NRNP 6560 – Advanced Care of Adults in Acute Settings III Course Assignments & Discussions Study Guide

NRNP 6560 – Advanced Care of Adults in Acute Settings III Course Assignments & Discussions Study Guide

NRNP 6560 – Advanced Care of Adults in Acute Settings III Course Description

3 credits

Students in this course will advance their clinical competence in the care of patients in acute care settings. Students will build confidence as they begin the transition from student to advanced practice nurse. Classroom activities and case studies will enable students to explore resources and support systems available to acutely ill adolescents, adults, and older adults. The  application of knowledge in the management of patients and the collaboration between the advanced practice nurse and the patient, family, and multi-disciplinary healthcare team are emphasized.

Prerequisites

• NRNP 6550

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NRNP 6560 – Advanced Care of Adults in Acute Settings III Course Syllabus & Assignments Summary

Wk 2 6560 – it a I-Human

WK2 Assignment 6540 SOAP NOTE

I-Human – Exercises – Herniated disk

I-Human Gloria Jenkins- Rank Differential Diagnosis

NRNP 6560 Nancy Penn Week9 I-Human

Midterm 6560 Winter 23 Concepts

I-Human – Diagnosis – Advanced Practice Care of Adults in Acute Care Settings II (NRNP 6550)

I-Human Walter Sobchak- History Questions Case Feedback

NRNP 6560 Alignment Chart

You can also read another study guide on nursing assignments for students from another post on NRNP 6568 – Synthesis in Advanced Nursing Practice of Patients in Family Care Settings Course Assignments & Discussions.

Course Specific Requirements

• PRAC 6560: Advanced Care of Adults in Acute Settings III Practicum
• Types of Patients: Ages 13 and older with acute, critical, or significant exacerbation of preexisting disease states
• Types of Services: Assessment and management of acute or critical disease states which may require airway management, pulmonary support, cardiovascular intervention, intravenous medication management, infection disease intervention, renal intervention, neurologic/neurosurgical management, or abdominal pathology management
• Possible Preceptor Choices: ACNP, AGACNP, ANP, AGPCNP, MD, DO, PA, intensivist, or hospitalist
• Unacceptable Preceptor Choices: CNS
• Possible Site Choices: Acute care hospital setting, critical care units, EDs 
• Note: The following in-hospital specialty rotations will be considered based on the services provided: Cardiology, endocrinology, gastroenterology, hematology/oncology, infectious disease, nephrology (excluding dialysis units), neurology/neurosurgery, pulmonology, surgery, transplant, and trauma
• Nonacceptable Sites: Dialysis units, palliative care units, Cancer Centers of America, urgent care, outpatient clinics, and family practice clinics/offices or retail health clinics
• Requirements: 160 hours; minimum 80 patients

Important Note for Preceptor and Site Requirements

To learn the role of the nurse practitioner, it is required that at least two preceptors be NPs in an area of practice clearly relevant to meeting the objectives of the NP program/specialty. The two NP preceptors must cover two separate practicum courses. Having two NP preceptors for one course does not meet this requirement. Following are additional preceptor requirements:

• Students may only use the same preceptor for two of their four practicum courses.
• Students cannot use the same preceptor at the same practicum site when they are doubling up practicum courses during the same quarter.

• Physicians (MDs, DOs) and physician assistants (PAs) may serve as preceptors but must be credentialed and licensed to practice in the population-focused and/or specialty area of practice in the state where the practicum will occur. In addition, this area of practice should be clearly relevant to meeting the course objectives of the student’s NP program and meet the course specific guidelines. Students are not allowed to use MDs or PAs for all four courses as at least two preceptors must be NPs.
• Special notes about Physician Assistants (PAs) as preceptors:
  • PAs do not count as meeting the requirement of having two NPs as preceptors.
  • PAs may not serve as preceptors in the PMHNP program.
  • PAs may not serve as preceptors in some states due to specific state board of nursing regulations. Students should verify with their state Board of Nursing for requirements. Examples of some states that do not allow PAs as preceptors:  Alaska, Arizona, Florida, and Alabama.
  • Preceptors who are an APRN or MD/DO are the best options. However, if you are considering using a PA or other professional as a preceptor, it is helpful to contact your Board of Nursing and the Office of Field Experience to determine whether the preceptor is acceptable.

Note: Approval of the preceptor must occur prior to the student starting the practicum course and logging hours. Students cannot begin logging practicum hours until their practicum application is fully approved, and they have been registered for the course.

NRNP 6560 – I-Human – Exercises – Herniated disk

Spinal Conditions: Herniated Disc, Compression Fracture, and Spondylolisthesis, Assignments of Nursing

A detailed analysis of three common spinal conditions: herniated disc, vertebral compression fracture, and spondylolisthesis. It includes visual aids, multiple-choice questions, and feedback to help students understand the differences between these conditions, their symptoms, and how they are diagnosed. This resource is ideal for medical students studying anatomy and pathology, particularly those focusing on the musculoskeletal system.

Download Spinal Conditions: Herniated Disc, Compression Fracture, and Spondylolisthesis and more Assignments Nursing in PDF only on Docsity! i-Human – Exercises 1 of 2 7/14/2023, 1:06 PM Gloria Jenkins: Ana Criselda Ballesta, Attending Learning Mode Histor y Physic al Exam Assessme nt Test Result s Diagnosi s Pla n Summary 1 of 1 Index of Exercises Correct Missed Incorrect Feedback Discussion This image depicts a herniated disc between the L2 and L3 vertebral bodies. The nucleus pulposus is extruded and is impinging on the nerve route and, to some degree, impinging on the cauda equina/spinal cord. • A single vertebral compression fracture would manifest as diminished height of one of the vertebral bodies. • Metastatic disease would be associated with discrete bony lesion(s) or a mass. • Spondylolisthesis would be demonstrated an anterior shifting of one vertebral body relative to its inferior counterpart. Proceed Choice Yours Graded Vertebral compression fracture Herniated nucleus pulposus (herniated disc) Spinal metastatic disease Spondylolisthesis

NRNP 6560 – Midterm 6560 Winter 23 Concepts

Midterm 6560 Winter 23 Concepts

Week 1

1. Know protein requirements for the critically ill.
2. Be familiar with enteral and parenteral nutrition.
3. Discuss recommended preoperative testing based on patient age and co-morbid conditions.
4. Describe the management of common medications in the preoperative period. (anti-hypertensives, anti-coagulants, and diabetic management agents)
5. Describe the components of risk stratification be able to determine a patient’s risk based on testing and co-morbid decisions.
6. Describe components of focused, comprehensive, and consultation notes.
7. Describe recommendations for preoperative infection prevention based on SCIP.
8. Describe methods to prevent post operative complications.
9. Be familiar with Mallampati scores.
10. Know reversal agents for neuromuscular blockades, benzos and narcotics.
11. Know the different types of monitoring.
12. Know doses of lidocaine.
13. Be familiar with malignant hyperthermia and the treatment.
14. Be familiar with types of wound healing.
15. Know about regional anesthesia. Contraindications to spinals and epidurals

Week 2

1. Describe common symptoms, diagnostics, and treatment (meds) for osteoarthritis.
2. Describe common symptoms, diagnostics, and treatment (meds) for rheumatoid arthritis.
3. Be able to differentiate between rheumatoid, osteoarthritis, septic arthritis.
4. Describe common symptoms, diagnostics, and treatment (meds) for compartment syndrome.
5. Recognize the six Ps associated with compartment syndrome.
6. Be familiar with symptoms, diagnostics and treatment for rhabdomyolysis.
7. Know symptoms, diagnostics and treatment for osteomyelitis.
8. Describe common symptoms, diagnostics, and treatment (meds) for back pan, joint pain.a. Know the different types of back and red flags.

Week 3

1. Differentiate between HIV and AIDS. Specifically what labs would assist in making this distinction?
2. Describe common symptoms by stage of HIV / AIDS
3. Describe strategies to prevent HIV.
4. Discuss the initiation and management of antiretroviral therapy in HIV.
5. Describe common symptoms and treatment of opportunistic infections related to HIV/AIDS
6. Describe common symptoms, diagnostics, and treatment (meds) for SLE (lupus)
7. Describe the absolute and relative contraindications to receive organs.
8. Describe common symptoms, diagnostics, and treatment (meds) of immunosuppression and organ rejection.
9. Describe common medical complications for solid organ transplant (Lung, heart, liver, kidney, intestine, pancreas.

Week 4

1. Describe common symptoms, diagnostics, and treatment (meds) for hepatitis.
2. Differentiate between Hepatitis A B C and D
3. Interpret the type of hepatitis based on the serologic testing results (IgG, IgM, etc).
4. Describe common symptoms, diagnostics, and treatment (meds) for alcoholic liver disease.a. Describe common symptoms, diagnostics, and treatment (meds) for acute liver failure.b. Describe common symptoms, diagnostics, and treatment (meds) for chronic liver disease.c. Be familiar with treatment for hepatic encephalopathy, ascites, variceal bleeding.
5. Describe common symptoms, diagnostics, and treatment (meds) for cholecystitis/cholangitis.
6. Describe common symptoms, diagnostics, and treatment (meds) for acute pancreatitis.a. Be familiar with the Ransom score system and its interpretation.
7. Describe common symptoms, diagnostics, and treatment (meds) for small bowel obstruction.
8. Describe common symptoms, diagnostics, and treatment (meds) for large bowel obstruction.
9. Describe common symptoms, diagnostics, and treatment (meds) for mesenteric ischemia/bowel infarction.
10. Know how to manage a bowel obstruction.

Week 5

1. Describe common symptoms, diagnostics, and treatment (meds) for diverticulitis.
2. Describe common symptoms, diagnostics, and treatment (meds) for inflammatory bowel diseasea. UC/Crohns-be familiar with medications for remission and steroid use. Know the different symptoms associated with UC and Crohns. What makes them different from each other.
3. Describe common symptoms, diagnostics, and treatment (meds) for peritonitis.
4. Describe common symptoms, diagnostics, and treatment (meds) for appendicitis.
5. Apply common abdominal assessment signs (McMurphy, Rovsing, etc) appropriate associated disease.
6. Describe common symptoms, diagnostics, and treatment (meds) for PUD.
7. Describe common symptoms, diagnostics, and treatment (meds) for GERD.
8. Know the mainstay of treatment for appendicitis.
9. Describe common symptoms, diagnostics, and treatment (meds) for upper GI bleeding.
10. Describe common symptoms, diagnostics, and treatment (meds) for lower GI bleeding.

NRNP 6560 – WK2 Assignment 6540 SOAP NOTE

1SOAP NOTE WK 2 Assignment Sample

Walden University

Student Name

RN BSN

Advanced Practice Care of Older Adults

NRNP 6540 Dr. Ann Krriebel

Date

Focused SOAP Note Template

Patient Information: MW 67-year-old African American female S (subjective) Chief Complaint (CC):  forgetfulness, short-term memory lossHPI (history of present illness): M. W. is a 67-year-old black female brought into the clinic by herdaughter. She reports that over the last three months, her mother has been repeating herself, often laughing off her symptoms or becoming agitated when others try to correct her. Her mother’s confusion is worsening, and she is becoming unsafe. She recently got lost in their localWalmart. The client has a history of Osteoporosis, Hyperlipidemia, and Hypertension, which sheis medicated for. Her clean and neat appearance, her speech is clear, and her eye contact is appropriate. Oriented to herself, she recognizes her daughter but cannot recall the date, time, and place and is unaware of her situation. She is cooperative with today’s physical exam and clinical interview. However, she cannot recall making an appointment for today and became upset when her daughter reminded her, they had made the date together. Ms. W.’s conversation is correct, but it can sometimes become erratic. She has no unusual body movements, tics, headaches, dizziness, or vision changes. She denies any hallucinations or suicidal ideations. Ms. W. is physically active without any mobility changes. She reports walking her dog twice daily. She denies an increase in pain, scoring 1/10 on the pain scale with activity and no pain at rest. Her daughter says that her mother has been sleeping more and eating less. The patient denies chills, fever, nausea, diarrhea, or any changes in urination. When asked about her daily routine, she laughed and said she works part-time at a school. The client’s daughter says her mother retired over seven years ago. Current Medications:Amlodipine 10 mg daily for hypertensionHydrochlorothiazide 12.5 mg daily for hypertension Atorvastatin 40 mg daily for hyperlipidemiaMultivitamins daily supplementAlendronate 70 mg by mouth once weekly for osteoporosisAllergies: Lisinopril – cough, penicillin – rash PMH:   The daughter reports that her mother has had her influenza vaccine this season. She received her. She received her second COVID-19 booster in July and received her Tdap and pneumonia two years ago. She has no history of significant illnesses.Surgical Hx: Tonsillectomy in childhood, one c-sectionSoc and Substance Hx: The daughter reports that until recently, her mother enjoyed attending the local senior center. She also went out with family and friends and attended online religious activities. Both deny smoking or drinking; there are no signs and symptoms of drug use. She lives with her daughter in a two-story home with a dog. Her daughter is a police officer and keeps her service weapon in a secure safe. They both wear seatbelts, and the house has working smoke detectors.

Fam Hx:Father deceased at 70 CVA, mother deceased at 55 M. I., brother deceased at 60 sarcoidosis. One daughter, 40 YO, has asthma and hypertension, both controlled with medication.Mental Hx:Cognitive impairment – The patient’s CT scan shows cerebral atrophy, short-term memory loss, and forgetfulness. GDS score is 8/ 30, with no reports of self-harm or symptoms of neglect. MMSE IS 18/ 30 scorings moderate level dementia with a decline in orientation, recall, attention calculation, and registration. Violence Hx: No historical daughter is advised to obtain caretaking services as the mother should not be left alone. Reproductive Hx: Post-menopausal and not currently sexually activeROS (review of symptoms): General:    The daughter reports that the patient has been eating less and sleeping long periods. Denies night sweats or chills. Head   :  appears intact EENT   : Eyes intact no changes in hearing, nose dry, throat intact, mucus membranes moist and pink SKIN: PT has a faded bruise left leg and denies fallingCARDIOVASCULAR/CV: denies chest pain, no edema palpation or fluttering, no recent echo or EKG. RESPIRATORY: Lungs are clear and diminished; denies shortness of breath, cough, or sputum. CXR is negative. GASTROINTESTINAL: No abdominal pain, nausea, constipation, bloody stools, or diarrhea. Her abdomen appears soft and non-distended. The daughter reports pt is eating lessGENITOURINARY: No changes in urine frequency or outputNEUROLOGICAL: No dizziness, headaches, syncope, paralysis, ataxia, tingling, or numbness in the extremities.  There are no reports of change in bowel or bladder control. MUSCULOSKELETAL: No stiffness or joint pain, no changes in mobility, denies back pain HEMATOLOGIC: faded bruise to left leg unable to recall etiology, no excessive bleeding or unusual fatigueLYMPHATICS: Lymph nodes intact, no swelling to extremities PSYCHIATRIC: No symptoms of anxiety or depression. No suicidal thoughts or hallucinationsENDOCRINOLOGIC: No increased sweating or changes in cold or heat intolerance. ALLERGIES: denies rash, hives, or itchy eyes, runny nose O (objective)Physical exam:   Vital Signs/VS:  p 120/55 HR 65 Temp 99 oral Resp 16 Wt. 135 HT 5’ 6 BMI 21.8GENERAL: Appearance is neat, clean, well-groomed in no physical distressHEENT:  *Eyes pupils equal reactive to light sclera white pale, conjunctiva pink lids uniform  * Head atraumatic normocephalic        * Ears tympanic membrane intact grey         * Nose symmetrical, no swelling or redness        * Throat supple intact, no swelling pink         * Mucus membranes moist pink        * Neck/thyroid no lymph swelling ROM intact         * Skin intact moist, no abnormal rashes         *  CARDIOVASCULAR/CV:   HR 70 rate regular S1 and S2 heart sounds heard no murmur no          edema RESPIRATORY:  Lung sounds clear and diminishedGASTROINTESTINAL:  abdomen is soft Non distended bowel sounds all four quads activeNEUROLOGICAL: Upper and lower extremity motor strength intact, cranial nerves II – XIIintact

5MUSCULOSKELETAL:  full ROM upper and lower extremities, good muscle strength and tone, able to sit and stand with no difficulty, gait intact PSYCHIATRIC: Mood/affect fluctuates; smiling at times, alert, and oriented to self.  I performed MMSE 18/ 30. Cognition is impaired, and forgetfulness increases (Grossman & Irwin, 2016). Ms. W. is cooperative with exams. GDS is 8 /30 and answers questions readily with no s/s of depression (Sultana et al., 2022). ENDOCRINOLOGIC: No malaise, fever, or chills; thyroid is midline; lymph nodes are non-painful, soft, and intact during palpation. Diagnostic results: 1. CXR – no abnormal findings2. CT of head– Cerebral Atrophy3. MMSE – 18/30 – moderate cognitive impairment 4. GDS score 8 / 30. Negative for depression symptoms5. CMP – protein 6.4 g/ dl creatinine 0.68 mg/ dl sodium of 136 mmol/L glucose 74 K+ 3.9CO2 25 albumin 5.0 g /dl 6. Urine culture and sensitivity – negative for nitrites PH 5.8 negative for leukocytes, no bacteria growth in 48 hours. 7. CBC- Show no abnormality in WBC at 6.4 / ml. HGB 11.4 g/dl platelets 22/UL. Vit d 38.7 ng/ml B12 8158. COVID 19 – NEGATIVE A (Assessment)1. Primary diagnosis – Alzheimer’s Dementia – characterized by a decline in self-performance of ADLs, independence, and complex thinking, Alzheimer’s is observed as a degeneration of brain cells (Breijyeh & Karaman, 2020). AD affects 5.8 million people in the United States. The burden and impact of the disease are projected to triple in thenext 25 years. The client, Ms. W., is exhibiting signs and symptoms of AD; her short-term memory loss, increased agitation, and forgetfulness are symptoms of the disease (Arvanitakis et al., 2019)—an MMSE score of 18/30 shows mild to moderate cognitive

6decline, which cannot be diagnosed alone. Brain atrophy is seen in 15 % of cases of AD. This was evident on MS. W.’s CT scans. 2. Urinary tract infection-induced delirium- UTIs are common in the elderly who are at riskdue to multiple co-morbidities, including malnutrition, urinary incontinence, vaginal atrophy, constipation, increased temp, and changes in mental states. Women are more at risk due to anatomy. More than 12 % of women develop UTIs versus less than 8 % of men. Often accompanied by acute changes in mood and increased confusion, early symptoms include elevated temp, pain when urinating, burning urination, decreased urine output, and or increased urine frequency (Dutta et al., 2022). Delirium is exhibited in the elderly as fluctuations in attention and changes in awareness and cognition. Many elderly may show all or one of these symptoms, but culture and sensitivity should be completed for a diagnosis. 3. Malnutrition induced cognitive decline – A decreased food intake and nutrient-poor diet are other risks for AD. Research revealed a link between malnutrition and acute and chronic disease. Long-term changes in dietary patterns cause changes in nutrient values like Vitamin D and B12. Many elderly show signs of confusion, forgetfulness, anda decline in performing ADLs. Although tools exist for screening nutrient intake, they often lead to overdiagnosis, and more reliable tests involve examining nutrient values (Sun et al., 2021). Diagnosing malnutrition is completed by reviewing weight and nutrient values. The imbalance is caused by low food intake and choices. Ms. W.’s weight falls in the normal range, with no weight loss above 10 lbs. in a month. Her Vit B12 is 815 pg./ml, and her Vit D is 38.7 ng/ml. These values reveal that she is not currently deficient and needs further examination for diagnosis. P (plan) Final diagnosis:  Alzheimer’s Dementia Labs and procedures: MRI of the brain to examine for progression of any neural changes observed in AD.CBC and BMP in six months to assess liver function and nutrient levels.Aricept 10 mg daily for dementia

7Multivitamins with minerals a tab dailyEnsure to drink 240 ml 3 times a day with meals.Non-Pharmacologic interventions – Referrals – Social services – to assist in making long-term care plans such as insurance, finances, end-of-lifedecisions.Adult services – including a daycare center or other caregivers’ services.Cognitive behavioral therapy – to maintain functioning memory. and tasks management. Occupational therapy to adapt the environment for Ms. W. to be safe and engage in activities.daily care, reducing risks and slowing decline. Physical therapy – for a safe, adapted exercise regimen.  Education: Caregiver burden – daughter is becoming a full-time caregiver and should be educated on the  need to seek support to avoid burnout. Safety- home should be altered, stove disabled, sharp objects removed, door locks changed the patient should not be alone,  Nutrition- mealtimes should be consistent, and the caregiver should offer nutritious snacks and supplements often to avoid changes in weight and deficits in nutrition (Sun et al., 2021). Medication Management – The caregiver must ensure the patient takes medication daily and monitor for side effects.    Reflection: Culture and race play essential roles in caregiver selection. Studies support the idea that in black communities, a spouse or child is most likely to care for a person living with dementia. Along with the challenge of taking care of a parent, a significant imbalance in healthcare access and support persists amongst older African Americans. Providers need to be aware of all

8barriers in care. SDOH, or Social Determinants of Health, is the imbalances in the structures of access to care, cultural beliefs, and socioeconomic deficits that directly impact a patient’s health outcome and should be reviewed and considered in every case (Rhee et al., 2021). As our nation ages and more older individuals will have caregivers, providers will need to be educated on the needs of caregivers and older patients with dementia. ReferencesArvanitakis, Z., Shah, R. C., & Bennett, D. A. (2019). Diagnosis and management of dementia: Review. JAMA, 322(16), 1589–1599. HYPERLINK “https://doi.org/10.1001/jama.2019.4782″https://doi.org/10.1001/jama.2019.4782Breijyeh, Z., & Karaman, R. (2020). Comprehensive review on alzheimer’s disease: Causes and treatment. Molecules (Basel, Switzerland), 25(24). HYPERLINK “https://doi.org/10.3390/molecules25245789″https://doi.org/10.3390/molecules25245789Dutta, C., Pasha, K., Paul, S., Abbas, M. S., Nassar, S. T., Tasha, T., Desai, A., Bajgain, A., Ali, A., & Mohammed, L. (2022). Urinary tract infection induced delirium in elderly patients:A systematic review. Cureus, 14(12), e32321. HYPERLINK “https://doi.org/10.7759/cureus.32321″https://doi.org/10.7759/cureus.32321Grossman, M., & Irwin, D. J. (2016). The mental status examination in patients with suspected dementia. Continuum (Minneapolis, Minn.), 22(2 Dementia), 385–403. HYPERLINK “https://doi.org/10.1212/CON.0000000000000298″https://doi.org/10.1212/CON.0000000000000298Rhee, T., Lee, K., & Schensul, J. J. (2021). Black-white disparities in social and behavioral determinants of health index and their associations with self-rated health and functional limitations in older adults. The journals of gerontology. Series A, Biological sciences andmedical sciences, 76(4), 735–740. HYPERLINK “https://doi.org/10.1093/gerona/glaa264″https://doi.org/10.1093/gerona/glaa264

Sultana, N., Nguyen, T. P., Hossain, A., Asaduzzaman, M., Nguyen, M. H., Jahan, I., Nguyen, K. T., & Duong, T. (2022). Psychometric properties of the short-form geriatric depressionscale (gds-sf) and its associated factors among the elderly in bangladesh. International journal of environmental research and public health, 19(13). HYPERLINK “https://doi.org/10.3390/ijerph19137935″https://doi.org/10.3390/ijerph19137935Sun, B., Zhao, Y., Lu, W., & Chen, Y. (2021). The relationship of malnutrition with cognitive function in the older chinese population: Evidence from the chinese longitudinal healthy longevity survey study. Frontiers in aging neuroscience, 13, 766159. HYPERLINK “https://doi.org/10.3389/fnagi.2021.766159″https://doi.org/10.3389/fnagi.2021.766159

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