NR601 Primary Care of the Maturing and Aged Family
Week 1 Discussion
DQ1 Comprehensive Geriatric Assessment
Purpose
The purpose of this assignment is to review the components of the comprehensive geriatric assessment
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Discuss components of a comprehensive geriatric assessment (WO 1.1, 1.2, 1.3, 1.4) (CO1, 5, 7)
Evaluate screening tools used as part of the comprehensive geriatric assessment (WO 1.4) (CO 1, 7)
Peer and faculty responses are due by Sunday, 11:59 p.m.?MT. ?Please note that the late assignment policy does not apply to the collaborative discussions.?
A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday@ 11:59 pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).
Requirements:
Step 1:
Review the assigned topics which are listed by student number. For example, if your student number is 2 you will discuss the functional health domain and then respond to a classmate who has posted on the psychological health domain.
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Your student number:
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Your assessment domain
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Your peer response domain
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1, 5 and 9
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Physical health
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Socioenvironmental health & quality of life measures
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2, 6 and 10
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Functional health
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Psychological health
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3 and 7
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Psychological health
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Functional health
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4 and 8
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Socioenvironmental health & quality of life measures
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Physical health
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Step 2:
For your assigned assessment domain:
Provide a brief 3-5 sentence summary of the components of the domain assessment*
Choose a screening tool which is appropriate for your domain. Explain the screening tool purpose, components and scoring technique*
Provide 2 references in APA format beneath the table which support your work. You may use the textbook. The second reference must be a scholarly source.
*All responses must be your work, in your own words.
Your table should look like the following:
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Comprehensive Geriatric
Assessment
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Domain
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Dimensions of assessment
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Screening tool related to the domain(s)
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References:
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Step 3:
Paste table inside the discussion board post. Do not attach as a document.
Step 4:
Respond to a peer’s post. Your assigned response to a peer requirement is listed within the assignment table.
Peer response will include:
Compares peer domain to student’s assigned assessment domain, noting similarities and differences*
Peer review: discuss how your assigned peer’s screening tool can be applicable in your own future practice*
*All responses must be your work, in your own words.
DQ2 Polypharmacy
Purpose
The purpose of student discussions is to provide the opportunity for deeper understanding of polypharmacy
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Summarize the different polypharmacy definitions found within the literature. (WO1.5) (CO1)
Discuss polypharmacy risk factors (WO1.5) (CO1)
Explain thee actions steps for polypharmacy prevention (WO1.5) (CO1, 7)
Due Date:
The?initial posting to the?graded?collaborative discussions?is?due by Wednesday, 11:59 p.m.?MT.?
Peer responses and responses to faculty must be posted prior to the week deadline of Sunday 11:59 MT.
A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).
Requirements:
Your initial discussion post should include the following:
Identify and discuss 2-3 definitions of polypharmacy (there are multiple definitions). Your textbook can count as 1 reference. You must also include an additional reference from an evidence-based practice journal article or national guideline.
Identify three risk factors that can lead to polypharmacy. Explain the rationale for why each listed item is a risk factor. Risk factors are different than adverse drug reactions. ADRs can be a result of polypharmacy, and is important, but ADRs are not a risk factor.
Explore three action steps that a provider can take to prevent polypharmacy.
Provide an example of how your clinical preceptors have addressed polypharmacy.
NR601 Primary Care of the Maturing and Aged Family
Week 2 Discussion
COPD Case Study Part 1
Purpose
Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1) ?(CO,2,3,4,5)
Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses.?(WO 2.2) (CO 2,4)
Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)
Case Study - Part 1
Date of visit: November 20,2019
A 62 year-old Caucasian male presents to the office with persistent cough and recent onset of shortness of breath. Upon further questioning you discover the following subjective information regarding the chief complaint.
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History of Present Illness
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Onset
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6 months
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Location
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Chest
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Duration
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Cough is intermittent but frequent, worse in the AM
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Characteristics
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Productive; whitish-yellow phlegm
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Aggravating factors
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Activity
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Relieving factors
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Rest
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Treatments
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Tried Robitussin DM without relief of symptoms
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Severity
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Unable to walk > 20ft without stopping to catch his breath. Last year at this time he routinely walked 1 mile per day without difficulty
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Review of Systems (ROS)
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Constitutional
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Denies fever, chills, or weight loss?
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Ears
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Denies otalgia and otorrhea
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Nose
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Denies rhinorrhea, nasal congestion, sneezing or post nasal drip.
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Throat
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Denies ST and redness
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Neck
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Denies lymph node tenderness or swelling
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Chest
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Describes a persistent productive cough upon wakening for the last 6 months. Color of phlegm is usually white-yellowish. Shortness of breath with activity.
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Cardiovascular
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Denies chest pain and lower extremity edema
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History
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Medications
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Metoprolol succinate ER (Toprol-XL) 50mg daily for hypertension; Multivitamin daily
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PMH
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Primary hypertension
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PSH
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Cholecystectomy, appendectomy
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Allergies
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Penicillin (hives)
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Social
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Married, 3 children
Senior accountant at a risk management firm
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Habits
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Former smoker (20 pack-year), quit “cold turkey” when father died; Denies alcohol or illicit drug use.
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FH
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Father died of MI & CHF at age 59 years (diabetes, hypertension, smoker)
Mother is alive (osteoporosis)
Healthy siblings
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Physical exam reveals the following:
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Physical Exam
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Constitutional
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Adult male in NAD, alert and oriented, able to speak in full sentences
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VS
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Temp-98.1, P-66, RR-20, BP 156/94, Height 68.9in, Weight 258 pounds, O2sat 94% on RA
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Head
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Normocephalic
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Ears
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Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender.
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Nose
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Nares patent. Nasal turbinates clear without redness or edema. Nasal drainage is clear.
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Throat
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Oropharynx moist, no lesions or exudate. Tonsils ¼ bilaterally. Teeth in good repair, no cavities noted.
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Neck
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Neck supple. No lymphadenopathy. Thyroid midline, small and firm without palpable masses. No JVD
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Cardiopulmonary
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Heart S1 and S2 with no murmurs, noted. Lungs clear to auscultation bilaterally with faint forced expiratory wheezes in bilateral bases. Respirations unlabored. Legs without edema.
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Abdomen
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Soft, non-tender. No organomegaly
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Requirements/Questions:
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. May use 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 (2-3 sentences) 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 practice (EBP) 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 EBP evidence.
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DISCUSSION FORMAT
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Category
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Points
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Description
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Organization
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5
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10%
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- Case study response is presented in a logical format, AND
- Responses are in sequence with the numbered questions AND
- The case study response is understandable and easy to follow AND
- All responses are relevant to the case topic
(4 critical elements)
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Grammar, Syntax, Spelling & Punctuation
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5
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10%
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Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*
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Total FORMAT Points= 10 pts
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DISCUSSION TOTAL= 50 pts
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DQ2 COPD Case Study Part 2
Purpose
Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1) (CO 2,3,4,5)
Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses.?(WO 2.2) (CO 2,4)
Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)
Case Study - Part 2
You ordered a CXR and spirometry at the previous visit and he returns today to review the results. Physical exam and symptoms are unchanged since last visit. Vital signs at this visit are: Temp-98.3, P-68, RR-20, BP 152/90, Height 68.9in., Weight 258 pounds, O2sat 94% on RA
CXR Result:
No acute infiltrates or consolidations are seen. Cardiac and mediastinal silhouettes are normal. No hilar enlargement is evident. Osseous thorax is intact.
Spirometry Results:
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Pre-Bronchodilator
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Post-Bronchodilator
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Predicted
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Actual
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%Predicted
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Actual
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% Predicted
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% Change
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FVC (L)
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4.52
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3.01
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67
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3.08
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68
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2
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FEV1 (L)
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3.40
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1.58
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46
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1.60
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47
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1
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FEV1/FV
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.75
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.52
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---
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.52
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---
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0
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Requirements/Questions:
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
Follow up
Provide an active problem list for this patient based on the information given in the case.
Are there any changes that you would also make to this patient’s overall treatment plan at this time? Must provide an EBP argument for each treatment or testing decision.
*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 practice (EBP) argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office.
Over-the-counter (OTC) and RXs must be written in full as if handing a prescription to the patient in the office.??
Example:??
Amoxicillin 500 mg capsule?
1 tab po BID q 10 days?
Disp #20 no refills??
NR601 Primary Care of the Maturing and Aged Family
Week 3 Discussion
Psychiatric Disorders and Screening
Purpose
The purpose of student discussions is to provide the opportunity for application of depression and anxiety screening tools to a selected case patient.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Explain the purpose of two selected screening tools (CO7)
Interpret the scoring criteria of two selected screening tools (CO7)
Discuss the mechanism of action, side effects and expected onset of action for a selected medication (CO4)
Requirements:
Anxiety and depression are the most common psychiatric problems you will encounter in your primary care practice.
Review this case study
HPI: KF, 56-year-old Caucasian female presents to office with complaints of “no energy and not wanting to go out.” These symptoms have been present for about 3?months and seem worse in the morning and improve slightly through the day. It is hard to get out of bed and get the day started because does not feel rested when she wakes up in the morning.? KF reports a "loss of joy". States" I really don't feel like going anywhere or doing anything".? She tries to do at least one social activity a week, but it can be really exhausting. Reports she also has difficulty completing projects for work, she cannot stay focused anymore. She reports not feeling hungry, so she is not eating regularly and has lost some weight.? KB has been a widow for 2 years. Her husband died unexpectedly, he had a MI. She recently got a puppy, which she thought would help with the loneliness, but the care of the puppy seems overwhelming at times. Rest and exercise, specifically yoga and meditation seem to help her feel better. At this time, she does not want to do either, it seems like too much effort to get up and go. She has not tried any medications, prescribed or otherwise. She reports drinking a lot of coffee, but that does not seem to help with her energy levels.?
Current medications: Excedrin PM about once a week when she can't sleep, seems to help a bit. NKDA.?
PMH: no major illnesses. Immunizations up to date.?
SH: widowed, employed full time as a consultant. Drinks 1 glass of wine almost every night. No tobacco use, no illicit drug use. Previously married 20 years ago while living in France, reports an abusive relationship. The French government gave custody of her son to the ex-husband. She returned to US without her son 10 years ago. She sees her son two times a year, they skype and text "all the time" but she misses him. Her son is now an adult and is considering moving to the US.??
FH: Parents are alive and well. Has one son, age 21, he is healthy but lives in France with his father.
ROS?
CONSTITUTIONAL: reports weight loss of 4-5 pounds, no fever, chills, or weakness reported. Daily fatigue.??
HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclera. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.?
CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.?
RESPIRATORY: No shortness of breath, cough or sputum.?
GASTROINTESTINAL: Reports decreased appetite for about 3 months. No nausea, vomiting or diarrhea. No abdominal pain or blood.?
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.?
GENITOURINARY: no burning on urination. Last menstrual period 4 years ago.?
PSYCHIATRIC: No history of diagnosed depression or anxiety. Reports history of great anxiety due to verbal and concern for physical abuse, reports feeling very sad and anxious when divorcing and leaving her son in France. Did not seek treatment. She started to feel better after about 4 months.?
ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia?
ALLERGIES: No history of asthma, hives, eczema or rhinitis.?
Discussion Questions:?
Research screening tools for depression and anxiety. Choose one screening tool for depression and one screening tool for anxiety that you feel are appropriate to screen KF.
Explain in detail why each screening tool was chosen. Include the purpose and time frame of each chosen tool.
Score KF using both of your chosen screening tools based on the information provided (not all data may be provided, those areas can be scored as not present). Pay close attention to the listed symptom time frame for your chosen assessment tool.? In your response include what questions could be scored, and your chosen score.? Interpret the score according to the screening tool scoring instructions. Assume that any question topics not mentioned are not a concern at this time.
Identify your next step for evaluation and treatment for KF. Remember to consider both physical and mental health differential diagnoses when answering this question.?? (2-3 sentences).
What medication or treatment is appropriate for KF based on her screening score today? Provide the rationale. Any medications should include the medication class, mechanism of action of the medication and why this medication is appropriate for KF. Include initial prescribing information.??
If the medication works as expected, when should KF expect to start feeling better??
Direct Quotes
Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.
**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.
NR601 Primary Care of the Maturing and Aged Family
Week 6 Discussion
Post-Menopausal and Sexuality Issues in the Maturing and Older Adult
Purpose
The purpose of this student discussion is to discuss Post-Menopausal and Sexuality Issues in the Maturing and Older Adult
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
1) Discuss the symptoms related to genitourinary syndrome of menopause (GSM) (WO 6.2,6.3) (CO 1,3,5)
2) Reflect on personal comfort level when performing a sexual history on the maturing an older adult. (WO 6.2,6.3) (CO 1,3,5)
Requirements:
Ageism and gender bias can affect to whom and how we ask about sexual health, sexual activity, and concerning symptoms. Depending on your own level of comfort and cultural norms this can be a tough conversation for some providers but this is an important topic. As this week's required NAMS videos discussed, women are wanting us to ask about sexual concerns. This week we also reviewed sexually transmitted diseases and the effects of ageism on the time to diagnosis so it is necessary to ask these questions and provide good education for all patients. You will not know any needs unless you ask.
Discussion Questions:Review the required NAMS videos. What was the most surprising statement or topic that you heard in the videos? Explain why this was surprising to you.
What is GSM? What body systems are involved? How does GSM affect a woman's quality of life?
Review one aspect of treatment that Dr Shapiro recommends for GSM and include an EBP journal article or guideline recommendation in addition to referencing the video in your response.
Sexuality and the older adult
What is your level of comfort in taking a complete sexual history? Is this comfort level different for male or female patients? If so, why?
How will this week's information impact the way you will interact with your mature and elderly clients in the future?
NR601 Primary Care of the Maturing and Aged Family
Week 7 Discussion
Reflection
Purpose
Students will complete a self-reflection assignment for the purpose of validating their personal progress and academic growth in NR 601. The goal for this activity is to engage the student in considering how their clinical abilities and professional growth are advancing .
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Reflect upon how the assigned program outcome, MSN Essential and NONFP competencies have been achieved in NR 601. (WO7.4) (CO1-7)
Link course assignments and clinical activities to the assigned program outcome, MSN Essential and NONPF competencies. (WO7.4) (CO1-7)
Requirements:
Reflect over the past seven weeks and describe how the achievement of the course outcomes in this course have prepared you to meet:
MSN program Outcome # 5
MSN Essential # VIII
NONPF Nurse Practitioner Core Competency # 8
Chamberlain College of Nursing Program Outcome #5
Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice. (Extraordinary nursing)
Masters Essential VIII: Clinical Prevention and Population Health for Improving Health
Integrate clinical prevention and population health concepts in the development of culturally relevant and linguistically appropriate health education, communication strategies, and interventions.
Design patient-centered and culturally responsive strategies in the delivery of clinical prevention and health promote on interventions and/or services to individuals, families, communities, and aggregates/clinical populations.
NONPF: #8 Ethics Competencies
Integrates ethical principles in decision making.
Evaluates the ethical consequences of decisions.
Applies ethically sound solutions to complex issues related to individuals, populations and systems of care.
Students will reflect on each of the listed outcomes or competencies listed above individually and provide two (2) examples for each. Examples can be from course assignments or clinical experiences.
Review the assignment rubric for specific requirements for this reflection post.
**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.
