionally, students examine content related to end-of-life care and caregiver issues to gain the knowledge and sensibilities needed to implement positive change for the quality of life available to this vulnerable population.

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NRNP 6540: Advanced Practice Care of Older Adults
Week 3
Introduction Resources Discussion Assignment Week in Review Looking Ahead
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A female caretaker assists senior women in knitting while a man reads a book in the background at the nursing home.

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 Psychosocial Disorders Assessing Diagnosing and Treating Dementia Delirium and Depression Assignment Example

NRNP 6540 Assessing Cardiovascular and Pulmonary Disorders Assignment Example

NRNP 6540 Assessing Diagnosing and Treating Abdominal Urological and Gynecological Disorders Assignment Example

NRNP 6540 Assessing Diagnosing and Treating Hematological and Immune System Disorders Assignment Example

Week 3: Geriatric Care Teams

Interdisciplinary geriatric care teams are a critical component of geriatrics, and I truly believe that geriatrics really does interdisciplinary care probably better than most other areas of health care because we have to—because we need to. Older adults have care needs that require the expertise of a community. No single provider can do it all well. The needs are just so vast.

—Dr. Barbara Resnick, CRNP, FAAN, FAANP, AGSF, President of the American Geriatrics Society

Dr. Resnick emphasizes the importance of interdisciplinary geriatric care teams, as geriatric patients often have complex health needs. This was the case for 90-year-old Gus Snare. A diagnosis of bile duct cancer resulted in the need for surgery to remove parts of his stomach, duodenum, pancreas, bile duct, and gallbladder. Snare’s care team included a geriatrician, surgical oncologist, and a team of nurses, including an advanced practice nurse. Together, they determined his eligibility for surgery, performed the surgery, and developed a treatment and management plan post-surgery (The University of Chicago Medicine, 2011). As an advanced practice nurse, you must identify your role within care teams for patients like Snare to ensure patients receive comprehensive care.

This week you explore models of interdisciplinary geriatric care teams and compare the roles of advanced practice nurses at various sites of care. Then, as you complete your first SOAP Note, you examine the assessment, diagnosis, and treatment of a geriatric patient from your practicum site.

Learning Objectives

By the end of this week, students will:

Compare models of interdisciplinary geriatric care teams
Analyze models of interdisciplinary geriatric care teams used in various sites
Analyze the roles of advanced practice nurses in different clinical sites
Evaluate diagnoses for patients*
Evaluate treatment and management plans*
*These Learning Objectives support assignments that are assigned this week, but due in Week 4.

Photo Credit: Maskot/ Maskot/Getty Images

Learning Resources

Note: To access this week\’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.

Chapter 18, “Hospital Care” (pp. 134-145)
This chapter explores systems of care for assessing and managing hospitalized older patients. It also examines alternatives to hospital care and transitions from hospital care.

Chapter 20, “Rehabilitation” (pp. 152-166)
This chapter describes essential components of geriatric rehabilitation, including sites of rehabilitation, roles of core health care providers on rehabilitation teams, and disease-specific care plans for older adults. It also explores mobility aids, orthotics, adaptive methods, and environmental modifications for older adults with disabilities.

Chapter 21, “Nursing-Home Care” (pp. 167-174)
This chapter identifies the demographic and functional characteristics of older adults living in nursing homes as well as the availability of nursing homes in the United States. It also describes staffing patterns, quality issues, and legislation related to nursing home care.

Chapter 22, “Community-Based Care” (pp. 175-180)
This chapter explores characteristics of care in communities, including home care, community-based services not requiring a change in residence, and community-based services requiring a change in residence. It examines older adult populations, health care issues, and the primary provider’s role in these sites of care.

Chapter 23, “Outpatient Care Systems” (pp. 181-185)
This chapter describes current approaches that maximize patient outcomes in geriatric outpatient care systems. It also examines new approaches that may benefit older adults in outpatient care systems.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Mosby.

Chapter 26, “Recording Information” (pp. 792–813)
This chapter outlines the components of SOAP notes and provides guidelines for writing SOAP notes after patient examinations.

Note: You should have this textbook in your personal library, as it was the required text in NURS 6512: Advanced Health Assessment and Diagnostic Reasoning.

Arbaje, A., Maron, D., Yu, Q., Wendel, V., Tanner, E., Boult, C., & … Durso, S. (2010). The geriatric floating interdisciplinary transition team. Journal of the American Geriatrics Society, 58(2), 364–370.

This article examines the Geriatric Floating Interdisciplinary Transition Team, a geriatric transitional care model. It describes the roles of health care providers on this care team and identifies potential benefits of this model.

The geriatric floating interdisciplinary transition team. Journal of the American Geriatrics Society, 58(2), by Arbaje, A., Maron, D., Yu, Q., Wendel, V., Tanner, E., Boult, C., & … Durso, S. Copyright 2010 by John Wiley& Sons, Inc. Journals. Reprinted by permission John Wiley & Sons, Inc. Journals via the Copyright Clearance Center.

Gagan, M. (2009). The SOAP format enhances communication. Nursing New Zealand, 15(5), 15.

Note: Retrieved from the Walden Library databases.

This article outlines the four parts of SOAP notes and examines the importance and effectiveness of SOAP notes in clinical settings.

American Geriatrics Society. (2011). The principles of geriatric care. Retrieved from http://www.americangeriatrics.org/files/documents/Adv_Resources/PayReform_fact3.pdf

This article identifies the principles of geriatric care, focusing on the geriatric care team, geriatric assessment, and care coordination. It also presents three models of care that encompass geriatric assessment and care coordination: the GRACE (Geriatric Resources for Assessment and Care of Elders) model, PACE (Program of All-inclusive Care for the Elderly) model, and the Guided Care model.

American Geriatrics Society. (2012). American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. Retrieved from http://www.guideline.gov/content.aspx?id=49933

This article examines three categories of medications that impact older adults: those that are potentially inappropriate and must be avoided, those that are potentially inappropriate and must be avoided in older adults with certain diseases, and those that must be used with caution.

Document: Comprehensive SOAP Note Template (Word document)

Required Media

Laureate Education (Producer). (2013b). Care team models [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 16:29 minutes.

In this video program, Dr. Kristen Mauk and Dr. Barbara Resnick discuss the importance of interdisciplinary geriatric care teams, as well as the role of the advanced practice nurse within these teams.

Accessible player

Discussion: Models of Interdisciplinary Geriatric Care Teams

With the growing population of frail elders, there is an increase of geriatric patients requiring ongoing care for multiple medical conditions. This creates the need for interdisciplinary geriatric care teams. Often, the dynamics and culture of these teams differ across various sites of care, such as assisted living, home care, hospitals, long-term care, and rehabilitation facilities. As an advanced practice nurse, it is important to understand your role in the care team as well as your potential impact on patient care. In this Discussion, you explore models of interdisciplinary geriatric care teams for different sites of care and the varying roles of the advanced practice nurse.

Consider the following three case studies:

Case Study 1

Mrs. Martinez is an 83-year-old Mexican American widow who lives in her own home and is cared for by her adult daughter. Mrs. Martinez owns the home, and her daughter lives with her and provides the care. Her daughter brought her mother to the clinic today to ask to speak to the social worker. She requests that her mother be placed in a nursing home. The daughter states that her mother has nothing to do during the day. The television is on The Weather Channel most of the day because Mrs. Martinez has limited English capability and is unable to read closed-captioning. Mrs. Martinez also has two sons who do not live in the local area, but they do call regularly and check in with their mother and sister. The two sons are opposed to moving their mother to a nursing home because they had promised her that they would “never put her away.”

Case Study 2

Mr. Williams, a 79-year-old African American widower, resides in a foster care home. He has lived there for 4 years since his wife died. He is a former minister. His medical history includes long-term diabetes, high blood pressure, and benign prostatic hypertrophy. The home care provider has requested a home visit to evaluate Mr. Williams’s ability to remain in the home. The provider states that because Mr. Williams’s vision is seriously compromised (he is nearly blind), and because he has been unable to get to the toilet as quickly as necessary (he is very unsteady on his feet), his care is becoming burdensome. According to the home care provider, for safety reasons, Mr. Williams may not fit the criteria for remaining in the foster care home.

Case Study 3

Mrs. Randall is a 77-year-old female who resides in a long-term care facility. She has a history of frequent falls and is severely cognitively impaired. The nursing staff at the long-term care facility called the nurse practitioner at the medical home office to report the recent development of productive cough and high fever. There have been cases of flu in the facility; however, Mrs. Randall has had a flu shot. The nurse practitioner in the office requests a chest x-ray in the long-term care facility. The nurse on duty in the facility states that there is no portable chest x-ray equipment available. She further requests that Mrs. Randall be transferred to the emergency room of the local hospital. Mrs. Randall’s daughter has durable power of attorney for health care decisions for her mother. The long-term care facility has notified the daughter of the change in her mother’s condition. The daughter says whatever the nursing home wants is fine with her.

To prepare:

Review this week’s media presentation, as well as the American Geriatrics Society and Arbaje et al. articles in the Learning Resources.
Research models of interdisciplinary geriatric care teams that are used at various sites, such as assisted living, home care, hospitals, long-term care, and rehabilitation facilities.
Consider the model used for the interdisciplinary geriatric care teams at your current practicum site. Compare this model to models used at other sites.
Reflect on how the role of the advanced practice nurse differs according to the site of care.
Select one of the three case studies. Consider how care should be facilitated for the patient in the case you selected based on the model used for the interdisciplinary geriatric care teams at your practicum site.

By Day 3

Post a comparison of the model used for the interdisciplinary geriatric teams at your current practicum site to models used at other sites. Then, explain how the role of the advanced practice nurse differs according to the site of care. Finally, explain how care should be facilitated for the patient in the case you selected based on the model used for the interdisciplinary geriatric teams at your practicum si

NRNP 6540: Advanced Practice Care of Older Adults – interdisciplinary geriatric care teams eassy assignment paper – assisted living, home care, hospitals, long-term care, and rehabilitation facilities

NRNP 6540 Raymond Young Week 1 Assessment of Older Adults Instructions

As patients age, they are more likely to develop health issues. While some of these health issues are normal changes due to aging, some of them are abnormal and require further evaluation. Consider a 92-year-old patient who has been diagnosed with several disorders, including obstructive sleep apnea, hypertension, mild chronic anemia, restless leg syndrome, and osteoporosis. Despite these disorders, he can independently perform all basic activities of daily living, walk a quarter mile without difficulty, and pass functional and cognitive assessments. However, he did report that he fell a few times and had lost his way while driving to a familiar location (Carr & Ott, 2010).

As an advanced practice nurse caring for geriatric patients, you will likely encounter patients like this. While he can pass the basic assessments, the report of falls and confusion might indicate underlying issues of immobility, sensory deprivation, and/or cognitive dysfunction that require further attention. To identify these potential underlying issues and distinguish between normal and abnormal changes due to aging, healthcare providers use a variety of assessments. These assessments are a key tool in the care of geriatric patients.

This week, you examine assessment tools and evaluation plans used to assess geriatric patients presenting with potential issues of immobility, sensory deprivation, and cognitive dysfunction.

Reference:
Carr, D. B., & Ott, B. R. (2010). The older adult driver with cognitive impairment: “It’s a very frustrating life.” Journal of the American Medical Association, 303(16), 1632–1641. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915446/

NRNP 6540 Raymond Young Week 1 Assessment of Older Adults Learning Objectives

Students will:

  • Analyze assessment tools used to assess older adults
  • Design evaluation plans for patients with immobility, sensory deprivation, and/or cognitive dysfunction
  • Identify immunization requirements related to health promotion and disease prevention for older adults

Learning Resources

Required Readings (click to expand/reduce)

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Changes with aging. In Advanced practice nursing in the care of older adults (2nd ed., pp. 2–5). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Health promotion. In Advanced practice nursing in the care of older adults (2nd ed., pp. 6–18). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Exercise in older adults. In Advanced practice nursing in the care of older adults (2nd ed., pp. 19–24). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Comprehensive geriatric assessment. In Advanced practice nursing in the care of older adults (2nd ed., pp. 26–33). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Symptoms and syndromes. In Advanced practice nursing in the care of older adults (2nd ed., pp. 34–94). F. A. Davis.

Centers for Disease Control and Prevention. (2020). Recommended adult immunization schedule for ages 19 years or older. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf

Coll, P. P., Costello, V. W., Kuchel, G. A., Bartley, J., & McElhaney, J. E. (2019). The prevention of infections in older adults: Vaccination. Journal of the American Geriatrics Society, 68(1), 207–214. https://doi.org/10.1111/jgs.16205

Hartford Institute for Geriatric Nursing. (2020). General assessment series. In Try This: Series. Author. https://consultgeri.org/try-this/general-assessment

U.S. Preventive Services Task Force. (n.d.). Information for health professionals. Retrieved June 8, 2020 from https://www.uspreventiveservicestaskforce.org/uspstf/information-health-professionals

U.S. Preventive Services Task Force. (2019). Appendix III. USPSTF LitWatch process. https://www.uspreventiveservicestaskforce.org/uspstf/procedure-manual-appendix-iii-uspstf-litwatch-process

Recommended Reading (click to expand/reduce)

Goldberg, C. (2019). Role of physical exam, general observation, skin screening and vital signs. https://meded.ucsd.edu/clinicalmed/assets/docs/Vital%20Signs%20and%20Introduction%20to%20the%20Exam.pdf

Recommended Media (click to expand/reduce)

Engage-IL (Producer). (2017m). Geriatric health promotion and disease prevention [Video]. https://engageil.com/modules/geriatric-health-promotion-and-disease-prevention/

Note: View the Geriatric Health Promotion and Disease Prevention video module available in this free course. If you choose to view the Engage-IL media, you will need to create a free account at the Engage-IL website. 

Engage-IL (Producer). (2017w). The process of aging [Video]. https://engageil.com/modules/the-process-of-aging/

Note: View the Process of Aging video module available in this free course.

Discussion: Evaluation Plan

As geriatric patients age, their health and functional stability may decline resulting in the inability to perform basic activities of daily living. In your role as a nurse practitioner, you must assess whether the needs of these aging patients are being met. Comprehensive geriatric assessments are used to determine whether these patients have developed or are at risk of developing age-related changes that interfere with their functional status. Since the health status and living situation of older adult patients often differ, there are a variety of assessment tools that can be used to evaluate wellness and functional ability. For this Discussion, you will consider which assessment tools would be appropriate for a patient in a case scenario.

Photo Credit: LIGHTFIELD STUDIOS / Adobe Stock

To prepare:

  • Review this week’s Learning Resources, considering how assessment tools are used to evaluate patients.
  • Your Instructor will assign a case study to use for this Discussion. Review the case study and, based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.
  • Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments such as language, education, prosthetics, missing limbs, etc.
  • Consider immunization requirements that may be needed for this patient.

By Day 3

Post an explanation of your evaluation plan for the patient in the case study provided, and explain which type of assessment tool you might use for the patient. Explain whether the assessment tool was validated for use with this patient’s specific patient population and whether this poses issues. Include additional factors that might present issues when performing assessments, such as language, education, prosthetics, etc. Also explain the immunization requirements related to health promotion and disease prevention for the patient.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in one or more of the following ways:

  • Suggest alternative assessment tools and explain why these tools might be appropriate for your colleagues’ patients.
  • Recommend strategies for mitigating issues related to use of the assessment tools your colleagues discussed.
  • Explain other health promotion considerations for patients in this population or with related issues.

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

NRNP 6540 Raymond Young Week 1 Assessment of Older Adults Rubric Detail

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Name: NRNP_6540_Week1_Discussion_Rubric

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List View

Excellent

Point range: 90–100       Good

Point range: 80–89         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.

35 (35%) – 39 (39%)

Responds to most of the discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least 3 credible references.

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.

5 (5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

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.

8 (8%) – 8 (8%)

Posts main discussion by due date.

Meets requirements for full participation.

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.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

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.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is 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.

4 (4%) – 4 (4%)

Meets requirements for full 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.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

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.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is 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.

4 (4%) – 4 (4%)

Meets requirements for full 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_6540_Week1_Discussion_Rubric

Week 2: Psychosocial Disorders

In so many countries, to be old is shameful; to be mentally ill as well as old is doubly shameful. In so many countries, people with elderly relatives who are also mentally ill are ashamed and try to hide what they see as a disgrace on the family.

—Dr. Nori Graham, Psychiatrist and Honorary Vice President of Alzheimer’s Disease International

In this quote, Dr. Graham is expressing her observations and experiences in her work with numerous international organizations. Many patients and their families experience feelings of anxiety and shame upon receiving a diagnosis of dementia, delirium, or depression. Among caregivers, 36% report having tried to hide the dementia diagnosis of their family member (Alzheimer’s Disease International, 2019). As an advanced practice nurse providing care to patients presenting with dementia, delirium, and depression, it is critically important to consider the impact of these disorders on patients, caregivers, and their families. A thorough understanding of the health implications of these disorders, as well as each patient’s personal concerns, will aid you in making effective treatment and management decisions.

This week, you explore geriatric patient presentations of dementia, delirium, and depression. You also examine assessment, diagnosis, and treatment for these disorders and complete a SOAP (subjective, objective, assessment, and plan) note.

Reference:
Alzheimer’s Disease International. (2019). World Alzheimer report 2019: Attitudes to dementia. Author. https://www.alz.co.uk/research/world-report-2019

Learning Objectives

Students will:

  • Evaluate patients presenting with symptoms of dementia, delirium, or depression
  • Develop differential diagnoses for patients with psychosocial disorders
  • Develop appropriate treatment plans, including diagnostics and laboratory orders, for patients with psychosocial disorders 

Assignment: Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression

Photo Credit: Getty Images

With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as an advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care. 

To prepare:

  • Review the case study provided by your Instructor. Reflect on the way the patient presented in the case, including whether the patient might be presenting with dementia, delirium, or depression.
  • Reflect on the patient’s symptoms and aspects of disorders that may be present. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?
  • Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
  • Access the Focused SOAP Note Template in this week’s Resources.

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? How would you interpret and address the results of the Mini-Mental State Examination (MMSE)?
  • 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 healthcare 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. 

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

By Day 7

Learning Resources

 

Rubric Detail Tutor needs to FOLLOW

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

Name: NRNP_6540_Week2_Assignment_Rubric

 

  Excellent Fair Poor
Create documentation in the Focused SOAP Note Template about the patient in the case study to which you were assigned.

In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Current medications, checked against Beers Criteria
• Allergies
• Patient medical history (PMHx)
• Review of systems

 9 (9%) – 10 (10%)

The response throughly and accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

 7 (7%) – 7 (7%)

The response describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. A cross-check of medications against the Beers Criteria has been completed but alternatives may be missing.

 0 (0%) – 6 (6%)

The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has not been completed. Or, subjective documentation is missing.
In the Objective section, provide:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses		 9 (9%) – 10 (10%)

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

 7 (7%) – 7 (7%)

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

 0 (0%) – 6 (6%)

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
In the Assessment section, provide:
• At least three (3) differentials with supporting evidence. Explain what rules each differential in or out, and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.		 23 (23%) – 25 (25%)

The response lists in order of priority at least three distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the conditions selected.

 18 (18%) – 19 (19%)

The response lists three possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.

 0 (0%) – 17 (17%)

The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.
In the Plan section, provide:
• A detailed treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits.
• A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors.
• Reflections on the case describing insights or lessons learned.		 27 (27%) – 30 (30%)

The response thoroughly and accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. A thorough and accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate strong critical thinking and synthesis of ideas.

 21 (21%) – 23 (23%)

The response somewhat vaguely or inaccurately outlines a treatment plan for the patient. The discussion on health promotion and disease prevention related to the case is somewhat vague or contains innaccuracies. Reflections on the case demonstrate adequate understanding of course topics.

 0 (0%) – 20 (20%)

The response does not address all diagnoses or is missing elements of the treatment plan. The discussion on health promotion and disease prevention related to the case is vague, innaccurate, or missing. Reflections on the case are vague or missing.
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. 9 (9%) – 10 (10%)

The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents the latest in standards of care and provides strong justification for treatment decisions.

 . 7 (7%) – 7 (7%)

Three evidence-based resources are provided to support treatment decisions, but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan.

 0 (0%) – 6 (6%)

Two or fewer resources are provided to support treatment decisions. The resources may not be current or evidence-based, or do not support the treatment plan.
Written Expression and Formatting—Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.		 5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

 3 (3%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

 0 (0%) – 2 (2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and proper punctuation		 5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

 3 (3%) – 3 (3%)

Contains several (three or four) grammar, spelling, and punctuation errors.

 0 (0%) – 2 (2%)

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

 3 (3%) – 3 (3%)

Contains several (three or four) APA format errors.

 0 (0%) – 2 (2%)

Contains many (≥ five) APA format errors.
Total Points: 100

Name: NRNP_6540_Week2_Assignment_Rubric

Week 2: Psychosocial CASE SCENARIO

Week 2 Case 1: Dementia

HPI: Ms. Peters is a 70-year-old female who is brought to your office by her son with reports of acute confusion (more than usual) and some agitation and restlessness. She has a known history of dementia, managed with Aricept 10 mg. daily. Her son, Jared, reports that 2 days ago she began to become more confused than usual and very easily agitated. He reports that yesterday, she couldn’t remember where she was in her own home. She had a doctor’s appointment 3 days ago and her HCTZ (hydrochlorothiazide) was increased to 50 mg. due to increased bp’s.

Ms. Peter’s last Mini-Mental State Exam (MMSE) score was 18/30. The assessment was repeated, and the score remained unchanged.

Ms. Peters and her son denies her having any falls or contributing traumas recently. She denies any changes in diet or routine regimens. No reported dysuria, no fever, nausea, or vomiting.

Note: Be sure to review the MMSE and how to interpret results (Mental State Assessment Tests). Make sure you document the patient’s score in your SOAP note document. Also review the Geriatric Depression Assessment (Geriatric Depression Scale [GDS]).

Ms. Peters is a 70-year-old female who is alert but easily distracted, at times, during today’s clinical interview. Her eye contact is fair. Speech is clear and coherent but tangential at times. She makes no unusual motor movements and demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She is alert but disoriented to place and time. She denies any falls, denies any pain. Her son does say she has had some “stumbling” and balance issues but no reported falls.

All other Review of System and Physical Exam findings are negative other than stated.

Vital Signs: 98.1 120/64 HR-72 20

PMH: Hypertension, Diabetes, Osteoporosis, Chronic Allergic Rhinitis

Allergies: Atorvastatin

Medications:

  • Multivitamin daily
  • Losartan 50mg daily
  • HCTZ 50mg daily
  • Fish Oil 1 tablet daily
  • Glyburide 5mg daily
  • Metformin 500mg BID
  • Donepezil 10mg daily
  • Alendronate 70mg orally once a week

Social History: As stated in Case Study

ROS: As stated in Case study

Diagnostics/Assessments done:

  1. CXR—no cardiopulmonary findings. WNL
  2. CT head—diffuse Cerebral Atrophy
  3. MMSE—Ms. Peters scored 18 out of 30 with primary deficits in orientation, registration, attention and calculation, and recall at a previous visit. At today’s visit, there is no change. The score suggests moderate dementia.
  4. Hemoglobin A1C7.2%
  5. Basic Metabolic Panel as shown below
TEST RESULT REFERENCE RANGE
GLUCOSE 90 65–99
SODIUM 130 135–146
POTASSIUM 3.4 3.5–5.3
CHLORIDE 104 98–110
CARBON DIOXIDE 29 19–30
CALCIUM 9.0 8.6–10.3
BUN 20 7–25
CREATININE 1.00 0.70–1.25
GLOMERULAR FILTRATION RATE (eGFR) 77 >or=60 mL/min/1.73m2

 

Focused SOAP Note Template

Patient Information:

Initials, Age, Sex, Race

S (subjective)

CC (chief complaint): a BRIEF statement identifying why the patient is here, stated in the patient’s own words (for instance “headache,” NOT “bad headache for 3 days”).

HPI (history of present illness): This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:

  • Location: Head
  • Onset: 3 days ago
  • Character: Pounding, pressure around the eyes and temples
  • Associated signs and symptoms: Nausea, vomiting, photophobia, phonophobia
  • Timing: After being on the computer all day at work
  • Exacerbating/relieving factors: Light bothers eyes; Aleve makes it tolerable but not completely better
  • Severity: 7/10 pain scale

Current Medications: Include dosage, frequency, length of time used, and reason for use; also include over the counter (OTC) or homeopathic products.

Allergies: Include medication, food, and environmental allergies separately, including a description of what the allergy is (i.e., angioedema, anaphylaxis, etc.). This will help determine a true reaction versus intolerance.

PMHx: Include immunization status (note date of last tetanus for all adults), past major illnesses, and surgeries. Depending on the CC, more info is sometimes needed.

Soc and Substance Hx: Include occupation and major hobbies, family status, tobacco and alcohol use (previous and current use), and any other pertinent data. Always add some health promo question here, such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

Fam Hx: Illnesses with possible genetic predisposition, contagious, or chronic illnesses. Reason for death of any deceased first-degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

Surgical Hx: Prior surgical procedures.

Mental Hx: Diagnosis and treatment. Current concerns (anxiety and/or depression). History of self-harm practices and/or suicidal or homicidal ideation.

Violence Hx: Concern or issues about safety (personal, home, community, sexual (current and historical).

Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse (oral, anal, vaginal, other, any sexual concerns).

ROS (review of symptoms): Cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows:

  • General:
  • Head:
  • EENT (eyes, ears, nose, and throat):
  • Etc.:

Note: You should list these in bullet format, and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT:

  • Eyes: No visual loss, blurred vision, double vision or yellow sclerae.
  • Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination. Last menstrual period (LMP), MM/DD/YYYY.

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC: No anemia, bleeding or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

REPRODUCTIVE: Not pregnant and no recent pregnancy. No reports of vaginal or penile discharge. Not sexually active.

ALLERGIES: No history of asthma, hives, eczema or rhinitis.

O (objective)

Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format (i.e., General: Head: EENT: etc.).

Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

A (assessment)

Differential diagnoses: List a minimum of three differential diagnoses. Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence-based guidelines.

P (plan)

Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner.

Also included in this section is the reflection. Reflect on this case, and discuss what you learned, including any “aha” moments or connections you made.

Also include in your reflection, a discussion related to health promotion and disease prevention taking into consideration patient factors (such as, age, ethnic group, etc.), PMH, and other risk factors (e.g., socio-economic, cultural background, etc.).

References

You are required to include 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 to use correct APA 7th edition formatting.

NRNP 6540—Week 2 Case Study

Mr. Y is a 78-year-old man who was born in Korea and moved to the U.S with his wife 50 years ago. Together, the couple opened a floral shop and ran the business for 40 years. Mrs. Y enjoyed watching her husband’s talent and love of nature come out in his flower arrangements.

When Mr. Y was in his late 60’s, he starting having difficulty making his favorite flower arrangements. Their son also noticed Mr. Y misplacing tools, losing paper orders, and forgetting important pick-up times. At home, Mrs. Y noticed her husband having problems remembering recent events, and waking up at odd hours in the night thinking it was time to open the shop. Mr. Y was becoming irritable at home and at the shop.

When Mr. Y was 70 years old, the family decided to sell the business. Their health-care providers confirmed that Mr. Y was presenting with early stage Alzheimer’s disease. The family then decided that Mrs. Y would be appointed as her husband’s Power of Attorney for personal care and property. She continued to care for her husband at home.

When Mr. Y turned 75 years old, he was having increased difficulty remembering where things were in the house. He often woke his wife at odd hours of the night thinking it was time to get up and ready. When Mrs. Y reoriented her husband that it was still night-time, he would get confused and easily upset. Mr. Y was also becoming more physically weak, but did not perceive his limitations. He was having frequent falls at home. A few times, Mr. Y had become lost outside of their home, forgetting where he had to go and which house was his.

Their son recognized that his mother was not as happy as she used to be. She was constantly worrying about her husband’s increasing care needs, and could not enjoy activities she used to do. She was stressed and was not sleeping properly. With support from their health-care providers, the family decided that a long-term care setting would benefit Mr. Y and Mrs. Y’s well-being.

Admission to long-term care

At the admission conference, the long-term care home’s social worker and charge nurse met Mr. Y and his family, and learned more about his history and preferences. His medical diagnosis includes moderate Alzheimer’s disease and osteoarthritis, with a history of urinary tract infections. Mr. Y hears well, uses reading glasses, and wears upper and lower dentures. Mr. Y also requires reminders to use his walker properly. Mrs. Y always prompted her husband for toileting, as well as when to eat and take medications. Mr. Y requires limited assistance from his wife during activities of daily living, such as dressing or transfers. As for his preferences, Mr. Y loves homemade Korean food, pastries, and warm drinks. He had always enjoyed baths in the evenings.

At the end of the second week in LTC, Mr. Y was no longer pacing the halls. He was often found napping in his room during the days. One afternoon, a nurse went into Mr. Y’s room and found him sleeping. She tried to gently wake Mr. Y, but he was not easy to arouse. She tried a second time and asked very loudly, “Mr. Y, it’s lunch time, are you ready to go?” Mr. Y slowly opened his eyes. The nurse repeated her question, and Mr. Y replied slowly, “Oh, I ate last week.” The nurse then asked, “I know you had breakfast this morning, now it’s lunch time.

Are you hungry?” Mr. Y paused and closed his eyes. The nurse gently woke him again by rubbing his arm and repeated her question. Mr. Y slowly replied, “Yes, my wife is cooking, I will eat”. Together, they walked slowly to the dining room.

In the dining room, Mr. Y stared out the window and did not answer the CNAs when they asked him for his lunch preference. When approached a third time, Mr. Y rambled slowly in English and in Korean to the CNAs. He continued to speak Korean to the CNAs as they tried to assist him with his lunch, but he was unfocused and inattentive. He was unable to finish his meal because of his behavior. The staff were worried that he was not eating or drinking enough since admission.

When there were group activities, the therapists found it harder to encourage Mr. Y to attend and participate like he had been doing before. It took a lot of encouragement and assistance to have him attend. During the activity, he did not participate or sometimes fell asleep in the middle of the exercise or social program.

A few nights in a row, he was found wandering outside his bedroom without his walker. One time, he told the nurse, “Someone is looking for me.” The nurse reassured him that he is safe, and tried to direct him back to his room. But Mr. Y walked past the nurse and said, “I have to go to the bus stop.” After a few attempts, the nurse was able to direct Mr. Y to his room to sleep, and reoriented him to the use of the call bell. This behavior continued with increasing disorientation. The sleep disturbances resulted in Mr. Y being too drowsy in the mornings, and not able to eat any breakfast.

Although Mrs. Y was kept informed of her husband’s condition since admission to long-term care, it was not until her first visit during Mr. Y’s third week in long-term care when she realized how much her husband had changed. She was alarmed and asked the staff, “What is happening? What will be done for him? How can I help?”

NRNP 6540 Week 2 Assignment

Case Study: Week 2 Case 2 (Alzheimer’s )

Dela Cruz, Dedic, Famador, Finefrock, Fritcher, Gallik, Gelegdorj, Go, Joseph, Kabir, Lopez

Ms. Washington is a 67-year-old African American female who is brought to your office by her daughter with concerns about “forgetfulness.” She has lived with her daughter for 4 years now, and her daughter reports noticing she asks the same questions even after they have been answered. She even reports her mom getting lost in Walmart recently. Ms. Washington has lived with her daughter since losing her husband of 57 years about 4 years ago. Her daughter states her mother is a retired teacher and usually very astute but notices more forgetfulness.

According to Ms. Washington’s daughter, Angela, her mom has been demonstrating increased forgetfulness of more recent things but can easily recall historical moments and events. She also reports that sometimes her mom has difficulty “finding the right words” in a conversation and then will shift to an entirely different line of conversation. She also said her mother will “laugh off” things when she forgets important appointments and/or becomes upset or critical of others who try to point these things out.

Note: Be sure to review the Mini-Mental State Exam (MMSE) and how to interpret the results. Use the MMSE in the attached document to determine the patient’s MMSE score in the video. Make sure you document the patient’s score in your SOAP note document: Mental State Assessment Tests.

Ms. Washington is a 67-year-old female who is alert and cooperative with today’s clinical interview. Her eye contact is fair. Speech is clear and coherent but tangential at times. She makes no unusual motor movements and demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She is alert and oriented to person, partially oriented to place, but is disoriented to time and place. (She reported that she thought was headed to work but “wound up here,” referring to your office, at which point she begins to laugh it off.) She denies any falls or pain.

All other Review of System and Physical Exam findings are negative other than stated.

PMH: Hypertension, Hyperlipidemia, Osteoporosis

Allergies: Penicillin, Lisinopril

Medications:

  • Amlodipine 10mg daily
  • HCTZ 12.5mg daily
  • Multivitamin daily
  • Atorvastatin 40mg daily
  • Alendronate 70mg orally once a week

Social History: As stated in the Case Study

ROS: As stated in the Case study

Diagnostics/Assessments done:

  1. CXR—no cardiopulmonary findings. WNL
  2. CT head—diffuse Cerebral Atrophy
  3. MMSE—Ms. Washington scores 18 out of 30 with primary deficits in orientation, registration, attention and calculation, and recall. The score suggests moderate dementia.

To prepare:

  • Review the case study provided by your Instructor. Reflect on the way the patient presented in the case, including whether the patient might be presenting with dementia, delirium, or depression.
  • Reflect on the patient’s symptoms and aspects of disorders that may be present. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?
  • Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
  • Access the Focused SOAP Note Template in this week’s Resources.

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? How would you interpret and address the results of the Mini-Mental State Examination (MMSE)?
  • 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 healthcare 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.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

NRNP_6540_Week2_Assignment_Rubric

Criteria Ratings Pts
This criterion is linked to a Learning OutcomeCreate documentation in the Focused SOAP Note Template about the patient in the case study to which you were assigned. In the Subjective section, provide: • Chief complaint • History of present illness (HPI) • Current medications, checked against Beers Criteria • Allergies • Patient medical history (PMHx) • Review of systems 10 to >9.0 pts
Excellent
The response thoroughly and accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable. 9 to >8.0 pts
Good
The response accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable. 8 to >7.0 pts
Fair
The response describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. A cross-check of medications against the Beers Criteria has been completed but alternatives may be missing. 7 to >0 pts
Poor
The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has not been completed. Or, subjective documentation is missing.
10 pts
This criterion is linked to a Learning OutcomeIn the Objective section, provide: • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history • Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses 10 to >9.0 pts
Excellent
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented. 9 to >8.0 pts
Good
The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented. 8 to >7.0 pts
Fair
Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies. 7 to >0 pts
Poor
The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
10 pts
This criterion is linked to a Learning OutcomeIn the Assessment section, provide: • At least three (3) differentials with supporting evidence. Explain what rules each differential in or out, and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case. 25 to >23.0 pts
Excellent
The response lists in order of priority at least three distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the conditions selected. 23 to >19.0 pts
Good
The response lists in order of priority at least three different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the conditions selected. 19 to >18.0 pts
Fair
The response lists three possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each. 18 to >0 pts
Poor
The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.
25 pts
This criterion is linked to a Learning OutcomeIn the Plan section, provide: • A detailed treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits. • A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors. • Reflections on the case describing insights or lessons learned. 30 to >27.0 pts
Excellent
The response thoroughly and accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. A thorough and accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate strong critical thinking and synthesis of ideas. 27 to >24.0 pts
Good
The response accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. An accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate critical thinking. 24 to >21.0 pts
Fair
The response somewhat vaguely or inaccurately outlines a treatment plan for the patient. The discussion on health promotion and disease prevention related to the case is somewhat vague or contains innaccuracies. Reflections on the case demonstrate adequate understanding of course topics. 21 to >0 pts
Poor
The response does not address all diagnoses or is missing elements of the treatment plan. The discussion on health promotion and disease prevention related to the case is vague, innaccurate, or missing. Reflections on the case are vague or missing.
30 pts
This criterion is linked to a Learning OutcomeProvide 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. 10 to >9.0 pts
Excellent
The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents the latest in standards of care and provides strong justification for treatment decisions. 9 to >8.0 pts
Good
The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents current standards of care and supports treatment decisions. 8 to >7.0 pts
Fair
Three evidence-based resources are provided to support treatment decisions, but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan. 7 to >0 pts
Poor
Two or fewer resources are provided to support treatment decisions. The resources may not be current or evidence-based, or do not support the treatment plan.
10 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. 5 to >4.0 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 to >3.0 pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. 3 to >2.0 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. 2 to >0 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors. 4 to >3.0 pts
Good
Contains a few (one or two) grammar, spelling, and punctuation errors. 3 to >2.0 pts
Fair
Contains several (three or four) grammar, spelling, and punctuation errors. 2 to >0 pts
Poor
Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5 to >4.0 pts
Excellent
Uses correct APA format with no errors. 4 to >3.0 pts
Good
Contains a few (one or two) APA format errors. 3 to >2.0 pts
Fair
Contains several (three or four) APA format errors. 2 to >0 pts
Poor
Contains many (≥ five) APA format errors.
5 pts
Total Points: 100

NRNP 6540 Week 4 Head Neck and Face Case Study

A 76-year-old woman presents today with complaints of nasal drainage, clearing of throat, and occasional nasal congestion, especially on waking in the morning. She has recently moved into an independent living center after living in her home for 40 years. She states that, although she has had these symptoms before, generally, the symptoms appeared in the spring, and she associated the nasal drainage with pollination. Because it is winter, she could not identify the trigger of her symptoms.

Chief complaint: Persistent “runny nose” for the 3-week duration, associated clearing of the throat and nasal congestion on awakening in the morning.

Objective data: Blood pressure (BP) 130/84, temperature 98.6, pulse 78, respiratory rate 20.

What further ROS questions will you want to ask her? List at least three.

What physical exam (PE) will you perform on this patient? List at least three.

What are the differential diagnoses that you are considering? Describe at least four.

What laboratory tests will help you rule out some of the differential diagnoses?

You have determined, by choosing your ROS, PE, and differential diagnosis, that this patient has allergic rhinitis (AR).

Describe the treatment options for your diagnosis, and what specific information about the prescription will you give to this patient?

List at least two treatment options: medications with dose, side effects, and/or cautions in the older adult.

When will you have the patient follow-up? Be specific.

NOTE: Write a focused SOAP note for this case. Choose the ROS, PE, and medications you will use in your SOAP note. Be creative, but do not deviate from the main points of the case study.

NRNP_6540_Week4_Assignment_Rubric

Criteria Ratings Pts

This criterion is linked to a Learning OutcomeCreate documentation in the Focused SOAP Note Template about the patient in the case study to which you were assigned. In the Subjective section, provide: • Chief complaint• History of present illness (HPI) • Current medications, checked against Beers Criteria• Allergies• Patient medical history (PMHx) • Review of systems 10 to >9.0 pts
Excellent
The response throughly and accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable. 9 to >8.0 pts
Good
The response accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable. 8 to >7.0 pts
Fair
The response describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. A cross-check of medications against the Beers Criteria has been completed but alternatives may be missing. 7 to >0 pts
Poor
The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has not been completed. Or, subjective documentation is missing.
10 pts
This criterion is linked to a Learning OutcomeIn the Objective section, provide: • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses 10 to >9.0 pts
Excellent
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented. 9 to >8.0 pts
Good
The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented. 8 to >7.0 pts
Fair
Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies. 7 to >0 pts
Poor
The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
10 pts
This criterion is linked to a Learning OutcomeIn the Assessment section, provide: • At least three (3) differentials with supporting evidence. Explain what rules each differential in or out, and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case. 25 to >23.0 pts
Excellent
The response lists in order of priority at least three distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the conditions selected. 23 to >20.0 pts
Good
The response lists in order of priority at least three different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the conditions selected. 20 to >18.0 pts
Fair
The response lists three possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each. 18 to >0 pts
Poor
The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.
25 pts
This criterion is linked to a Learning OutcomeIn the Plan section, provide: • A detailed treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits. • A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors. • Reflections on the case describing insights or lessons learned. 30 to >27.0 pts
Excellent
The response thoroughly and accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. A thorough and accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate strong critical thinking and synthesis of ideas. 27 to >24.0 pts
Good
The response accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. An accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate critical thinking. 24 to >21.0 pts
Fair
The response somewhat vaguely or inaccurately outlines a treatment plan for the patient. The discussion on health promotion and disease prevention related to the case is somewhat vague or contains innaccuracies. Reflections on the case demonstrate adequate understanding of course topics. 21 to >0 pts
Poor
The response does not address all diagnoses or is missing elements of the treatment plan. The discussion on health promotion and disease prevention related to the case is vague, innaccurate, or missing. Reflections on the case are vague or missing.
30 pts
This criterion is linked to a Learning OutcomeProvide 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. 10 to >9.0 pts
Excellent
The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents the latest in standards of care and provides strong justification for treatment decisions. 9 to >8.0 pts
Good
The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents current standards of care and supports treatment decisions. 8 to >7.0 pts
Fair
Three evidence-based resources are provided to support treatment decisions, but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan. 7 to >0 pts
Poor
Two or fewer resources are provided to support treatment decisions. The resources may not be current or evidence-based, or do not support the treatment plan.
10 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. 5 to >4.0 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 to >3.0 pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. 3 to >2.0 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. 2 to >0 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors. 4 to >3.0 pts
Good
Contains a few (one or two) grammar, spelling, and punctuation errors. 3 to >2.0 pts
Fair
Contains several (three or four) grammar, spelling, and punctuation errors. 2 to >0 pts
Poor
Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5 to >4.0 pts
Excellent
Uses correct APA format with no errors. 4 to >3.0 pts
Good
Contains a few (one or two) APA format errors. 3 to >2.0 pts
Fair
Contains several (three or four) APA format errors. 2 to >0 pts
Poor
Contains many (≥ five) APA format errors.
5 pts
Total Points: 100
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NRNP 6540 Week 5 Case Assignment

Case Title: A 67-year-old With Tachycardia and Coughing

Ms. Jones is a 67-year-old female who is brought to your office today by her daughter Susan. Ms. Jones lives with her daughter and is able to perform all activities of daily living (ADLs) independently. Her daughter reports that her mother’s heart rate has been quite elevated, and she has been coughing a lot over the last 2 days. Ms. Jones has a 30-pack per year history of smoking cigarettes but quit smoking 3 years ago. Other known history includes chronic obstructive pulmonary disease (COPD), hypertension,
vitamin D deficiency, and hyperlipidemia. She also reports some complaints of intermittent pain/cramping in her bilateral lower extremities when walking, and has to stop walking at times for the pain to subside. She also reports some pain to the left side of her back, and some pain with aspiration.

Ms. Jones reports she has been coughing a lot lately, and notices some thick, brown-tinged sputum. She states she has COPD and has been using her albuterol inhaler more than usual. She says it helps her “get the cold up.” Her legs feel tired but denies any worsening shortness of breath. She admits that she has some weakness and fatigue but is still able to carry out her daily routine.

Vital Signs: 99.2, 126/78, 96, RR 22
Labs: Complete Metabolic Panel and CBC done and were within normal limits
CMP Component Value CBC Component Value
Glucose, Serum 86 mg/dL White blood cell count 5.0 x 10E3/uL
BUN 17 mg/dL RBC 4.71 x10E6/uL
Creatinine, Serum 0.63 mg/dL Hemoglobin 10.9 g/dL
EGFR 120 mL/min Hematocrit 36.4%
Sodium, Serum 141 mmol/L Mean Corpuscular Volume 79 fL
Potassium, Serum 4.0 mmol/L Mean Corpus HgB 28.9 pg
Chloride, Serum 100 mmol/L Mean Corpus HgB Conc 32.5 g/dL
Carbon Dioxide 26 mmol/L RBC Distribution Width 12.3%
Calcium 8.7 mg/dL Platelet Count 178 x 10E3/uL
Protein, Total, Serum 6.0 g/dL
Albumin 4.8 g/dL
Globulin 2.4 g/dL
Bilirubin 1.0 mg/dL
AST 17 IU/L
ALT 15 IU/L
Allergies: Penicillin
Current Medications:
ï‚· Atorvastatin 40mg p.o. daily

ï‚· Multivitamin 1 tablet daily
ï‚· Losartan 50mg p.o. daily
ï‚· ProAir HFA 90mcg 2 puffs q4–6 hrs. prn
ï‚· Caltrate 600mg+ D3 1 tablet daily

Diagnosis: Pneumonia
Directions: Answer the following 10 questions directly on this template.

Question 1: What findings would you expect to be reported or seen on her chest X-ray results, given the diagnosis of pneumonia?

Question 2: Define further what type of pneumonia Ms. Jones has, HAP (hospital-acquired pneumonia) or CAP (community-acquired pneumonia)? What’s the difference/criteria?

Question 3:
ï‚· 3A) What assessment tool should be used to determine the severity of pneumonia and treatment options?

ï‚· 3B) Based on Ms. Jones’ subjective and objective findings, apply that tool and elaborate on each clinical factor for this patient.

Question 4: Ms. Jones was diagnosed with left lower lobe pneumonia. What would your treatment be for her based on her diagnosis, case scenario, and evidence-based guidelines?

Question 5: Ms. Jones has a known history of COPD. What is the gold standard for measuring airflow limitation?

Question 6: Ms. Jones mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain/cramps. Which choice below would be the best choice for a potential diagnosis for this? Explain your reasoning.
a. DVT (Deep Vein Thrombosis)
b. Intermittent Claudication
c. Cellulitis
d. Electrolyte Imbalance

Question 7: Ms. Jones mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain. What test could be ordered to further evaluate this?

Question 8: Name three (3) differentials for Ms. Jones’ initial presentation.

Question 9: What patient education would you give Ms. Jones and her daughter? What would be your follow-up instructions?

Question 10: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Jones’ Pneumonia? Explain why or why not.

NRNP 6540 Week 6 Focused SOAP Note Example

Patient Information:

GM, 79, Male, White

Subjective: Patient resting in bed quietly, endorses right flank pain, denies nausea/vomiting, or fever.

CC (chief complaint): Patient presents to hospital with right flank pain.

HPI: Patient is a 79 year old male with PMH of AFIB, HTN, HLD, and urinary retention that presents to the hospital with right flank pain. The right flank pain wraps around to the right upper quadrant, patient describes as a dull aching. This pain has been progressing over the last 2-3 days. Patient had nausea and 1-2 episodes of emesis. No fever, chills, diarrhea. Pain started while feeding cattle and has progressively worsened. Patient has taken Tylenol without relief in symptoms. Patient rates pain 10/10.

Current Medications:

  • Eliquis 2.5mg PO BID, AFIB
  • Aspirin 81mg PO QD, CHF
  • Ancef 1G IV Q12H, UTI
  • Colace 100mg PO QD, constipation
  • Lasix 20mg PO QD, CHF
  • Normal Saline 0.9 IV continous 100ml/hr, hydration
  • Dilaudid 0.5mg IV q2h PRN, PAIN
  • Melatonin 5mg PO PRN nightly, sleep
  • Zofran 4mg PO q6h PRN, nausea
  • Senna 8.6mg PO BID PRN, constipation

Allergies:

  • Tamsulosin – hives

PMHx:

  • AFIB
  • CHF
  • Closed nondisplaced fracture of third metacarpal bone of right hand
  • Constipation
  • Hypertension
  • Mixed Hyperlipidemia
  • Traumatic Compression fracture of T9 vertebra

Vaccines

  • Tdap 2022
  • PPSV23 2022
  • FLU 9/1/23
  • COVID negative

Soc and Substance Hx: Patient is a cattle farmer and raises them for meat. Patient still currently works on his own farm. Tobacco use: No, Alcohol use: Occasional mixed drink, Substance abuse: No. Patient always uses his seatbelt, has no issues obtaining food, medications, or making it to appointments. Patient lives at home with his wife. Close support from children.

Fam Hx:

  • Heart Attack, Father

Surgical Hx:

  • Bilateral Cataract Extraction
  • Colonoscopy 2014
  • Cardiac Ablation 04/2023
  • Hernia Repair
  • Kidney Surgery
  • Prostate Surgery
  • EGD 2014
  • Wrist Surgery

Mental Hx: No history of anxiety/depression. No history of self-harm practices and/or suicidal or homicidal ideation.

Violence Hx: Patient feels safe in home and relationships.

Reproductive Hx: Not currently sexually active

ROS: Cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: Shortness of breath, no cough, or sputum.

GASTROINTESTINAL: No anorexia or diarrhea. Nausea and vomiting. No abdominal pain or blood.

GENITOURINARY: No burning on urination. Chronic foley catheter.

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness. Right flank pain.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

ALLERGIES: No history of asthma, hives, eczema, or rhinitis.

Objective: BP 113/65, HR 90, Temp 98.9, RR 18, SpO2 94%

Physical exam:

General Appearance: Alert, acutely ill appearing, in mild acute distress

HEENT: Head normocephalic, Eyes-EOMI, sclera anicteric, Throat mucus membranes moist

Cardiovascular: regular rate and rhythm, normal S1, S2, no murmurs, rubs, clicks, gallops, peripheral edema absent

Respiratory: lungs clear to auscultation, without wheezes rales, or rhonchi, on nasal cannula 3L

Abdomen: soft, non-tender, right CVA tenderness, right upper quadrant pain, mildly distended

Genitourinary: chronic foley catheter in place

Neurological: oriented x3, normal speech, no focal findings or movement disorders noted

Musculoskeletal: no significant deformity, or tenderness to palpitation

Skin: normal coloration

Psych: Normal mood and affect

Diagnostic results:

Na 127

Creatinine 1.69

WBC 12.07

Urinalysis: Moderate blood, positive nitrates, large leukocyte esterase, WBC 69, RBC 12, Bacteria few, WBC clumps rare, Mucus rare

Urine Culture: Negative Bacilli

Blood Cultures: Pending

US Abdomen 9/16: No gallstones. Right hydronephrosis.

Chest X-Ray 9/17:

  • Lungs: Pulmonary vascular congestion and interstitial prominence has developed. Mild hazy opacities of left perihilar region and right lung base. No definite effusion. No evidence of pneumothorax.
  • Heart/mediastinum: Stable contours. Stable enlargement of cardiac silhouette.
  • Bones: No acute bony abnormality.
  • Impression: Findings are suspicious for pulmonary edema pattern versus mild CHF decompensation. Infiltrate is a secondary consideration.

CT Kidney Stone 9/15:

  • Impression:
    • Massive right chronic hydronephrosis and hydronephrotic sac, stable, presumably related to chronic UPJ stenosis. However, perinephric fluid is present on today’s examination, suggesting ascending urinary tract infection.
    • Short-segment circumferential thickening consistent at hepatic flexure at the distal ascending and proximal transverse colon without secondary bowel obstruction. These findings are likely secondary to inflammation from adjacent ascending urinary tract infection.
    • Normal appendix. No adenopathy.
    • No urinary tract calculi or hydronephrosis.
    • Severe pectus excavatum deformity.

Assessment:

Primary Diagnosis:  Right pyelonephritis with hydronephrosis, acute UTI

Secondary Diagnosis: CHF exacerbation due to fluid overload

Differential Diagnoses:

  • Cholelithiasis/Cholecystitis: Due to location of pain in right flank and nausea, vomiting this is a potential diagnosis. This was ruled out by abdominal ultrasound (Cleveland Clinic, 2023).
  • Renal colic due to kidney stone: Patient presented with flank pain and CVA tenderness. This was ruled out by CT Kidney stone. No stones found on CT (Time of Care, 2023).
  • Shingles: shingles can cause deep nerve pain and is often found on the trunk of the body. This was ruled out due to the patient not having a rash (Keck Medicine of USC, 2020).

Plan.

Right pyelonephritis with hydronephrosis/Acute UTI

  • CT Kidney Stone-massive right chronic hydronephrosis and hydronephrotic sac, related to chronic UPJ stenosis. Perinephric fluid present suggesting ascending UTI. US abdomen: No gallstones, right hydronephrosis, known UPJ obstruction.
  • Consult Urology
  • Rocephin started in ER, changed to Ancef 2G q12h (Diaz-Brochero, et al., 2022).
  • Pain Management PRN
  • UA- Large leukocytes, positive nitrates
  • Urine Culture: Negative Bacilli
  • Blood Culture Pending
  • Care Management

Leukocytosis

  • WBC 13.04>10.9
  • Trend CBC
  • No fevers

Chronic Kidney Disease

  • Creatinine 1.62>1.6
  • Baseline 1.7
  • IV hydration-stopped due to fluid overload

Hyponatremia

  • Na 127>128>122
  • Monitor

Chronic AFIB s/p ablation 4/13/23

  • Continue Eliquis
  • Rate Controlled
  • Keep K+>4, Mag >2

Hypertension Hyperlipidemia

  • No current home medications
  • Continue to monitor

HFrEF-CHF

  • BNP-pending
  • Echo 1/25/23 EF 67%
  • Change Lasix to 40mg IV x1, then 20mg IV BID (Yoshioka, et al., 2022).
  • Daily Weights
  • Strict I&O
  • Repeat Echocardiogram
  • Weight up 8# since admission
  • Chest Xray suspicious for pulmonary edema pattern vs mild CHF decompensation

Chronic Urinary Retention

  • Chronic Indwelling Catheter
  • Follows with Dr. Peck
  • Consult Urology

Reflection

          This patient was a truly unique case. He originally came in with right flank pain and ended up being fluid overloaded. The admitting doctor started the patient on IV hydration due to AKI on CKD and the acute urinary tract infection. Orders were not placed to keep a watch on the patient’s intake and output and daily weight. The patient did not have bilateral lower extremity edema and he only had diminished lung sounds. His main symptoms of fluid overload were a distended belly and shortness of breath. This patient needed his IV fluids stopped and his Lasix transitioned to IV. Once the patient started to put more out his shortness of breath resolved.

Objectives:

After viewing the presentation:

  • You will be able to explain why the patient became fluid overloaded.
  • Explain two ways to facilitate diuresis of the patient.
  • Explain what was still pending that could narrow done the antibiotic choices.

Discussion Questions:

  • The patient was initially started on Rocephin, and then switched to Ancef. The urine culture was not fully resulted and only showed negative bacilli. What additional information would you need to make sure that you have chosen the appropriate antibiotic therapy?
  • What labs are important to monitor while a patient is receiving IV Lasix and why?
  • What are the risks involved with having a chronic indwelling catheter? What education can you provide the patient?

References

Cleveland Clinic. (2023). Flank pain. Retrieved from          https://my.clevelandclinic.org/health/symptoms/21541-flank-pain

Diaz-Brochero, C., Valderrama-Rios, M. C., Nocua-Baez, L. C., & Cortes, J. A. (2022).       First-generation cephalosporins for the treatment of complicated upper urinary        tract infections in adults: A systematic literature review. International Journal of          Infectious Disease, 116, 403-410. Retrieved from https://www.sciencedirect.com/science/article/pii/S1201971221012613

Keck Medicine of USC. (2020). 5 reasons you might have flank pain. Retrieved from          https://www.keckmedicine.org/blog/5-reasons-you-might-have-flank-pain/

Time of Care. (2023). Flank pain. Retrieved from https://www.timeofcare.com/flank-          pain-ddx/

Yoshioka, K., Maeda, D., Okumura, T., Kida, K., Oishi, S., Akiyama, E., Suzuki, S.,    Yamamoto, M., Mizukami, A., Kuroda, S., Kagiyama, N., Yamaguchi, T., Sasano,     T., Matsumura, A., Kitai, T., & Matsue, Y. (2022). Clinical implications of initial intravenous diuretic dose for acute decompensated heart failure. Scientific   Reports, 12, 2127. Retrieved from          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8825846/

NRNP 6540 Week 7 Assignment

R.B.is a 95-year-old white male, currently living in a skilled nursing facility (SNF)

Chief complaint: “My urine is really red.”

HPI: On Wednesday (2 days ago), the patient was brought to your clinic by his son and complained that his urine appeared to be bright red in color. You ordered labs, urinalysis, culture, and sensitivity, and the results are below.

Allergies: Penicillin: Hives

Medications: Tamsulosin 0.4 mcg, 2 capsules daily, Aspirin 325 mg daily, Atorvastatin 10 mg 1 tablet daily, Donepezil 10 mg 1 tablet PO QHS, Metoprolol 25 mg 0.5 mg tablet every 12 hours, Acetaminophen 500 mg 1 tablet BID

Code status: DNR

Diet: Regular diet, pureed texture, honey-thickened liquids

Vitals: BP 122/70, HR 66, Temp 98.0 F, Resp 18, Pulse ox 98%

PMH: Cognitive communication deficit, pneumonitis due to inhalation of food and vomit, dysphagia, R-sided hemiplegia and hemiparesis from a previous ischemic CVA, moderate vascular dementia, malignant neoplasm of prostate, new-onset atrial fibrillation (12/2019), DVT on the left lower extremity, gross hematuria

Labs:

RBC                         3.53 (L)

Hemoglobin           10.2 (L)

Microscopic Analysis, Urine, straight cath

Component:

WBC UA                                    42 (H) (0-5/ HPF)

RBC, UA                                    >900 (H) (0-5/HPF)

Epithelial cells, urine               2           (0-4 /HPF)

Hyaline casts, UA                     0           (0-2 /LPF)

Urinalysis

Color                           Red

Appearance (Urine)     Clear

Ketones, UA                 Trace

Specific gravity             1.020               (1.005-1.025)

Blood, UA                     Large

PH, Urine                      7.0       (5.0-8.0)

Leukocytes                   Small

Nitrites                         Positive

C&S results were not available yet.

Please include differential diagnosis with explanation and citation.

NRNP_6540_Week 7 Assignment Instructions

Accurate history taking of abdominal, urological, and gynecological complaints is essential for completing an assessment of the older adult. For this Assignment, as you examine this week’s patient case study, consider how you might evaluate and treat older adult patients who present with health concerns related to the abdominal, urological, or gynecological systems.

To prepare:

  • Review the case study provided by your Instructor.
  • Reflect on the patient’s symptoms and aspects of disorders that may be present.
  • Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
  • Access the Focused SOAP Note Template in this week’s Resources.

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.

NRNP_6540_Week7_Assignment_Rubric

NRNP_6540_Week7_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeCreate documentation in the Focused SOAP Note Template about the patient in the case study to which you were assigned. In the Subjective section, provide: • Chief complaint• History of present illness (HPI) • Current medications, checked against Beers Criteria• Allergies• Patient medical history (PMHx) • Review of systems

10 to >9.0 pts

Excellent

The response throughly and accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

9 to >8.0 pts

Good

The response accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

8 to >7.0 pts

Fair

The response describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. A cross-check of medications against the Beers Criteria has been completed but alternatives may be missing.

7 to >0 pts

Poor

The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has not been completed. Or, subjective documentation is missing.

10 pts

This criterion is linked to a Learning OutcomeIn the Objective section, provide: • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses

10 to >9.0 pts

Excellent

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

9 to >8.0 pts

Good

The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.

8 to >7.0 pts

Fair

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

7 to >0 pts

Poor

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.

10 pts

This criterion is linked to a Learning OutcomeIn the Assessment section, provide: • At least three (3) differentials with supporting evidence. Explain what rules each differential in or out, and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.

25 to >23.0 pts

Excellent

The response lists in order of priority at least three distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the conditions selected.

23 to >20.0 pts

Good

The response lists in order of priority at least three different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the conditions selected.

20 to >18.0 pts

Fair

The response lists three possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.

18 to >0 pts

Poor

The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.

25 pts

This criterion is linked to a Learning OutcomeIn the Plan section, provide: • A detailed treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits. • A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors. • Reflections on the case describing insights or lessons learned.

30 to >27.0 pts

Excellent

The response thoroughly and accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. A thorough and accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate strong critical thinking and synthesis of ideas.

27 to >24.0 pts

Good

The response accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. An accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate critical thinking.

24 to >21.0 pts

Fair

The response somewhat vaguely or inaccurately outlines a treatment plan for the patient. The discussion on health promotion and disease prevention related to the case is somewhat vague or contains innaccuracies. Reflections on the case demonstrate adequate understanding of course topics.

21 to >0 pts

Poor

The response does not address all diagnoses or is missing elements of the treatment plan. The discussion on health promotion and disease prevention related to the case is vague, innaccurate, or missing. Reflections on the case are vague or missing.

30 pts

This criterion is linked to a Learning OutcomeProvide 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.

10 to >9.0 pts

Excellent

The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents the latest in standards of care and provides strong justification for treatment decisions.

9 to >8.0 pts

Good

The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents current standards of care and supports treatment decisions.

8 to >7.0 pts

Fair

Three evidence-based resources are provided to support treatment decisions, but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan.

7 to >0 pts

Poor

Two or fewer resources are provided to support treatment decisions. The resources may not be current or evidence-based, or do not support the treatment plan.

10 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 to >4.0 pts

Excellent

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.0 pts

Good

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 to >2.0 pts

Fair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.

2 to >0 pts

Poor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.0 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.0 pts

Good

Contains a few (one or two) grammar, spelling, and punctuation errors.

3 to >2.0 pts

Fair

Contains several (three or four) grammar, spelling, and punctuation errors.

2 to >0 pts

Poor

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.

5 to >4.0 pts

Excellent

Uses correct APA format with no errors.

4 to >3.0 pts

Good

Contains a few (one or two) APA format errors.

3 to >2.0 pts

Fair

Contains several (three or four) APA format errors.

2 to >0 pts

Poor

Contains many (≥ five) APA format errors.

5 pts

Total Points: 100

PreviousNext

NRNP 6540 Week 8 Assignment Paper

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.HPI:

She states that she has had a sensation of deep pain in her bones and joints.

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)

PE shows 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.

To prepare:

  • Review the case study provided by your Instructor.
  • Reflect on the patient’s symptoms and aspects of disorders that may be present.
  • Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
  • Access the Focused SOAP Note Template in this week’s Resources.

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.

NRNP_6540_Week8_Assignment_Rubric

NRNP_6540_Week8_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeCreate documentation in the Focused SOAP Note Template about the patient in the case study to which you were assigned. In the Subjective section, provide: • Chief complaint• History of present illness (HPI) • Current medications, checked against Beers Criteria• Allergies• Patient medical history (PMHx) • Review of systems

10 to >9.0 pts

Excellent

The response throughly and accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

9 to >8.0 pts

Good

The response accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

8 to >7.0 pts

Fair

The response describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. A cross-check of medications against the Beers Criteria has been completed but alternatives may be missing.

7 to >0 pts

Poor

The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has not been completed. Or, subjective documentation is missing.

10 pts
This criterion is linked to a Learning OutcomeIn the Objective section, provide: • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses

10 to >9.0 pts

Excellent

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

9 to >8.0 pts

Good

The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.

8 to >7.0 pts

Fair

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

7 to >0 pts

Poor

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.

10 pts
This criterion is linked to a Learning OutcomeIn the Assessment section, provide: • At least three (3) differentials with supporting evidence. Explain what rules each differential in or out, and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.

25 to >23.0 pts

Excellent

The response lists in order of priority at least three distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the conditions selected.

23 to >20.0 pts

Good

The response lists in order of priority at least three different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the conditions selected.

20 to >18.0 pts

Fair

The response lists three possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.

18 to >0 pts

Poor

The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.

25 pts
This criterion is linked to a Learning OutcomeIn the Plan section, provide: • A detailed treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits. • A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors. • Reflections on the case describing insights or lessons learned.

30 to >27.0 pts

Excellent

The response thoroughly and accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. A thorough and accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate strong critical thinking and synthesis of ideas.

27 to >24.0 pts

Good

The response accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. An accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate critical thinking.

24 to >21.0 pts

Fair

The response somewhat vaguely or inaccurately outlines a treatment plan for the patient. The discussion on health promotion and disease prevention related to the case is somewhat vague or contains innaccuracies. Reflections on the case demonstrate adequate understanding of course topics.

21 to >0 pts

Poor

The response does not address all diagnoses or is missing elements of the treatment plan. The discussion on health promotion and disease prevention related to the case is vague, innaccurate, or missing. Reflections on the case are vague or missing.

30 pts
This criterion is linked to a Learning OutcomeProvide 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.

10 to >9.0 pts

Excellent

The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents the latest in standards of care and provides strong justification for treatment decisions.

9 to >8.0 pts

Good

The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents current standards of care and supports treatment decisions.

8 to >7.0 pts

Fair

Three evidence-based resources are provided to support treatment decisions, but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan.

7 to >0 pts

Poor

Two or fewer resources are provided to support treatment decisions. The resources may not be current or evidence-based, or do not support the treatment plan.

10 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 to >4.0 pts

Excellent

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.0 pts

Good

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 to >2.0 pts

Fair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.

2 to >0 pts

Poor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.

5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.0 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.0 pts

Good

Contains a few (one or two) grammar, spelling, and punctuation errors.

3 to >2.0 pts

Fair

Contains several (three or four) grammar, spelling, and punctuation errors.

2 to >0 pts

Poor

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.

5 to >4.0 pts

Excellent

Uses correct APA format with no errors.

4 to >3.0 pts

Good

Contains a few (one or two) APA format errors.

3 to >2.0 pts

Fair

Contains several (three or four) APA format errors.

2 to >0 pts

Poor

Contains many (≥ five) APA format errors.

5 pts
Total Points: 100

PreviousNext

NRNP 6540 Week 9 Assignment

To prepare:

  • Review the case study provided below
  • Reflect on the patient’s symptoms and aspects of disorders that may be present.
  • Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
  • Access the Focused SOAP Note Template in this week’s Resources.

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 assessment 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 is in or out. Explain the critical thinking process that led you to your primary diagnosis. 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 differential diagnoses. Be sure they are current (no more than five years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.

HPI: Ms. Juggenmeir is a 71-year-old Female who comes into your office with concerns about fatigue and dry skin. She is a retired Banker. She is AAOx4, ambulatory, and lives by herself. She does report increased fatigue no matter how much sleep she gets.  She is also concerned that she may need to come off one of her meds because her hair is thinning.  She had labs done and was informed they would review the results at this visit. Other pertinent diagnoses include Hypertension, Hyperlipidemia, and Vitamin D deficiency. She admits to not taking her vitamin D daily as prescribed.

RESOURCE FOR THIS WEEK: Review Endocrine-related Evidence-Based Practice Guidelines.

Ms. Juggenmeir is a 71 y/o female who is AAOX4.  She makes no unusual motor movements and demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She denies any falls or pain.

(All other Review of System and Physical Exam findings are negative other than stated.)

Vital Signs: BP 137/82, HR 89, RR 20, Temp 98.1

PMH: Hypertension, Hyperlipidemia, Vitamin D deficiency

Allergies: I.V. Contrast, ACE Inhibitors

Medications:

Women’s One A Day-Multivitamin daily

Chlorthalidone 25mg daily

Fish Oil 1  tablet daily

Amlodipine 5mg p.o. daily

Losartan 100mg p.o. daily

Atorvastatin 40mg p.o. at bedtime daily

Aspirin 81mg p.o. daily

Ergocalciferol 50,000 units PO once a month

Social History: as stated in the Case Study

ROS: as stated in the Case study

Diagnostics/Assessments done:

  1. CXR – The last CXR showed no cardiopulmonary findings. WNL
  2. TSH/Free T4, T3 – as noted below in lab results
  3. Basic Metabolic Panel and CBC as shown below
  4. Vitamin D Level – as noted below in lab results
TEST RESULT REFERENCE RANGE
GLUCOSE 85 65-99
SODIUM 134 135-146
POTASSIUM 4.2 3.5-5.3
CHLORIDE 104 98-110
CARBON DIOXIDE 29 19-30
CALCIUM 9.0 8.6- 10.3
BUN 20 7-25
CREATININE 1.01 0.70-1.25
GLOMERULAR FILTRATION RATE (eGFR) 76 >or=60 mL/min/1.73m2

 

TEST RESULT REFERENCE RANGE
TSH 23 0.4-4.0
FREE T4 0.05 0.9-2.4 mcg/dl
T3 3.0 2.0-4.4 ng/dl
Vitamin D 1,25 OH 14 36-144

 

TEST RESULT REFERENCE RANGE
WBC 7.3 3.4- 10.8
RBC 4.31 135-146
HEMOGLOBIN 14 13-17.2
HEMATOCRIT 42% 36-50
MCV 90 80-100
MCHC 34 32-36
PLATELET 272 150-400

NRNP_6540_Week9_Assignment_Rubric

NRNP_6540_Week9_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeCreate documentation in the Focused SOAP Note Template about the patient in the case study to which you were assigned. In the Subjective section, provide: • Chief complaint• History of present illness (HPI) • Current medications, checked against Beers Criteria• Allergies• Patient medical history (PMHx) • Review of systems

10 to >9.0 ptsExcellent

The response throughly and accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

9 to >8.0 ptsGood

The response accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

8 to >7.0 ptsFair

The response describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. A cross-check of medications against the Beers Criteria has been completed but alternatives may be missing.

7 to >0 ptsPoor

The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has not been completed. Or, subjective documentation is missing.

10 pts
This criterion is linked to a Learning OutcomeIn the Objective section, provide: • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses

10 to >9.0 ptsExcellent

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

9 to >8.0 ptsGood

The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.

8 to >7.0 ptsFair

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

7 to >0 ptsPoor

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.

10 pts
This criterion is linked to a Learning OutcomeIn the Assessment section, provide: • At least three (3) differentials with supporting evidence. Explain what rules each differential in or out, and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.

25 to >23.0 ptsExcellent

The response lists in order of priority at least three distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the conditions selected.

23 to >20.0 ptsGood

The response lists in order of priority at least three different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the conditions selected.

20 to >18.0 ptsFair

The response lists three possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.

18 to >0 ptsPoor

The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.

25 pts
This criterion is linked to a Learning OutcomeIn the Plan section, provide: • A detailed treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits. • A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors. • Reflections on the case describing insights or lessons learned.

30 to >27.0 ptsExcellent

The response thoroughly and accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. A thorough and accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate strong critical thinking and synthesis of ideas.

27 to >24.0 ptsGood

The response accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. An accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate critical thinking.

24 to >21.0 ptsFair

The response somewhat vaguely or inaccurately outlines a treatment plan for the patient. The discussion on health promotion and disease prevention related to the case is somewhat vague or contains inaccuracies. Reflections on the case demonstrate adequate understanding of course topics.

21 to >0 ptsPoor

The response does not address all diagnoses or is missing elements of the treatment plan. The discussion on health promotion and disease prevention related to the case is vague, innaccurate, or missing. Reflections on the case are vague or missing.

30 pts
This criterion is linked to a Learning outcome of at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than five years old) and support the treatment plan in following current standards of care.

10 to >9.0 ptsExcellent

The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents the latest in standards of care and provides strong justification for treatment decisions.

9 to >8.0 ptsGood

The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents current standards of care and supports treatment decisions.

8 to >7.0 ptsFair

Three evidence-based resources are provided to support treatment decisions, but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan.

7 to >0 ptsPoor

Two or fewer resources are provided to support treatment decisions. The resources may not be current or evidence-based or do not support the treatment plan.

10 pts
This criterion is linked to a Learning outcome Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long, rambling, short, and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 to >4.0 ptsExcellent

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.0 ptsGood

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. The assignment’s purpose, introduction, and conclusion are stated, yet are brief and not descriptive.

3 to >2.0 ptsFair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. The assignment’s purpose, introduction, and conclusion are vague or off-topic.

2 to >0 ptsPoor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.

5 pts
This criterion is linked to a Learning outcome Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.0 ptsExcellent

Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.0 ptsGood

Contains a few (one or two) grammar, spelling, and punctuation errors.

3 to >2.0 ptsFair

Contains several (three or four) grammar, spelling, and punctuation errors.

2 to >0 ptsPoor

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts
This criterion is linked to a Learning outcome. Expression and Formatting – The paper follows the correct APA format for the title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.

5 to >4.0 ptsExcellent

Uses the correct APA format with no errors.

4 to >3.0 ptsGood

Contains a few (one or two) APA format errors.

3 to >2.0 ptsFair

Contains several (three or four) APA format errors.

2 to >0 ptsPoor

Contains many (≥ five) APA format errors.

5 pts
Total Points: 100

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NRNP 6566 Branching Exercise Cardiac Case 1 Assignment Example

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NRNP 6566 Branching Exercise Cardiac Case 1 Assignment Example

NRNP 6566 Branching Exercise: Cardiac Case 1 AssignmentNRNP 6566 Branching Exercise: Cardiac Case 1 Assignment

NRNP 6566 Branching Exercise Cardiac Case 1 Assignment Brief

Course: NRNP 6566 – Advanced Care of Adults in Acute Settings I

Assignment Title: NRNP 6566 Branching Exercise: Cardiac Case 1 Assignment

Assignment Instructions Overview

This assignment requires you to engage with an interactive media piece focusing on a cardiac patient case. You will be responsible for reviewing the patient presentation, including vital signs, past medical history (PMH), home medications, and diagnostic results. Based on this information, you will develop a comprehensive set of admission orders as the admitting provider, ensuring all aspects of patient care are addressed.

Understanding Assignment Objectives

The primary objective of this assignment is to apply your clinical knowledge and critical thinking skills to assess and treat a patient presenting with specific symptoms. You will develop a complete set of admission orders, ensuring no assumptions are made about prior treatments or protocols. The orders should include additional lab tests, diagnostics, medication adjustments, and rationales for each decision made.

The Student’s Role

As a student, you will take on the role of the admitting provider, responsible for the initial assessment and treatment plan for the patient. You must use the provided admission orders template, ensuring that each order is specific and leaves no room for interpretation by the nursing staff. Your role also involves justifying your decisions with evidence-based references, demonstrating an understanding of current guidelines and standards of care.

Competencies Measured

This assignment will measure your ability to:

  • Analyze patient data critically and develop appropriate treatment plans.
  • Apply current clinical guidelines and evidence-based practices in patient care.
  • Write clear and precise medical orders.
  • Justify clinical decisions with appropriate rationale and references.
  • Address all aspects of patient care, from immediate medical needs to long-term health promotion and discharge planning.

You Can Also Check Other Related Assessments for the NRNP 6566 – Advanced Care of Adults in Acute Settings I Course:

NRNP 6566 Impact of Pharmacokinetics on Medication Selection and Administration Assignment Example

NRNP 6566 Branching Exercise Cardiac Case 1 Assignment Example

Admission Orders for Cardiac Case 1: 63-Year-Old Female

Primary Diagnosis

Atrial Fibrillation with Rapid Ventricular Response

Status/Condition

Critical

Code Status

Full Code

Allergies

Penicillin

Admit to Unit

Intensive Care Unit (ICU)

Activity Level

Ambulate as tolerated

Diet

  • Clear liquids, advance as tolerated to a cardiac diet and low carbohydrate diet

IV Fluids

  • 0.9% Normal Saline at 75 mL/hr for hydration. Discontinue once the patient starts oral intake adequately.

Critical Drips

  • None required at this time as the patient’s rate is controlled with Metoprolol tartrate IV bolus. Monitor closely and reassess need for additional bolus if the rate increases again.

Respiratory

  • Oxygen via nasal cannula at 2 L/min. Wean if oxygen saturation remains >95% and the patient does not experience shortness of breath.

Medications

  • Heparin 5000 units subcutaneously BID for anticoagulation to prevent thromboembolic events (source: Harris, 2023).
  • Metoprolol tartrate 50 mg PO BID for ongoing rate control (source: Barkley & Myers, 2020).
  • Lisinopril 10 mg PO daily (reduce from home dose of 20 mg due to addition of Metoprolol) for hypertension management (source: Fuller & McCauley, 2023).
  • Metformin 500 mg PO BID, continue as home medication for diabetes management.

Nursing Orders

  • Vital signs every 15 minutes for 1 hour, then every 30 minutes for 1 hour, then hourly if stable.
  • Continuous cardiac monitoring.
  • Strict intake and output monitoring.
  • Daily weight.
  • Skin care and reposition every 2 hours.
  • Encourage use of incentive spirometer every hour while awake.

Follow-Up Lab Tests

  • Repeat CBC: To monitor hemoglobin, hematocrit, and platelet levels.
  • Repeat CMP: To assess electrolyte balance, renal function, and liver enzymes.
  • TSH: To rule out thyroid-related causes of atrial fibrillation.
  • INR: To monitor anticoagulation status with Heparin.

Diagnostic Testing

  • Echocardiogram: To evaluate cardiac function and structure, particularly to assess for any valvular disease or cardiomyopathy.
  • Chest X-ray: To rule out any pulmonary causes for the shortness of breath and to assess cardiac silhouette.

Consults

  • Cardiology: For evaluation and management of new-onset atrial fibrillation, including consideration for potential cardioversion or ablation if rhythm does not stabilize with medical management.

Patient Education and Health Promotion

  • Educate the patient on the importance of medication adherence, particularly the new anticoagulant and rate control medications.
  • Discuss lifestyle modifications for heart health, including a low-sodium, heart-healthy diet, regular physical activity, and smoking cessation if applicable.
  • Explain the need for regular follow-up appointments to monitor the condition and adjust treatment as necessary.

Discharge Planning and Required Follow-Up Care

  • Plan for discharge once the patient is hemodynamically stable, with controlled heart rate and without symptoms.
  • Schedule follow-up with primary care provider and cardiology within one week of discharge.
  • Arrange for outpatient monitoring of INR if the patient continues on anticoagulation therapy.

References

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

Fuller, V. J., & McCauley, P. S. (2023). Textbook for the adult-gerontology acute care nurse practitioner: Evidence-based standards of practice. Springer Publishing Company.

Harris, C. (2023). Adult-gerontology acute care practice guidelines (2nd ed.). Springer Publishing Company.

Detailed Assessment Instructions for the NRNP 6566 Branching Exercise Cardiac Case 1 Assignment

Description

Assignment: Branching Exercise: Cardiac Case 1

For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.

Photo Credit: [IMAGEMORE Co., Ltd.]/[none]/Getty Images

To prepare:

  • Review the information provided in the case (patient presentation, vital signs, pmh, home meds, results of labs and diagnostics. With this information, critically think about what is happening with the patient.
  • Use your critical thinking skills and current guidelines to develop orders. Include additional labs/diagnostics, what needs repeated and followed up on. Medications that need to be ordered or changed.

The Assignment:

  • Using the required admission orders template found under the Learning Resources: Required Reading.
  • Develop a set of orders as the admitting provider.
  • Be sure to address each aspect of the order template
  • Write the orders as you would in the patient’s chart. Be specific. Do not leave room for the nurse to interpret your orders.
  • Do not assume anything has already been done/order. Use the information given. Example: If the case does not mention fluids were given, the patient did not receive fluids. You may have to start from scratch as if you are working in the ER. And you must provide orders if the patient needs to be admitted.
  • Make sure the order is complete and applicable to the patient.
  • Make sure you provide rationales for your labs and diagnostics and anything else you feel the need to explain. This should be done at the end of the order set – not included with the order.
  • Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is the appropriate standard of care for this patient.
  • A minimum of three current (within the last 5 years), evidenced based references are required

By Day 7 of Week 2

Submit your completed Assignment by Day 7 of Week 2 in Module 2.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “MD2Assgn1+last name+first initial.(extension)” as the name.
  • Click the Module 2 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
  • Click the Module 2 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “MD2Assgn1+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.

 CASE STUDY INFORMATION:

BACKGROUND

Scenario #1 63 year old female (Branching Exercise: Cardiac Case 1: 63 Year Old Female)

    • 63-year-old female presents to the Emergency Department complaining of dizziness and shortness of breath.

VITAL SIGNS

    • PMH: HTN, Diabetes, TIA
    • Home Meds: Lisinopril, Metformin
    • Allergies: Penicillin
    • HR: 180, O2 Sat 94%, BP: 107/78, RR: 21
    • The patient is a full code 
    • Atrial Fibrillation with Rapid Ventricular Response
    • 12 lead EKG, TSH, CBC,CMP, INR
    • Metoprolol tartrate 2.5mg IV bolus over 2 minutes (Rate control in this patient is the first priority in order to enable ventricular filling and cardiac output. Anticoagulation is indicated unless there is a contraindication. Rate control and anticoagulation are the priority then Cardiology will advise on TEE/Cardioversion.)

Learning Resources – Branching Exercise: Cardiac Case 1: 63 Year Old Female

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 21, “Arrhythmias” (pp. 263–290)

Fuller, V. J., & McCauley, P. S. (2023). Textbook for the adult-gerontology acute care nurse practitioner: Evidence-based standards of practice. Springer Publishing Company.

Tachycardia’s, pp. 106-109

Harris, C. (2023). Adult-gerontology acute care practice guidelines (2nd ed.). Springer Publishing Company.

Arrhythmias, pp. 54-58

Document: Admission Orders Template (Word document)Download Admission Orders Template (Word document)

Document: Admission Orders Template (Word document)

Required Media (click to expand/reduce)

MedCram. (2019, June 9). ECG interpretation explained clearly and succinctly – arrhythmias, blocks, hypertrophy [Video file]. Retrieved from https://www.youtube.com/watch?v=Rv6l0ViRJDQ

MedCram. (2018, July 15). ST elevation – EKG/ECG interpretation case 12 (STEMI, MI, ACS) [Video file]. Retrieved from https://www.youtube.com/watch?v=8ajWCLqz3VQ

MedCram. (2017, July 23). EKG/ECG practice strip interpretation explained clearly – case 10 [Video file]. Retrieved from https://www.youtube.com/watch?v=zA1Dpwnzrxg

Walden University (Producer). (2019a). Branching exercise: Cardiac case 1 [Interactive media file]. Minneapolis, MN: Author.

Walden University (Producer). (2019a). Branching exercise: Cardiac case 1.[Interactive media file]. Minneapolis, MN: Author.

Antiarrhythmic Drugs for the AGACNP

Dr. Tony Anno, core faculty for the AGACNP program at Walden University reviews that cardiac cycle and arrythmia pathophysiology. A review and discussion on the use of antiarrhythmic drugs that the AGACNP may encounter in practice is also provided. (18m)

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

ECG Review for the AGACNP

Dr. Tony Anno reviews important concepts and skills needed in understanding and interpreting ECGs for the AGACNP in practice. This review will also build upon you previous knowledge and expertise in diagnosing and treating cardiac disorders. (14m)

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

LEARNING RESOURCES

Required Media

The assignment this week is the branching exercise.  You can go through the exercise as much as you want, until it is submitted.  You can only submit the assignment one time for grading.   Your assignment at the end of the exercise is to write orders that reflect your treatment plan for this patient.  The template for your order set is located in the required reading. Please be sure that you are writing specific orders exactly as you would in a patient’s chart.    The assignment is due by Sunday. 

Admission Orders Template

Primary Diagnosis:

Status/Condition (Critical, Guarded, Stable, etc.):

Code Status:

Allergies:

Admit to Unit:

Activity Level:

Diet:

IV Fluids:

 Critical Drips (If ordered, include type and rate. Do not defer to ICU protocol.):

Respiratory: Oxygen (If ordered, include type and rate.), pulmonary toilet needs, ventilator settings:

Medications (include ALL, tx of primary condition, underlying conditions, pain, comfort needs, etc., dose and route):

Nursing Orders (vital signs, skin care, toileting, ambulation, etc.):

Follow-Up Lab Tests:

 Diagnostic testing (CXR, US, 2D Echo, etc.):

Consults:

NOTE: (Do not defer management to a specialist. As an ACNP, you must manage the patient’s acute needs for at least a 24-hour period]. Include indication for consult. For example: “Cardiology consult for evaluation of new-onset atrial fibrillation,” or “Nutrition consult for TPN recommendations.”

Patient Education and Health Promotion (address age-appropriate patient education. if applicable):

Discharge Planning and Required Follow-Up Care:

References (minimum of three timely references that prove this plan follows current standards of care):

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