NR511 Week 3 Discussion 1 & 2 Latest 2018 April
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Week 3: Discussion Part One
22 unread replies.2525 replies.
Date of visit: October 20, 2017
A 19-year-old male freshman college student presents to the student health center today with complaints of bilateral eye discomfort. Upon further questioning you discover the following subjective information regarding the chief complaint.
History of Present Illness |
Onset | 2-3 days ago |
Location | Both eyes |
Duration | Constant |
Characteristics | Both eyes feel "gritty" with mild to moderate amount of discomfort. Further describes the gritty sensation "like sand caught in your eye" |
Aggravating factors | None identified |
Relieving factors | None identified |
Treatments | Tried OTC visine drops yesterday which temporarily improved the redness but the gritty sensation, tearing and itching remained. |
Severity | Level of discomfort is 2/10 on pain scale |
Review of Systems (ROS) |
Constitutional | Denies fever, chills, or recent illnesses |
Eyes | Denies contact lenses or glasses, has never experienced these symptoms previously. Last eye exam was "a few years ago". Denies recent trauma or eye injury. Denies crusting of lids or mucoid or purulent drainage. Bilateral symptoms of +redness, +itching, +tearing + FB sensation. |
Ears | -otalgia, -otorrhea |
Nose | +occasional runny nose with intermittent nasal congestion, denies sneezing. History of seasonal nasal allergies which is aggravated in the spring but is well controlled on loratadine and fluticasone nasal spray taken during peak season. |
Throat | Denies ST and redness |
Neck | Denies lymph node tenderness or swelling |
Chest | Denies cough, SOB and wheezing |
Heart | Denies chest pain |
History |
Medications | Loratadine 10mg daily and fluticasone nasal spray daily (only takes during the spring months when nasal allergies flare) |
PMH | Seasonal allergic rhinitis with springtime triggers |
PSH | None |
Allergies | None |
Social | Freshman student at the University of Awesome located in central Illinois. Home is in Phoenix. |
Habits | Denies cigarettes +recreational marijuana use +drinks 3-6 beers per weekend |
FH | Adopted, does not know biological parents history |
Physical exam reveals the following.
Physical Exam |
Constitutional | Young adult male in NAD, alert and oriented, cooperative |
VS | Temp-97.9, P-68, R-16, BP 120/75, Height 6'0, Weight 195 pounds |
Head | Normocephalic |
Eyes | Visual Acuity 20/20 (uncorrected) OU. PERRL with white sclera bilaterally. + photosensitivity. No crusting, lesions or masses on lids noted. Bilateral conjunctiva with diffuse redness and tearing but no mucoid or purulent drainage noted. No visible FBs under lids or on cornea to gross examination. Fundiscopic examination: Discs flat with sharp margins. Vessels present in all quadrants without crossing defects. Retinal background has even color, no hemorrhages noted. Macula has even color. |
Ears | Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. |
Nose | Nares patent. Nasal turbinates are pale and boggy with mild to moderate swelling. Nasal drainage is clear. |
Throat | Oropharynx moist, no lesions or exudate. Tonsils ¼ bilaterally. Teeth in good repair, no cavities noted. |
Neck | Neck supple. No lymphadenopathy. Thyroid midline, small and firm without palpable masses. |
Cardiopulmonary | Heart S1 and S2 noted, no murmurs, noted. Lungs clear to auscultation bilaterally. Respirations unlabored. |
- Briefly and concisely summarize the history and physical (H&P) findings as if you were presenting it to your preceptor using the pertinent facts from the case. Use shorthand where possible and approved medical abbreviations. Avoid redundancy and irrelevant information.
- Provide a differential diagnosis (minimum of 3) which might explain the patient's chief complaint along with a brief statement of pathophysiology for each.
- Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis. Rank the differential in order of most likely to least likely.
- Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based medicine (EBM) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBM evidence.
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Week 3: Discussion Part Two
11 unread reply.2525 replies.
Now, assume that any procedures and/or testing which were performed are NORMAL.
- What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case)
- Identify the corresponding ICD-10 code.
- Provide a treatment plan for this patient's primary diagnosis which includes:
- Medication*
- Any additional testing necessary for this particular diagnosis*
- Patient education
- Referral and follow-up to the treatment plan
- Provide an active problem list for this patient based on the information given in the case.
*If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST be supported with an evidence-based medicine (EBM) argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office.
NR511 Week 6 Discussion 1 & 2 Latest 2018 April
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Week 6: Discussion Part One
33 unread replies.2727 replies.
Date of visit: November 7, 2017
A 56-year-old Caucasian female presents to the office today with complaints of fatigue. Upon further questioning you discover the following subjective information regarding the chief complaint.
History of Present Illness |
Onset | "about 2-3 months" |
Location | Generalized |
Duration | Constant |
Characteristics | Progressively worsening since onset, feels tired all of the time, sleeps 8hrs per night but does not feel well rested. "No energy to do anything I normally can do" |
Aggravating factors | Exertion |
Relieving factors | None identified |
Treatments | None |
Severity | Denies pain; missed 1 day of work 2 weeks ago because "couldn't get out of bed" |
Review of Systems (ROS) |
Constitutional | Denies fever, chills, or recent illnesses. +5lb. weight gain since last visit 6 months ago. |
Eyes | No visual changes or diploplia |
ENT | Denies ear pain, coryza, rhinorrhea, or ST. Had tonsillectomy as child Denies snoring or history of sleep apnea. |
Neck | Denies lymph node tenderness or swelling |
Chest | Denies cough, SOB, DOE or wheezing |
Heart | Denies chest pain |
Abdomen | Denies N/V/D. + Constipation |
Endocrine | Denies polyuria, polydipsia. + cold intolerance. Menopause status x 5 yrs. |
Skin | No changes in skin, hair or nails |
Psych | Reports worsening of depressive symptoms but thinks it is because she is so "unproductive" lately and tired all of the time. -Suicidal or homicidal thoughts. Sleeping 8-9hrs per night (no changes), but not feeling rested. |
Musculoskeletal | Generalized weakness and intermittent muscles cramping in calves |
History |
Medications | Multivitamin, B-Complex, Prozac 20mg, Bisoprolol-HCTZ 2.5mg/6.25mg, Calcium 500mg + Vit D3 400IU. |
PMH | HTN, Depression, Postmenopausal status |
PSH | Tonsillectomy |
Allergies | Iodine dyes |
Social | Married; Works full time as office manager of an internal medicine office; 2 kids (grown) |
Habits | Denies cigarettes or drug use. +Occasional glass of wine (1-2 per month). |
FH | Maternal GM & GF deceased with CHF, T2DM and HTN; Mother alive (age 82) +HTN, +Hyperlipidemia, +T2DM; Father alive (age 84) +HTN, +Hyperlipidemia, +T2DM, +ASHD (s/p CABG 2 years ago). Also had +CVA at time of CABG (work-up revealed +DVT and +PFO; remains anticoagulated); Oldest child (26) with seasonal allergies Youngest child (24) with Bipolar depression and ADHD, and anxiety |
Physical exam reveals the following:
Physical Exam |
Constitutional | Middle aged Caucasian female alert, oriented and cooperative |
VS | Temp-98.2, P-74, R-16, BP 146/95, Height: 5'7", Weight: 180 pounds |
Head | Normocephalic, atraumatic |
Eyes | PERRLA |
Ears | Tympanic membranes gray and intact with light reflex noted. |
Nose | Nares patent. Nasal turbinates without swelling. Nasal drainage is clear. |
Throat | Oropharynx moist, no lesions or exudate. Surgically removed tonsils bilaterally. Teeth in good repair, no cavities. |
Neck | Neck supple. No lymphadenopathy. Thyroid midline, small and firm without palpable masses. |
Cardiopulmonary | Heart S1 and s2 noted, no murmurs, noted. Lungs clear to auscultation bilaterally. Respirations unlabored. No pedal edema |
Abdomen | Soft, non-tender. BS active |
Skin | Skin overall dry, hair coarse and thick, nails without ridging, pitting or discoloration |
Psych | Mood pleasant and appropriate. |
Musculoskeletal | Strength full throughout |
Neuro | DTRs 2+ at biceps, 1+ at knees and ankles |
- Briefly and concisely summarize the H&P findings as if you were presenting it to your preceptor using the pertinent facts from the case. Use shorthand where possible and approved medical abbreviations. Avoid redundancy and irrelevant information.
- Provide a differential diagnosis (minimum of 3) which might explain the patient's chief complaint along with a brief statement of pathophysiology for each.
- Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis. Rank the differential in order of most likely to least likely.
- Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based medicine (EBM) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBM.
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Week 6: Discussion Part Two
77 unread replies.2121 replies.
Now, assume that you sent your patient for labs and she returns the following day, as instructed, to review the results.
CBC with differential
WBC | 8.6 x10E3/uL |
RBC | 4.44 x 10E6/uL |
Hemoglobin | 14.0 g/dL |
Hematocrit | 41.2% |
MCV | 93fL |
MCH | 31.5 pg |
MCHC | 34.0 g/dL |
RDW | 13% |
Platelet | 241 x 10E3/uL |
Neutrophils % | 67% |
Lymphocytes % | 22% |
Monocytes % | 8% |
Eosinophils % | 3% |
Basophils % | 0% |
Absolute Neutrophils | 5.7 x 10E3/uL |
Absolute Lymphocytes | 1.9 x 10E3/uL |
Absolute Monocytes | 0.7 x 10E3/uL |
Eosinophils Absolute | 0.3 x 10E3/uL |
Basophile Absolute | 0.0 x 10E3/uL |
Immature Grans % | 0% |
Absolute Immature Grans | 0.0 x 10E3/uL |
TSH with Reflex to FT4
TSH | 6.770 uIU/mL |
FT4 | 0.62 ng/dL |
PHQ-9 Depression Score=10 (previous was 5 at last visit 6 months ago)
- What is your primary diagnosis for this patient as the cause for the CC of fatigue? (support your decision for your diagnosis with pertinent positives and negatives from the case)
- Identify the corresponding ICD-10 code.
- Provide a treatment plan for this patient's primary diagnosis which includes:
- Medication*
- Any additional testing necessary for this particular diagnosis*
- Patient education*
- Referral and follow-up to the treatment plan
- Provide an active problem list for this patient based on the information given in the case.
- Are there any changes that you would make to the patient's overall plan at this time? Must provide an evidence-based medicine (EBM) argument to support any treatments or testing decisions.
- Provide an appropriate follow-up plan (include any additional testing that you feel is necessary and include an EBM argument).
*If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST be supported with an EBM argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office.
NR511 Week 7 Clinical Practice Guideline Assignment Latest 2018 April
CLINICAL PRACTICE GUIDELINE ASSIGNMENT
GUIDELINESWITH SCORING RUBRIC
Purpose
Clinical guidelines provide recommendations on the diagnosis and management of certain conditions. Recommendations are based on evidence from a rigorous systematic review and synthesis of the published medical literature. Interpreting and learning to apply guidelines into practice is necessary to develop and enhance diagnostic reasoning skills.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
1) Locate a current, primary careclinical practice guideline for a specific condition. (CO 3)
2) Read and interpret the guidelines for use in practice. (CO 3)
3) Evaluate the recommendations and apply to patients in the clinical setting as appropriate. (CO 3)
Due Date:
Students will RANDOMLY be assigned a topic by your instructor in Week 1. Students will post a brief PowerPoint summary presentation by Wednesday 11:59p.m. MT of Week 7. This will allow others to view their peer’s presentations in order to provide peer evaluations before Sunday. Presentations submitted after Wednesday 11:59p.m. MT of Week 7 will receive an automatic 0.
Total Points Possible: 150
Requirements:
1. Students will be randomlyassigned a disease topic from the instructor in Week 1.
2. Each student will locate and examine a current CPG for the assigned topic.
3. A copy (or reference) of the intended CPG should be submitted to the instructor by Week 3 for approval.
4. In Week 7,students will summarize the CPG and give a brief, oral presentation according to the directions and rubric listed below.
5. In addition to the presentation, a written transcript (for the instructor) must be submitted to the Week 7 assignment box.
6. Students will share a copy of the CPG along with a link to their presentation.
7. Presentations and transcripts are due beforeWednesday 11:59p.m. MT of Week 7,Presentations and/or papers submitted after the deadline will receive an automatic 0.
Preparing the paper
· The presentation should be developed using the guidelines listed below. All presentations must be in PowerPoint format.
· The PowerPoint file should be uploaded to Voice Thread in order to add the narrated portion.
· The presentation should be “published” or shared with the class for viewing by posting a link in the discussion forum along with a copy of the CPG before Wednesday 11:59p.m. MT of Week 7.
· The written transcript should also be submitted to the drop-box for the instructor’s reference before Wednesday 11:59 p.m. MT of Week 7.
· Correct grammar, punctuation, and spelling should be observed in the slides and script.
NR511 Week 8 Reflection Latest 2018 April
Reflection Assignment
Purpose
Students will complete a self-reflection assignment for the purpose of validating their clinical progress. The goal for this activity is to engage the student in considering how their clinical abilities and professional growth are changing.
Activity Learning Outcomes
Through this assignment, the student will:
1) Review clinical encounters to identify gaps in experience.
2) Propose a plan to narrow the gaps in experience.
3) Identify their own feelings regarding their progress, achievement of personal goals and weaknesses.
4) Chose two (2) NONPF competencies and discuss how the student has met or plans to meet them in the future.
Due Date: Assignment must be submitted by Saturday11:59p.m. MT.
Total Points Possible: 50
REQUIREMENTS:
There are two parts to this assignment.
1. In part 1, students will review their clinical experience documentation in to write a NARRATIVE about their experience thus far. Students should:
• Review their patient encounters and identify experience gaps in terms of age, acuity, certain procedures, level of complexity, etc.
• State how they plan to narrow this gap in future practicums (i.e., focus on seeing pediatric patients under the age of 5, finding a separate pediatric site for a later practicum, etcetera)
• Discuss how they have progressed throughout the practicum by identifying the goals that they have achieved and/or are still working toward
• Identify areas of weakness and communicate a plan to address these areas
2. Choose two of the NONPF competencies and describe either (a) how you have met them or (b) how you plan to work toward meeting them in the future. Provide specific examples from your clinical rotation as support. FNP NONPF competencies can be found at: http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/Competencies/CompilationPopFocusComps2013.pdf
PREPARING THE PAPER
The written portion of this assignment is to be completed in a WORD document (.doc) and submitted to the course. Grammar, punctuation, spelling should be observed. In-text citations and reference page should follow APA format. Additionally, the following parameters should be set in the template before you begin:
• Font: Times New Roman 11pt
• Single space
• Spacing set at 0pt before and after paragraphs (under page layout)
