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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 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:

2. Worsening Dementia – Progressive confusion and disorientation typical of dementia; however, acute exacerbation suggests an additional factor.
3. 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

• Required Readings (click to expand/reduce)

• Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Psychosocial disorders. In Advanced practice nursing in the care of older adults (2nd ed., pp. 428–469). F. A. Davis.
• Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Appendix B: Laboratory values in the older adult. In Advanced practice nursing in the care of older adults (2nd ed., pp. 505–506). F. A. Davis.
• Note: See the labs that are relevant to this week’s topics.
• Laske, R. A., & Stephens, B. A. (2018). Confusion states: Sorting out delirium, dementia, and depression. Nursing Made Incredibly Easy!, 16(6), 13–16. https://doi.org/10.1097/01.NME.0000546254.38666.1f
• NIH National Institute on Aging. (2017). Basics of Alzheimer’s disease and dementia: What is Alzheimer’s disease? [Multimedia file]. https://www.nia.nih.gov/health/what-alzheimers-disease

• Document: Focused SOAP Note Template (Word Document) (attach sent)

Rubric Detail Tutor needs to FOLLOW

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

Name: NRNP_6540_Week2_Assignment_Rubric

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

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 6566 Branching Exercise Cardiac Case 1 Assignment Example

NRNP 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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NURS 6512 Assessing the Abdomen Lab Assignment Example

NURS 6512 Assessing the Abdomen Lab Assignment

NURS 6512 Assessing the Abdomen Lab Assignment Brief

Course: NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning

Assignment Title: NURS 6512 – Assignment 1: Lab Assignment: Assessing the Abdomen

Assignment Instructions Overview

In this lab assignment, you will analyze an episodic note case study describing abnormal findings in patients presenting with abdominal symptoms. Your task is to thoroughly assess the provided patient scenario, identifying essential history elements, performing appropriate physical examinations, and recommending diagnostic tests to aid in formulating a differential diagnosis.

Understanding Assignment Objectives

This assignment aims to evaluate your ability to:

• Analyze subjective and objective data in an episodic note.
• Apply concepts from advanced health assessment to assess abdominal and gastrointestinal conditions.
• Formulate a differential diagnosis based on clinical findings and evidence-based literature.

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The Student’s Role

As a student, your role is to:

• Review the provided episodic note case study and associated learning resources.
• Determine relevant patient history details crucial for accurate assessment.
• Recommend appropriate physical exams and diagnostic tests based on the patient’s clinical presentation.
• Formulate a differential diagnosis considering potential conditions aligned with the patient’s symptoms and clinical data.

Competencies Measured

This assignment assesses the following competencies:

• Ability to collect comprehensive patient history related to abdominal and gastrointestinal symptoms.
• Proficiency in conducting systematic physical examinations to assess abdominal findings.
• Skill in recommending evidence-based diagnostic tests to aid in accurate diagnosis.
• Capacity to critically evaluate and justify differential diagnosis based on clinical evidence.

You Can Also Check Other Related Assessments for the NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Course:

NURS 6512 Diversity and Health Assessments Discussion Assignment Example

NURS 6512 Differential Diagnosis for Skin Conditions Lab Assignment Example

NURS 6512 Building a Comprehensive Health History Discussion Assignment Example

NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children Assignment Example

NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat Case Study Assignment Example

NURS 6512 Assessing the Abdomen Lab Assignment Example

NURS 6512 – Assignment 1: Lab Assignment: Assessing the Abdomen

SOAP Note

S:

CC: “My stomach hurts, I have diarrhea, and nothing seems to help.”

HPI: M.N, a 47-year-old woman, presents with an abdominal pain complaint that began three days ago. She hasn’t taken any medicines since she didn’t know what to take. She states her pain rate is 5/10 better than it first began.

PMH: Hypertension, Diabetes, GI bleeding history four years back.

Medications: Amlodipine 5 mg, Lisinopril 10mg, and Metformin 1000mg.

Allergies: NKDA

Family History: No history of colon cancer, Father has DMT2, Hypertension, Mother as well has HTN, Hyperlipidemia, and GERD

Social: Doesn’t smoke, married with three kids (2 girls and a boy)

O:

Vital signs: Temp 99.8; RR 16; P 92; BP 160/86; Height 5’10”; Weight 248lbs

Heart: No murmurs

Lungs: Clear chest walls

Skin: Intact without urticaria and lesions

Abdomen: hyperactive bowel sounds, soft

Assessment:

Gastroenteritis

Subjective Portion Analysis

The subjective portion of the SOAP note details the patient’s symptoms and history. It is crucial for understanding the patient’s current condition and guiding further examination and treatment. The covered areas include chief complaints, history of present illness, past medical history, current medications, social history, allergies, and family history. However, additional information should be gathered to complete the history, such as the patient’s location and recent dietary intake which could contribute to symptoms (Colyar, 2015).

Objective Portion Analysis

The objective part of the SOAP note provides the physician’s findings from the physical examination. While it includes vital signs, cardiovascular, respiratory, and abdominal assessments, a more comprehensive head-to-toe examination is necessary. This would encompass evaluation of additional areas like neurological and musculoskeletal systems to rule out other potential causes of symptoms (LeBlond et al., 2014).

Assessment

The assessment is supported by both the subjective and objective data. Subjective data supports the diagnosis through the patient’s reported symptoms and history. Objective findings include abdominal tenderness and hyperactive bowel sounds, aligning with the diagnosis of gastroenteritis (Dains et al., 2019).

Diagnostic Tests

Appropriate diagnostic tests for this case include stool culture to identify infectious agents causing gastroenteritis. Endoscopy or colonoscopy may also be considered to evaluate for other gastrointestinal conditions presenting similarly to gastroenteritis (LeBlond et al., 2014).

Current Diagnosis

The current diagnosis of gastroenteritis is well-supported by the patient’s symptoms and objective findings. Symptoms include abdominal pain, diarrhea, and nausea, which are typical manifestations of gastroenteritis. The absence of severe complications and improvement without treatment further supports this diagnosis (Bányai et al., 2018).

Differential Diagnosis

1. Amebiasis: Parasitic infection causing symptoms similar to gastroenteritis, including diarrhea and abdominal pain (Bányai et al., 2018).
2. Bacterial gastroenteritis: Infection of the gut by bacterial pathogens presenting with severe abdominal cramps and diarrhea (Barrett & Fhogartaigh, 2017).
3. Food poisoning: Toxin-mediated illness from contaminated food, leading to gastrointestinal symptoms like vomiting and diarrhea (Barrett & Fhogartaigh, 2017).

References

Bányai, K., Estes, M. K., Martella, V., & Parashar, U. D. (2018). Viral gastroenteritis. The Lancet, 392(10142), 175-186. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0140673618311280

Barrett, J., & Fhogartaigh, C. N. (2017). Bacterial gastroenteritis. Medicine, 45(11), 683-689. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1357303917302177

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

Detailed Assessment Instructions for the NURS 6512 Assessing the Abdomen Lab Assignment

Week 6: Assessment of the Abdomen and Gastrointestinal System

On your way home from dinner, you start experiencing sharp pains in your abdomen. You ate seafood—could you have food poisoning? What else might be causing your pain? Appendicitis? Should you head to the emergency room, or should you wait and see how you feel in the morning?

Numerous ailments can affect the GI system and the abdomen. Because the organs are so close, it can be difficult to conduct an accurate assessment. Also, pain in another area of the body can affect the GI system. For example, patients with chronic migraines often report nausea.

This week, you will explore how to assess the abdomen and gastrointestinal system.

Learning Objectives

Students will:

• Evaluate abnormal abdomen and gastrointestinal findings
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the abdomen and gastrointestinal system
• Identify concepts, theories, and principles related to advanced health assessment

Learning Resources

Required Readings

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 6, “Vital Signs and Pain Assessment”

This chapter describes the experience of pain and its causes. The authors also describe the process of pain assessment.

• Chapter 18, “Abdomen”

In this chapter, the authors summarize the anatomy and physiology of the abdomen. The authors also explain how to conduct an assessment of the abdomen.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

• Chapter 3, “Abdominal Pain”

This chapter outlines how to collect a focused history on abdominal pain. This is followed by what to look for in a physical examination in order to make an accurate diagnosis.

• Chapter 10, “Constipation”

The focus of this chapter is on identifying the causes of constipation through taking a focused history, conducting physical examinations, and performing laboratory tests.

• Chapter 12, “Diarrhea”

In this chapter, the authors focus on diagnosing the cause of diarrhea. The chapter includes questions to ask patients about the condition, things to look for in a physical exam, and suggested laboratory or diagnostic studies to perform.

• Chapter 29, “Rectal Pain, Itching, and Bleeding”

This chapter focuses on how to diagnose rectal bleeding and pain. It includes a table containing possible diagnoses, the accompanying physical signs, and suggested diagnostic studies.

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.

These sections below explain the procedural knowledge needed to perform gastrointestinal procedures.

Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487)

Chapter 115, “X-Ray Interpretation of Abdomen” (pp. 514–520)

Note: Download this Student Checklist and Abdomen Key Points to use during your practice abdominal examination.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Document: Midterm Exam Review (Word document)

Optional Resource

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

• Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)

This chapter explores the health assessment processes for the abdomen, perineum, anus, and rectosigmoid. This chapter also examines the symptoms of many conditions in these areas.

• Chapter 10, “The Urinary System” (pp. 528–540)

In this chapter, the authors provide an overview of the physiology of the urinary system. The chapter also lists symptoms and conditions of the urinary system.

Required Media

Assessment of the Abdomen and Gastrointestinal System – Week 6 (14m)

Online media for Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 17 that relate to the assessment of the abdomen and gastrointestinal system. Refer to Week 4 for access instructions on https://evolve.elsevier.com/

Assignment 1: Lab Assignment: Assessing the Abdomen

A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the doctor ordered a CT scan. The CT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping.

Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.

In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

To Prepare

Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.

• With regard to the Episodic note case study provided:
  • Review this week’s Learning Resources, and consider the insights they provide about the case study.
  • Consider what history would be necessary to collect from the patient in the case study.
  • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
  • Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Assignment

1. Analyze the subjective portion of the note. List additional information that should be included in the documentation.
2. Analyze the objective portion of the note. List additional information that should be included in the documentation.
3. Is the assessment supported by the subjective and objective information? Why or why not?
4. What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?
5. Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

By Day 7 of Week 6

Submit your Lab 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 “WK6Assgn1+last name+first initial. (extension)” as the name.
• Click the Week 6 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 6 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 “WK6Assgn1+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 6 Assignment 1 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 6 Assignment 1 draft and review the originality report.

Submit Your Assignment by Day 7 of Week 6

To participate in this Assignment:

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NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children Assignment Example

NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children Assignment

NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children Assignment Brief

Course: NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning

Assignment Title: NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children Assignment

Assignment Instructions Overview

In this assignment, you will explore the application of assessment tools and diagnostic tests used by advanced practice nurses to evaluate patient health conditions. Understanding the validity and reliability of these tools is crucial for accurate diagnosis and patient management. For pediatric cases, considerations such as growth, measurements, and nutrition play significant roles in assessing health risks and recommending interventions.

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Understanding Assignment Objectives

The primary objective of this assignment is to assess your understanding of assessment tools and diagnostic tests in healthcare settings, both for adults and children. You will evaluate the purpose, conduct, and information gathered by these tools. Additionally, you will critically analyze factors influencing their validity, reliability, sensitivity, specificity, and predictive values. For child health cases, you will identify relevant health risks, determine necessary information for comprehensive assessment, and develop strategies to engage parents or caregivers in proactive health management.

The Student’s Role

As a student, your role is to conduct comprehensive research on the assigned assessment tool or diagnostic test. You will analyze its clinical utility, strengths, and limitations based on current literature. For child health cases, you will identify potential health risks and formulate sensitive approaches to gather necessary information from parents or caregivers.

Competencies Measured

This assignment assesses your ability to:

• Analyze the purpose and use of assessment tools and diagnostic tests in healthcare.
• Evaluate the validity, reliability, sensitivity, specificity, and predictive values of selected tools.
• Identify and assess health risks relevant to pediatric patients.
• Develop effective communication strategies to engage parents or caregivers in proactive health practices.

You Can Also Check Other Related Assessments for the NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Course:

NURS 6512 Diversity and Health Assessments Discussion Assignment Example

NURS 6512 Differential Diagnosis for Skin Conditions Lab Assignment Example

NURS 6512 Building a Comprehensive Health History Discussion Assignment Example

NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat Case Study Assignment Example

NURS 6512 Assessing the Abdomen Lab Assignment Example

NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children Assignment Example

Uses of BMI in Healthcare

Body Mass Index (BMI) serves as a widely used anthropometric measurement to estimate body fat by comparing an individual’s weight to their height. This metric is essential for public health purposes, providing clear indications of whether individuals have an ideal weight for their height (Hall & Cole, 2016). Primarily, BMI categorizes individuals into groups such as underweight, normal weight, overweight, and obese, helping identify those at risk for chronic conditions like type 2 diabetes, cardiovascular diseases, and hypertension (Hall & Cole, 2016). For adults, BMI remains unaffected by age or sex. However, for children and adolescents, age and sex are critical factors due to the different growth rates and body fat levels in boys and girls. Consequently, BMI measurements for this younger population must be plotted on a sex-specific BMI-for-age growth chart (Centers for Disease Control and Prevention [CDC], 2018). Children are classified as obese if their BMI-for-age is at or above the 95th percentile and overweight if it is between the 85th and 94th percentiles (CDC, 2018).

BMI’s Validity and Reliability

The validity and reliability of BMI as a tool for assessing body fat and obesity risk are subjects of ongoing debate. Validity refers to the tool’s accuracy in measuring what it intends to measure, while reliability denotes the consistency of these measurements. The accuracy of BMI in estimating body fat across different populations and individuals is often questioned. Factors such as age, physical activity, ethnicity, and gender can significantly influence the relationship between BMI and actual body fat percentage (Freedman & Sherry, 2015). As individuals age, changes in body composition, such as decreased muscle mass and increased visceral fat, can occur even if overall body weight remains stable (Zhang et al., 2018). Health risks correlate more closely with visceral fat, which BMI does not measure accurately. Thus, BMI may not always reliably indicate an individual’s health, particularly in children who exhibit significant variations in body composition based on sex and developmental stage. Moreover, ethnic differences in body composition mean that BMI thresholds may not equally predict health risks across various racial groups (Freedman & Sherry, 2015).

Health Issues/Risks Relevant to the 5-Year-Old Overweight African American Boy

The 5-year-old African American boy faces significant health risks due to his overweight status and low physical activity levels. These risks include elevated cholesterol levels, high blood pressure, and a predisposition to cardiovascular diseases. Additionally, respiratory issues such as sleep apnea and asthma pose significant concerns. The boy also risks developing impaired glucose tolerance, potentially leading to type 2 diabetes, as well as fatty liver disease, musculoskeletal discomfort, gastroesophageal reflux, and gallstones (Gibbs & Chapman-Novakofski, 2012).

Additional Information Needed

To thoroughly assess the boy’s weight-related health, gathering detailed information about his dietary habits is essential. This includes data on the types of food consumed, meal frequency, portion sizes, nutritional quality, snack consumption, food preparation methods, and the mealtime environment (Gibbs & Chapman-Novakofski, 2012). Understanding his physical activity levels, including the types and frequency of physical activities, is also crucial.

Identification of Risks to the Child’s Health

Examining the child’s dietary intake and social behaviors, such as playing with friends, enables healthcare providers to identify specific health risks. A diet high in fast foods and processed snacks, combined with a lack of physical activity, increases the child’s susceptibility to obesity and related health issues. Gathering this sensitive information from parents can be achieved by clearly explaining the study’s objectives and the benefits it can bring to their child’s health. Ensuring confidentiality will also encourage parental cooperation (Ball et al., 2019).

Specific Questions Relating to the Child

1. How many meals does the child consume daily?
2. What is the composition of the meals consumed throughout the day?
3. Is the child involved in any physical activities? How frequently?

Strategies to Help Parents Control the Child’s Weight and Health

Promoting physical activity and providing nutritional guidance are essential strategies for parents. Encouraging the child to engage in daily physical activities, such as walking, cycling, or swimming, ideally involving the parents, fosters a supportive environment. Providing educational materials like a food pyramid can assist parents in planning balanced and nutritious meals, thereby guiding healthier food choices and controlling portion sizes. These measures contribute to gradual and sustainable weight loss (Ball et al., 2019).

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Centers for Disease Control and Prevention. (2018). Childhood overweight and obesity. Retrieved from http://www.cdc.gov/obesity/childhood.

Freedman, D. S., & Sherry, B. (2015). The validity of BMI as an indicator of body fatness and risk among children. Pediatrics, 124(Supplement 1), S23–S34. https://doi.org/10.1542/peds.2008-3586e

Gibbs, H., & Chapman-Novakofski, K. (2012). Exploring nutrition literacy: Attention to assessment and the skills clients need. Health, 4(3), 120–124.

Hall, D. M., & Cole, T. J. (2016). What use is the BMI?. Archives of Disease in Childhood, 91(4), 283–286. https://doi.org/10.1136/adc.2005.077339

Zhang, L., Fos, P. J., Johnson, W. D., Kamali, V., Cox, R. G., Zuniga, M. A., & Kittle, T. (2018). Body mass index and health-related quality of life in elementary school children: A pilot study. Health and Quality of Life Outcomes, 6, 77. https://doi.org/10.1186/1477-7525-6-77

Detailed Assessment Instructions for the NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children Assignment

Assessment Tool, Diagnostics, Growth, Measurements, and Nutrition in Adults and Children – Week 3 (11m)

Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children

When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.

Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.

For this Assignment, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. You will also consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

To Prepare

• Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.
• By Day 1 of this week, you will be assigned to one of the following Assignment options by your Instructor: Adult Assessment Tools or Diagnostic Tests (option 1), or Child Health Case (Option 2). Note: Please see the “Course Announcements” section of the classroom for your assignments from your Instructor.
• Search the Walden Library and credible sources for resources explaining the tool or test you were assigned. What is its purpose, how is it conducted, and what information does it gather?
• Also, as you search the Walden library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.
• If you are assigned Assignment Option 2 (Child), consider what health issues and risks may be relevant to the child in the health example.
  • Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
  • Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

The Assignment

Assignment (3–4 pages, not including title and reference pages):

Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:

Include the following:

• A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.
  • What is its purpose?
  • How is it conducted?
  • What information does it gather?
• Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

Assignment Option 2: Child Health Case:

Include the following:

• An explanation of the health issues and risks that are relevant to the child you were assigned.
• Describe additional information you would need in order to further assess his or her weight-related health.
• Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
• Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.
• Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.

By Day 6 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 Option 1 Rubric

To access your rubric:

Week 3 Assignment 1 Option 2 Rubric

To check your Assignment draft for authenticity:

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

Submit Your Assignment by Day 6 of Week 3

To participate in this Assignment:

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NURS 6512 Differential Diagnosis for Skin Conditions Lab Assignment Example

NURS 6512 Differential Diagnosis for Skin Conditions Lab Assignment

NURS 6512 Differential Diagnosis for Skin Conditions Lab Assignment Brief

Course: NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning

Assignment Title: NURS 6512 Differential Diagnosis for Skin Conditions Lab Assignment

Assignment Instructions Overview

In this lab assignment, you will engage in differential diagnosis to determine the probable cause of a patient’s skin condition based on visual representations. You will utilize clinical terminologies to describe physical characteristics, formulate a differential diagnosis, and justify the most likely diagnosis using evidence-based practices and resources provided in the course.

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Understanding Assignment Objectives

The primary objective of this assignment is to develop your proficiency in differential diagnosis skills specific to dermatological conditions. By analyzing visual representations of skin abnormalities and applying clinical reasoning, you will enhance your ability to identify and prioritize potential diagnoses.

The Student’s Role

As a student, your role involves:

• Reviewing provided resources on skin conditions.
• Analyzing visual depictions of skin abnormalities.
• Using clinical terminologies to describe observed characteristics.
• Formulating a differential diagnosis of potential conditions.
• Justifying your diagnosis with evidence-based references.
• Completing and submitting a SOAP note following the Comprehensive SOAP template provided.

Competencies Measured

This assignment measures the following competencies:

• Ability to apply differential diagnosis principles.
• Proficiency in using clinical terminologies.
• Capacity to analyze and interpret visual data.
• Skill in integrating evidence-based practices into clinical decision-making.
• Capability to communicate findings effectively in a SOAP note format.

You Can Also Check Other Related Assessments for the NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Course:

NURS 6512 Diversity and Health Assessments Discussion Assignment Example

NURS 6512 Building a Comprehensive Health History Discussion Assignment Example

NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children Assignment Example

NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat Case Study Assignment Example

NURS 6512 Assessing the Abdomen Lab Assignment Example

NURS 6512 Differential Diagnosis for Skin Conditions Lab Assignment Example

NURS 6512 – Lab Assignment: Differential Diagnosis for Skin Conditions

SOAP Note

Comprehensive SOAP NOTE

Patient Initials: N/A

Age: N/A

Gender: N/A

Student’s Name: [Your Name]

Institutional Affiliation: [Your Institution]

SUBJECTIVE DATA

Chief Complaint (CC):

Patient presents with non-scaly annular papules distributed along the nape, described as having well-defined borders and appearing reddish in color.

History of Present Illness (HPI):

A Caucasian male of unknown age with no provided medical history is observed with annular papules on the neck. No specific medications or allergies noted. Comprehensive inquiry pending into sexual/reproductive, personal/social, and immunization histories. Family history pertinent to skin conditions not disclosed.

Review of Systems:

General: No report of symptoms such as fatigue, fever, sweating, or weight changes.

HEENT: No reported changes in vision, hearing, chewing, swallowing, or nasal functions.

Neck: Presence of red lesions noted on the back of the neck.

Breasts: No history of lesions, masses, or rashes reported.

Respiratory/CV/GI/GU/MS/Psych/Neuro/Integument/Heme/Lymph/Endocrine/Allergic-Immunologic: No reported complications in any of these systems.

OBJECTIVE DATA

Physical Exam:

General: Vital signs including blood pressure, temperature, heart rate, and BMI within normal limits. No signs of fatigue or discomfort noted.

HEENT: Eyes, ears, and nose examined; no abnormalities detected.

Neck: Non-scaly annular papules observed at the nape, texture and warmth palpated.

Chest/Lungs/Heart/Peripheral Vascular/ABD/Genital/Rectal/Musculoskeletal/Neuro: No abnormalities noted in these systems.

Skin/Lymph Nodes: Non-scaly annular lesions observed at the back of the neck; assessment for lesions on other body regions recommended.

ASSESSMENT

Diagnostics:

Lab:

Recommended diagnostic procedures include dermoscopy, diascopy, and punch biopsy to further investigate the lesions and determine appropriate treatment.

Differential Diagnosis (DDx):

Tinea corporis: Red, circular, itchy rashes; common on arms and legs due to skin contact with infected persons or animals.

Pityriasis rosea: Oval rash starting on chest/back, spreading; affects young adults, often self-resolving.

Lupus: Autoimmune disorder affecting skin, joints, organs; presents with various symptoms including butterfly-shaped rashes and systemic involvement.

Guttate psoriasis: Small, red, itchy lesions; associated with streptococcal infections and genetic predisposition.

Primary Diagnosis:

Granuloma annulare: Circular, reddish lesions triggered by skin injury or specific medications; may resolve spontaneously over time or with treatment.

Discussion

Diagnosing skin conditions is challenging, especially through image interpretation without direct patient interaction. Primary diagnosis of granuloma annulare was selected based on symptoms observed. Consideration of alternative diagnoses such as tinea corporis, pityriasis rosea, and lupus is warranted due to overlapping symptoms. Further physical exams and lab assessments are necessary for accurate diagnosis and management.

References

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2015). Advanced Health Assessment & Clinical Diagnosis in Primary Care-E-Book. Elsevier Health Sciences.

Halder, R. M., & Nootheti, P. K. (2014). Ethnic skin disorders overview. Journal of the American Academy of Dermatology, 48(6), S143-S148.

Detailed Assessment Instructions for the NURS 6512 Differential Diagnosis for Skin Conditions Lab Assignment

Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

To Prepare

• Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.
• Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
• Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
• Consider which of the conditions is most likely to be the correct diagnosis, and why.
• Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.
• Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.
• Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.

The Lab Assignment

• Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.
• Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.

By Day 7 of Week 4

Submit your Lab 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 “WK4Assgn1+last name+first initial.(extension)” as the name.
• Click the Week 4 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 4 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 “WK4Assgn1+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 4 Assignment 1 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 4 Assignment 1 draft and review the originality report.

Submit Your Assignment by Day 7 of Week 4

To participate in this Assignment:

Comprehensive SOAP Template

This template is for a full history and physical. For this course include only areas that are related to the case.

Patient Initials: _______ Age: _______ Gender: _______

Note: The mnemonic below is included for your reference and should be removed before the submission of your final note.

L =location

O= onset

C= character

A= associated signs and symptoms

T= timing

E= exacerbating/relieving factors

S= severity

SUBJECTIVE DATA:Include what the patient tells you, but organize the information.

Chief Complaint (CC):In just a few words, explain why the patient came to the clinic.

History of Present Illness (HPI):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. 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: NURS 6512 Week 4 Assignment 1- Differential Diagnosis for Skin Conditions

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

Medications:Include over-the-counter, vitamin, and herbal supplements. List each one by name with dosage and frequency.

Allergies:Include specific reactions to medications, foods, insects, and environmental factors. Identify if it is an allergy or intolerance.

Past Medical History (PMH):Include illnesses (also childhood illnesses), hospitalizations.

Past Surgical History (PSH):Include dates, indications, and types of operations.

Sexual/Reproductive History: If applicable,include obstetric history, menstrual history, methods of contraception, sexual function, and risky sexual behaviors.

Personal/Social History:Include tobacco use, alcohol use, drug use, patient’s interests, ADL’s and IADL’s if applicable, and exercise and eating habits. NURS 6512 Week 4 Assignment 1- Differential Diagnosis for Skin Conditions

Immunization History:Includelast Tdap, Flu, pneumonia, etc.

Significant Family History: Include history of parents, grandparents, siblings, and children.

Lifestyle:Include cultural factors, economic factors, safety, and support systems and sexual preference.

Review of Systems:From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History (this includes the systems that address any previous diagnoses).Remember that the information you include in this section is based on what the patient tells you so ensure that you include all essentials in your case (refer to Chapter 2 of the Sullivan text).

General:Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data here.

HEENT:

Neck:

Breasts:

Respiratory:

Cardiovascular/Peripheral Vascular:

Gastrointestinal:

Genitourinary:

Musculoskeletal:

Psychiatric:

Neurological:

Skin:

Hematologic:

Endocrine:

Allergic/Immunologic:

OBJECTIVE DATA:From head-to-toe, includewhat 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 unless you are doing a total H&P- only in this course. Do not use “WNL” or “normal.” You must describe what you see.

Physical Exam:

Vital signs: Include vital signs, ht, wt, and BMI.

General:Include general state of health, posture, motor activity, and gait. This may also include dress, grooming, hygiene, odors of body or breath, facial expression, manner, level of consciousness, and affect and reactions to people and things. NURS 6512 Week 4 Assignment 1- Differential Diagnosis for Skin Conditions

HEENT:

Neck:

Chest

Lungs:

Heart

Peripheral Vascular: Abdomen:

Genital/Rectal:

Musculoskeletal:

Neurological:

Skin:

Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses.

ASSESSMENT:List your priority diagnosis (es). For each priority diagnosis, list at least three differential diagnoses, each of which must be supported with evidence and guidelines. For holistic care, you need to include previous diagnoses and indicate whether these are controlled or not controlled. These should also be included in your treatment plan.

PLAN:This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

REFLECTION: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.Reflect on your clinical experience, and consider the following questions: What did you learn from this experience? What would you do differently? Do you agree with your preceptor based on the evidence?

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