Module 1 Assignment

egin Research for Your Case Presentation

Begin research for your Case Presentation based on what you have chosen in Module 3 Discussion ii.

Due in module 7.

No submission in this module.

Module 2 Discussion

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 The 50-Year-Old Patient Evaluation & Management Plan

A 50-year-old woman presents to the office with complaints of excessive fatigue and shortness of breath after activity, which is abnormal for her. The woman has a history of congestive heart failure with decreased kidney function within the last year. The woman appears unusually tired and slightly pale. Additional history and examination rules out worsening heart failure, acute illness, and worsening kidney disease. The CBC results indicate hemoglobin is 9.5 g/dL, which is a new finding, and the hematocrit is 29%. Previous hemoglobin levels have been 11 to 13g/dL. The patient’s vital signs are temperature 98.7°F, heart rate 92 bpm, respirations 28 breaths per minute, and blood pressure 138/72. The practitioner suspects the low hemoglobin level is related to the decline in kidney function and begins to address treatment related to the condition. Discuss the following:

Which test(s) should be performed to determine whether the anemia is related to chronic disease or iron deficiency, and what would those results show?

Should the practitioner consider a blood transfusion for this patient? Explain your answer.

Which medication(s) should be considered for this patient?

What considerations should the practitioner include in the care of the patient if erythropoietic agents are used for treatment?

What follow-up should the practitioner recommend for the patient?

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 

All replies must be constructive and use literature where possible.

Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.

You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date. 

Module 3 Discussion i

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 The House Painter Patient Evaluation & Management Plan

A 52-year-old male patient who is a house painter presents to the office reporting chronic fatigue and “mild” chest pain. When he is painting, chest pain is relieved after taking a break. He reports that the pain usually lasts 5 minutes or less and occasionally spreads to his left arm before subsiding. The patient was last seen 3 years ago by you, and you recommended diet changes to manage mild hyperlipidemia, but the patient has gained 30 pounds since that time. The patient’s medical history includes anxiety, vasectomy, cholecystectomy, and mild hyperlipidemia. The patient does not smoke or use other tobacco or nicotine products. The patient cares for his wife, who has multiple sclerosis and requires 24-hour care. His daughter and grandson also live with the patient. His daughter assists with the care of his wife, and his job is the major source of income for the family. The initial vital signs are: blood pressure 158/78, heart rate 87, respiratory rate 20, and body mass index 32. As part of the diagnostic work-up, an ECG, lipid levels, cardiac enzymes, and C-reactive protein (CRP) are ordered. The patient reports that he does not have time to “be sick” and says that he needs to take care of everything during this visit so he can return to work and care for his wife. Discuss the following: 

What additional information should you obtain about the pain the patient is experiencing?

What additional physical assessment needs to be performed with this patient?

What considerations are important to remember if the patient’s CRP level is elevated?

What differential diagnoses should be considered for the patient?

What patient teaching will be incorporated into the visit to modify the patient’s risk factors?

How will you respond to the patient’s statement that he does not have time to “be sick” and needs to take care of everything during this visit?

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 

All replies must be constructive and use literature where possible.

Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.

You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date. 

Module 3 Assignment

ontinue to Work on Your Case Presentation

Continue to research and work on your Case Presentation. Module 7 Assignment: Case Presentation. Due in module 7.

No submission in this module. 

Module 4 Discussion

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 The Homeless Patient Evaluation & Management Plan

The nurse practitioner (NP) is working at a health clinic in a homeless shelter during the early evening. A 48-year-old African American man approaches the practitioner and asks to have his blood pressure taken, saying that he has not had it checked “in a while”.

The man appears to be in some type of distress and experiencing pain. The man walks slowly, using a guarded manner, and he appears diaphoretic. His mucous membranes also appear pale. The patient’s blood pressure is 210/98. The patient reports that he has not been diagnosed with hypertension previously. The patient reveals that he has severe abdominal pain that is radiating to his back. The nurse finds a heart rate of 110, respirations 30 with shallow inspirations, and temperature 102.2°F. The patient’s skin is cool and clammy.

The patient reports a history of alcoholism, homelessness, and lack of access to health care. He says that the symptoms have been present and worsening over 3 days. The man says he thinks he might have pancreatitis again, which he had “a couple of years ago”. The NP recommends that the man should be seen at a hospital for his condition, but the patient says he does not have health insurance, so he does not want to go.

The NP proceeds with a physical examination, finding severe abdominal pain in the epigastric area, yellowed sclera, no abdominal distention, and hypoactive bowel sounds. The clinic is equipped with basic materials but no means to conduct lab or radiologic testing. Discuss the following:

Considering the patient’s homelessness and lack of insurance, what action should the practitioner take?

When the patient asks why his condition cannot be managed outside of the hospital, how should the practitioner respond?

When the patient arrives at the hospital for further diagnostic work-up, what tests will likely be performed to evaluate the patient’s condition?

How will the severity of the pancreatitis be assessed when the patient is hospitalized?

How should the patient’s condition be managed when hospitalized?

What patient education should be included after the pancreatitis is resolved?

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 

All replies must be constructive and use literature where possible.

Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.

You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date. 

Module 5 Discussion

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 The 34-Year-Old Patient Evaluation & Management Plan

A 34-y.o. female presents with the complaint of a sudden excruciating pain in her back and points to her flank area on the right side. She rates the pain as 10 on a scale of 1 to 10, with 10 being the worst. She also complains of nausea with the pain. She states that she has never had anything like this before, and the pain is subsiding a little now.

What additional questions should you ask the patient and why?

What should be included in the physical examination at this visit?

What are the possible differential diagnoses at this time?

What tests should you order and why?

How should this patient be managed?

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 

All replies must be constructive and use literature where possible.

Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.

You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date. 

Module 6 Discussion

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 The 41-Year-Old Patient Evaluation & Management Plan

A 41-year-old male patient presents at the community walk-in clinic with complaints of severe elbow pain radiating into the forearm. His 13-year-old daughter is serving as a translator because her father is unable to speak English and understands only a few words in English. The daughter explains that he has been taking Tylenol to manage pain, but the pain is getting worse and is keeping him from working. You ask the daughter to describe the type of work her father does, and you notice she is hesitant to respond, first checking with her father. He responds, and she translates that he works in construction. Based on the response and the apparent concern, you suspect that the patient may be an undocumented worker. Further conversation reveals that several members of the family are working with the same local construction company.

You suspect the pain reported as coming from the elbow and radiating down the forearm is caused by repetitive motions, perhaps indicating lateral epicondylitis. What can you do to confirm this diagnosis?

While performing the physical examination, you ask the patient, through his daughter, if he has reported this injury to his employer, because the injury is most likely work-related. The daughter responded without consulting her father that this is an old injury that happened before he started working at his current place of employment. You could tell that she was becoming more distressed. What is the most likely explanation for her concern?

Visual inspection reveals erythema around the affected area with no evidence of overlying skin lesions, scars, or deformities. What other assessments should you perform?

How is lateral epicondylitis treated?

When discussing possible treatment approaches, you notice that the patient is very worried and seems to suggest to his daughter that they should leave. The daughter begins trying to explain why they have to leave right away. What would you tell the patient and his daughter to help them feel comfortable staying for treatment?

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 

All replies must be constructive and use literature where possible.

Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.

You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date. 

Module 7 Discussion

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 The 15-Year-Old Patient Evaluation & Management Plan

You are seeing a 15-year-old female patient for a gynecological exam and to explore birth control options. The patient’s mother scheduled the appointment after learning that her daughter has become sexually active. The patient is current with all immunizations, including Gardasil, and has no significant health history that would contraindicate the use of birth control.

This is the patient’s first gynecological exam, and she expresses feeling nervous and embarrassed that her mother has shared her sexual experience with strangers. Taking this into account, how would you begin the patient encounter?

As you begin asking questions to determine the patient’s gynecological history, the patient appears frustrated and embarrassed and reminds you that she has only had sex one time. What should the patient understand about the importance of reviewing gynecological history?

What are the most popular birth control methods prescribed in the United States? What determines the success or failure of a birth control method?

The patient expresses a desire for the most effective form of birth control but is concerned about weight gain and other side effects. How should you respond to her concerns?

The patient seems unsure about the best option for birth control and asks if she can take some time to think about the choices. As the use of birth control is ultimately the patient’s choice, you offer to answer any questions and agree to a follow-up visit or call. The patient asks whether using a condom is okay if she decides to have sexual intercourse before selecting a method of birth control. What should you tell her?

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 

All replies must be constructive and use literature where possible.

Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.

You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date. 

Module 7 Assignment

Power Point Presentation: Realistic Clinical Case Study

For this assignment, you will develop a presentation on a clinical case. Develop your presentation based on a clinical case based on the topic you have chosen in Module 3 Discussion ii

Content Requirements You will create a PowerPoint presentation with a realistic case study and include appropriate and pertinent clinical information that will be covering the following:

Subjective data: Demographics; Chief Complaint; History of the Present Illness (HPI) that includes the presenting problem and the 8 dimensions of the problem; Medications; Allergies; Past medical history; Family history; Past surgical history; Social history;  Review of Systems (ROS)

Objective data: Vital signs; Physical exam, Labs (reviewed from the patient's medical records, if no lab/diagnostic tests were done recently to review, you must indicate that to receive credit).

Assessment: Differential diagnosis; Primary Diagnosis

Plan: Laboratory and diagnostic tests; Pharmacologic treatment plan; Non-pharmacologic treatment plan; Anticipatory guidance (primary prevention strategies); Follow up plan.

Other: Incorporation of current clinical guidelines; Integration of research articles; Role of the Nurse practitioner

Submission Instructions:

The presentation is original work and logically organized, formatted, and cited in the current APA style, including citation of references.

The presentation should consist of 10-15 slides and less than 5 minutes in length. 

Incorporate a minimum of 4 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles and books should be referenced according to APA style (the library has a copy of the APA Manual).

Complete and submit the assignment by 11:59 PM ET Sunday

Grading Rubric