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:

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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

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 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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