Table of Contents
NR 603 Advanced Clinical Diagnosis And Practice Across The Lifespan Practicum
NR 603 Week 1 Comparison and Contrast Assignment (Collection)
NR 603 Week 1 Comparison and Contrast Assignment: Comparison between Dementia and Delirium
NR-603 Week 1 Comparison and Contrast Assignment: Concussive Syndrome and Traumatic Brain Injury
NR 603 Week 1 Comparison and Contrast Assignment: Migraine and Post-Concussive Syndrome
NR-603 Week 1 Comparison and Contrast Assignment: Migraine Headache and Concussive Syndrome
NR 603 Week 1 Comparison and Contrast Assignment: Trigeminal Neuralgia and Giant Cell Arteritis
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NR 603 Week 1 Comparison and Contrast Assignment: Dementia and Delirium
Requirements
For Week 1 of the course, there is no case study given to you by the faculty. Instead, you will … assigned to diseases to compare and contrast based on the first letter of your last name (Dementia and Delirium). This information will … posted in the course announcements under Week 1 Welcome as well as the “Assignment” portion of the Week 1 module.
A comparison and contrast assignment’s focus is to identify and explore similarities and differences between two similar topics. The goal of this exploration is to bring about a better understanding of both topics.
You will research the two areas of content assigned to you. Compare and contrast them in discussion post in a discussion post.
NOTE: A comparison and contrast assignment is not about listing the info regarding each disease separately but rather looking at each disease side by side and discussing the similarities and differences given the categories in the categories below. Evaluation of mastery … student’s ability to demonstrate specific understanding of how to … differ and relate to one another. Address the following topics below:
- Presentation
- Pathophysiology
- Assessment
- Diagnosis
- Treatment
Throughout the Week: Participate in interactive dialogue with faculty and students responding to their Part 1 post moving the discussion forward.
NR 603 Week 1 Comparison and Contrast Assignment: Concussive Syndrome and Traumatic Brain Injury
Concussive Syndrome and Traumatic Brain Injury
Requirements
For Week 1 of the course there is no case study given to you by the faculty. Instead you will … assigned to diseases to compare and contrast based on the first letter of your last name (Concussive Syndrome and Traumatic Brain Injury). This information will … posted in the course announcements under Week 1 Welcome as well as the “Assignment” portion of the Week 1 module.
A comparison and contrast assignment’s focus is to identify and explore similarities and differences between two similar topics. The goal of this exploration is to bring about a better understanding of both topics.
You will research the two areas of content assigned to you. Compare and contrast them in discussion post in a discussion post.
NOTE: A comparison and contrast assignment is not about listing the info regarding each disease separately. But rather looking at each disease side by side and discussing the similarities and differences given the categories in the categories below. Evaluation of mastery… student’s ability to demonstrate specific understanding of how to … differ and relate to one another. Address the following topics below:
- Presentation
- Pathophysiology
- Assessment
- Diagnosis
- Treatment
Throughout the Week: Participate in interactive dialogue with faculty and students responding to their Part 1 post moving the discussion forward.
NR 603 Week 1 Comparison and Contrast Assignment: Migraines and Post-Concussive Syndrome
Requirements
For Week 1 of the course there is no case study given to you by the faculty. Instead you will … assigned to diseases to compare and contrast based on the first letter of your last name (Migraines and Post-Concussive Syndrome). This information will … posted in the course announcements under Week 1 Welcome as well as the “Assignment” portion of the Week 1 module.
A comparison and contrast assignment’s focus is to identify and explore similarities and differences between two similar topics. The goal of this exploration is to bring about a better understanding of both topics.
You will research the two areas of content assigned to you. Compare and contrast them in discussion post in a discussion post.
NOTE: A comparison and contrast assignment is not about listing the info regarding each disease separately but rather looking at each disease side by side and discussing the similarities and differences given the categories in the categories below. Evaluation of mastery … student’s ability to demonstrate specific understanding of how to … differ and relate to one another. Address the following topics below:
- Presentation
- Pathophysiology
- Assessment
- Diagnosis
- Treatment
Throughout the Week: Participate in interactive dialogue with faculty and students responding to their Part 1 post moving the discussion forward.
NR 603 Week 1 Comparison and Contrast Assignment: Trigeminal Neuralgia and Giant Cell Arteritis
Trigeminal Neuralgia and Giant Cell Arteritis
Requirements
For Week 1 of the course there is no case study given to you by the faculty. Instead you will … assigned to diseases to compare and contrast based on the first letter of your last name (Trigeminal Neuralgia and Giant Cell Arteritis). This information will … posted in the course announcements under Week 1 Welcome as well as the “Assignment” portion of the Week 1 module.
A comparison and contrast assignment’s focus is to identify and explore similarities and differences between two similar topics. The goal of this exploration is to bring about a better understanding of both topics.
Week 1- Part 1: Due Wednesday: – You will research the two areas of content assigned to you. Compare and contrast them in discussion post in a discussion post.
NOTE: A comparison and contrast assignment is not about listing the info regarding each disease separately but rather looking at each disease side by side and discussing the similarities and differences given the categories in the categories below. Evaluation of mastery is focused on the student’s ability to demonstrate specific understanding of how to … differ and relate to one another. Address the following topics below:
- Presentation
- Pathophysiology
- Assessment
- Diagnosis
- Treatment
Throughout the Week: Participate in interactive dialogue with faculty and students. Responding to their Part 1 post moving the discussion forward.
NR 603 Week 1 Quiz (Jan 2021)
- Question: Which of the following are potential causes of delirium in the elderly? Mark all that apply.
- Question: Personality changes in patients with Traumatic Brain Injury include all of the following except:
- Question: Common presenting symptoms of dementia include all of the following except:
- Question: Which type of medication may be particularly dangerous when treating aggression in patients with traumatic brain injury (TBI) because it could cause paradoxical agitation?
- Question: Chris is a 28-year-old marine who just returned from active duty from Iraq. He has been complaining of dizziness, extreme headaches, and memory problems related to traumatic brain injury. His neurological injuries are most likely the effect of:
- Question: A pleasant 73-year-old male presents to the clinic with his wife. His wife states that she has noted increasing problems with his memory including forgetting to get some items on his grocery list and misplacing his car keys. You administer the MMSE in the office and he scores 24/30 which is consistent with Mild Dementia per the scoring guidelines. Your best response to his wife is:
- Question: Collaborating with specialists is an important part of primary care involving patients with neurologic injuries. It is important as an APN to know when to refer to a specialist and what the goal of that referral is: further information, diagnostic testing or treatment recommendations? Which of the following are accurate goals of referral of a patient for Neuropsychological Testing?
- Question: Key early warning signs for Alzheimer’s disease include all of the following except:
- Question: Benzodiazepines are appropriate for which of the following disorders? (Choose all that apply)
- Question: Match the type of Injury with the neurologic damage.
NR 603 Week 2 Case Discussion: Pulmonary – Part 1 (Collection)
The purpose of this assignment is for students to:
- Improve their ability to formulate diagnoses based on clinical presentation of patients
- Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of Pulmonary disorders
Requirements
Setting: A free medical clinic that provides health care for the under-insured.Your next patient, Michelle G., age 40, is a regular of the clinic and the last patient of the day. The chart states she is here for recent episodes of shortness of breath.
You enter the room and Michelle G is … in work clothes, standing up looking at a health poster on the wall. You introduce yourself and ask her what brings her to the clinic today. “I think I may have a cold. I’ve been having a hard time breathing on and off lately.”
HPI: “I notice I’m short of breath mostly at work but by the time I get home feel fine. No episodes of shortness of breath on the weekends that I can recall. But a few hours backat work and I start to feel like I cannot catch my breath again. A few months ago this happened and it was so bad I left work and went to urgent care where they gave me a breathing treatment of some kind and sent me home on an antibiotic. I would like you to give me another antibiotic. She denies sputum. No new allergy triggers noted. She denies heartburn.
PMHx: Michelle G. reports her overall health as good.
Childhood/previous illnesses: eczema as a child
Chronic illnesses: Has seasonal allergies, spring is her worst season. Was seen by an allergy specialist ten years ago, Took allergy shots for five years with great results, now only takes Zyrtec when needed.
Surgeries: Cholecystectomy
Hospitalizations: childbirth x 3.
Immunizations: up-to-date on all vaccinations.
Allergies: Strawberries-Rash; erythromycin- severe GI upset.
Blood transfusions: none
Drinks alcohol socially, smoked 1 pack per week for 3 years in her 20’s. Denies illicit drug use.
Sleeps 6 to 7 hours a night. Exercises four to five days per week.
Current medications: Multivitamin, Zyrtec
Social History: Married, lives with husband and 3 children. Worked in advertising up until 18 months ago when she got laid off. In order to help with the household finances she took a job as a Baker’s assistant at an Artisan Bread Bakery. She arrives at 4 a.m. every morning to begin baking breads/pastries for the day.
Family History: Children are healthy- daughter currently has a sinus infection. Parents are deceased. Mother at age 80 from congestive heart failure. Father died at age 82 from lung cancer, diagnosed when metastasized to brain. PGM: died from unknown causes, PGF: Stroke at age 82. MGM: died at 83, had HTN, atherosclerosis and many heart attacks. PGF: died at 71 from complications of COPD.
PE: Height 5’10”, Weight 140 pounds
Vital signs : BP 130/70, T 98.0, P 75, R 18 Sao2 98% on RA
General: 40-year-old Caucasian female appears stated age in no apparent distress. Alert, oriented, and cooperative. Able to speak in full sentences and does not appear breathless. Skin: Skin warm, dry, and intact. Skin color is pale pink, no cyanosis or pallor.
HEENT: Head normo-cephalic. Hair thick and distribution even throughout scalp.
Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact.
Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus non-tender
Nose: Nares patent with thin white exudate noted. Mucosa appears boggy and pale. Deviated septum noted. Sinuses non-tender to palpation.
Throat: Oropharynx pink, moist, no lesions or exudate. Tonsils 1+ bilaterally. Teeth in good repair, no cavities noted. Tongue smooth, pink, no lesions, protrudes in midline. Neck supple. No cervical lymphadenopathy or tenderness noted. Thyroid midline, small and firm without palpable masses.
Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. Slight wheezing noted inspiration and on forced expiration. Wheezing does not clear with forced cough.
CV: Heart S1 and S2 noted, RRR, no murmurs noted, no displaced PMI. Peripheral pulses equal bilaterally, no peripheral edema
Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organo-megaly noted.
Diagnostic Testing:
Review of the patient’s EMR reveals an old CXR from last winter when she had Bronchitis.
CXR Report: 11/7/2016
This is a PA and lateral chest radiograph on Ms. Michelle X, performed on 11/7/16. Clinical information: low grade fever, productive cough, malaise.
Findings: Cardio-mediastinal silhouette is normal. B/L lung fields are clear. There are no effusions. The bony thorax appears normal. No opacities or fluid. Diaphragm normal.
Impression: Normal chest radiograph without pathology.…….
You suspect an obstructive/restrictive process and order Pulmonary Function Testing
Pre-Bronchodilator Challenge- FEV1/FVC 60%, FVC decreased
Post Bronchodilator Challenge- FEV1/FVC 75%
Discussion Questions Part One:
- What is your primary … for Michelle given pattern of occurrence of symptoms, exam results, and recent history? Include the rationale and a reference for your diagnoses.
- What is your first-line treatment plan for Michelle including medications, labs, education, referrals, and follow-up? Identify the drug class of each medication you prescribe and exactly what symptom it is … to address.
- Address Michelle’s request for an antibiotic.
- What clinical decision did the NP make?
- What benefit would a peak flow meter offer? Should this … included?
NR 603 Week 2 Case Discussion: Pulmonary – Part 2 Follow up Visit (Collection)
Purpose
The purpose of this assignment is for students to:
- Improve their ability to formulate diagnoses based on clinical presentation of patients
- Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of Pulmonary disorders
- Design a relevant treatment plan
Requirements:
Michelle continues to work in the bakery and her asthma has been well … on a low-dose … corticosteroid inhaler, Singular 10mg daily, and Albuterol prn which she uses 1-2 times per week. Michelle presents to the clinic with an acute illness that developed 2 days ago and has a respiratory rate of 24, mild SOB with exertion, O2 saturation of 94%, and complaint of inspiratory and expiratory wheezing. She is able to speak and states her temperature over the last 2 days has been 101 to 102 F. Cough is productive of white sputum. Influenza A is going around the bakery. Exam findings show a woman who appears her … age and is alert and … and though calm, is having mild work of breathing. AR 110 BPM, BP is 150/85, RR: 24, Temp 101.4. She has a nonproductive, dry cough, is mildly short of breath, fair chest expansion, + inspiratory/expiratory wheezes, no rales, no rhonchi. Auscultation reveals no thrills, gallops or extra heart sounds. Apical rate is … at 110. Physical exam is otherwise unremarkable. The MA has swabbed her for Influenza A- test is positive.
Discussion Questions Part Two:
- Determine appropriate treatment plan for Michelle. Discuss medications, doses, Durable Medical Equipment, and any testing, and apply these directly to her case. Provide your rationale with evidence.
- Decide whether she is safe to return home, include any prescriptions, or if a referral to a higher level of care is … Discuss the criteria … to make your decision, how a referral is made and defend your position.
- Discuss relevant education and follow up plan.
NR 603 Week 3 Case Discussion: Cardiovascular
Discussion Questions
- What Leads Demonstrate the ST Depression?
- Is Lorene Hypertensive per ACA 2017 Guidelines? Compare the ACA guidelines to JNC 8 guidelines and discuss what treatment you recommend for her BP and why.
- What is the Primary diagnosis causing Lorene’s chest pain? Include ICD 10 codes (no differentials)
- What other secondary diagnoses does Lorene have that should be addressed? (Include the rationale and a reference for your diagnoses)
- Design a treatment plan and discuss how each intervention is applicable to Lorene’s case. Consider the following interventions:
- Labs
- Durable Medical Equipment Diagnostic tests- discuss the goal/purpose
- Any consultation with outside providers/services
- Medications- discuss why you chose each specific medication
- Referrals- who and why
- Follow up- why and when
- Education- specific and measureable
- Lifestyle Changes- specific to her cultural preferences, values and beliefs
NR 603 Week 4 Clinical VISE Assignment
Purpose
The VISE assignment (Virtual Interactive Student Evaluation) is to evaluate student progress in clinical, based on per course clinical objectives. This will be a mid-term check to identify and assist students who may be struggling with clinical critical thinking and communication. Students who do not pass the VISE on the first attempt will be placed on a clinical PIP and given a second attempt at passing the VISE prior to course end. The student must successfully pass the VISE to pass clinical within a course.
Directions
These will … done by phone between the VP and the student sometime between the beginning of week 3 and the end of week 5. Immediately following the VISE the VP and student will do the mid-term phone call check in and review of clinical. VPs should have clinical logs pulled up to review with the student.
603 – Referral to specialist – The VP (professor) will review the student’s clinical logs, from the past two weeks, and select one patient with a complex chronic illness who needs a specialist referral. The professor will notify the student of the patient selected, prior to the call. During the VISE assignment call, the professor will act as specialist taking the call.
The student is to do the following:
- Pick the correct specialty to refer to
- Give a SNAPPS summary to the specialist
- Answer the specialist’s questions about the patient
NR 603 Week 5 APEA Predictor Assignment – Part One
- Step 1. Review your Week 4 APEA Predictor Exam Results and focus on the “Percent Correct by Knowledge Area” Choose a knowledge area on which you scored the lowest to work on this week.
- Step 2. Once you’ve chosen the subject, research and work up a common chief complaint from that system that you haven’t learned already in the program and present your findings in the discussion threads. Push yourself to explore diagnoses in this area that are still common to primary care, but not a repeat of content learned in this or other courses.
- Step 3. Respond to one other student’s CC work up as well as any questions posed to you by faculty.
Work up includes:
- Chief complaint, PMHx, Demographics, PSHx, allergies, lifestyle
- Associated risk factors/demographics that contribute to the chief complaint and differential diagnoses
- Three common differential diagnoses represented by the CC including pathophysiology and rationale:
- Discuss how the three differential diagnoses differ from each other in: occurance, pathophysiology and presentation.
- Relevant testing required to diagnose/evaluate severity of the three differential diagnoses; and
- Review of relevant national guidelines related to the diagnosis and diagnostic testing for these diagnoses
NR 603 Week 5 APEA Predictor – Part Two
Requirements
For Week 5 of the course the faculty will not be providing a case study. Instead you will choose from an area that you have an opportunity for improvement that was … on your APEA predictor exam. You will research that area of content in relation to complaints and disorders that commonly occur in family practice. Please work up a case study that begins with a chief complaint commonly seen in primary care basedon that disorder. The case should … clear and include all elements of a normal case that might … presented in class (subjective, objective, assessment, and full five (5) point plan). The clinical logs will be helpful for this process, or notes you have taken in clinical regarding cases. The case should … clear, organized, and meet the following guidelines:
Week 5 Part 2: Due by end of Week 5
- Post your first line treatment plan based on one dx your differential list in SOAP format.
- Responds to atleast one student’s CC write up and all faculty questions posted directly to you.
NR 603 Week 6 Mental Health Clinical Presentation Part 1
Requirements: For Week 6 of the course there will not … a case study given to you by the faculty. Instead … assigned a mental health disorder commonly seen in primary care & you will create a case study based on that disorder. You may create a case study either from a previous clinical patient experience. Or if you have not had a patient in clinical that represents your assigned topic you may research your disease using the week’s classroom material & evidence-based literature. The case should … presented in class (subjective, objective, assessment, and full 5 point plan). The clinical practicum documentation will … helpful for this process, or notes you have taken in clinical regarding cases. The case should … clear, organized, and meet the following guidelines:
Week 6 Part One – This part goes in part one and should begin with subjective and objective data. Just like we do in your weekly case study discussion. Do not put diagnosis until your peers respond. The case should lead the class toward the mental health diagnosis assigned to you by your instructor.
Specific Guide: If this is an actual patient from clinical- Include their actual chief complaint, demographic data, HPI, PMHX, PSHX, medications, allergies, subjective and objective findings without identifying the patient’s name.
If this is a fictitious case you’ve created from the literature/readings you should design an example patient and include chief complaint, demographic data, HPI, PMHX, PSHX, medications and allergies, subjective and objective findings. Be mindful that the background data for the case should bear some relevance to the diagnosis.
The case should not … overly simple. Like your weekly case studies, it should include subjective data that loosely represents the … you have been given. But includes elements of the pathophysiology/presentation of the disease. You must include the following elements in part one. subjective. Chief complaint/HPI, demographic data, HPI, PMHX, PSHX, subjective and objective findings.
NEXT: Leading the discussion in part one: You must respond to any student who posts regarding your case with a substantial response. Either answering their questions or noting their response and acting as leader. You also must respond to any faculty responses to your initial posting. Use references to support your responses. Remember: Your response … invented case. Your treatment plan should address any national guidelines as appropriate for the …
Participating in part one: As a student you will … student, whom has no responses to their posting. In your response to your peer you must include the following: Your top (3) differentials based on the information provided, the primary … how you would treat that … Use references to support your response.
NR 603 Week 6 Mental Health Final Treatment Plan/Analysis – Part 2
Requirements: For Week 6 of the course there will not … a case study given to you by the faculty. Instead … assigned a mental health disorder commonly seen in primary care & you will create a case study based on that disorder. You may create a case study either from a previous clinical patient experience. Or if you have not had a patient in clinical that represents your assigned topic you may research your disease using the week’s classroom material & evidence-based literature. The case should … presented in class (subjective, objective, assessment, and full 5 point plan). The clinical practicum documentation will … helpful for this process, or notes you have taken in clinical regarding cases. The case should … clear, organized, and meet the following guidelines:
Week 6 Part Two – Turning in your final SOAP/Analysis: The final SOAP will include your case as posted in part one and two of the clinical case presentation. After you write out the SOAP include the following sections in a large area called ANALYSIS:
- Pathophysiology and Pharmacology: For the primary diagnoses in the case, write a brief summary of the underlying pathophysiology and tie pharmacological treatment chosen in the reversal or control of that pathology.
- Additional analysis of the case: This includes national guidelines that were or … how care was unique but … in guidelines.
- Follow-up: This means how the patient was doing when seen a second time if this applies. This would … their response to your plan of care.
- Quality: Include that considered in hindsight or changes you would make in seeing similar patients in future with the same complaint, history, exam, or diagnosis. Add anything you learned from discussion in the class that shed new light on this patient.
- Coding and Billing. Any or all CPT and ICD-10 codes that should … used (List them and name them only.
Written in a word document and submitted in the Week 6 case study summary.
NR 603 Week 7 Quiz
Osteo Arthritis
- Question: Which patient below should be screened for osteoporosis?
- Question: … medication is recommended by the American college of rheumatology as first line agent for a patient who has been unsuccessful with non-pharmacologic interventions for osteoarthritis pain?
- Question: Which joints are least commonly involved in osteoarthritis?
- Question: A 75-year-old female who is otherwise healthy has mild osteoarthritis in her right knee. She complains of pain not relieved by acetaminophen 2000 mg daily. What should … done?
- Question: An 80-year-old patient is very active but presents today with posterior hip pain for the past week. Which of the following is least likely part of the differential diagnosis?
- Question: A 62-year-old female presents with atraumatic right knee pain. On exam she has mildly swollen right knee that is not war or tender to touch. She has a negative McMurry test. Her x-ray demonstrates tibiofemoral joint narrowing and visualization of osteophytes. How should the nurse practitioner interpret the results of this x-ray?
Rheumatoid Arthritis
- Question: Which findings are most commonly … with rheumatoid arthritis?
- Question: Which of the following test if positive is part of the criteria for systemic lupus erythematosus (SLE)?
NR 603 Week 7 Open Forum Discussion: Inflammatory Disorder
This is a required but not graded open forum discussion. An open forum encourages you to post freely without the requirements of traditional discussion posts. What questions/insights do you have about inflammatory disorders? Are you comfortable with your knowledge of pathophysiology, risk factors, and diagnosis? How about diagnostic testing? What types of inflammatory disorders have you encountered in clinical? The floor is open to reinforce your learning.
NR 603 Week 8 Reflection (2 Versions)
Reflect back over the past eight weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #4, the MSN Essential IV, and the Nurse Practitioner Core Competencies # 7.
Program Outcome #4: Integrate professional values through scholarship and service in health care. (Professional identity
MSN Essential IV: Translating and Integrating Scholarship into Practice Recognize that the master’s-prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results.
Nurse Practitioner Core Competencies # 7
Health Delivery System Competencies
- Applies knowledge of organizational practices and complex systems to improve health care delivery.
- Effects health care change using broad based skills including negotiating, consensus-building, and partnering.
- Minimizes risk to patients and providers at the individual and systems level.
- Facilitates the development of health care systems that address the needs of culturally diverse populations, providers, and other stakeholders.
- Evaluates the impact of health care delivery on patients, providers, other stakeholders, and the environment.
- Analyzes organizational structure, functions and resources to improve the delivery of care.
- Collaborates in planning for transitions across the continuum of care.
**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.
NR 603 Week 8 MyEvaluations Log – Clinical Evaluation
PATIENT INFO
VISIT INFO
- Minutes
Client Complexity
Student Level of Function
CODING
- Diagnosis Information
COMPETENCIES
- Skills & Procedures
- Notes
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