NURS 6531 Week 1 Discussion – Competencies for Nurse Practitioners
NURS 6531 Week 1 Discussion – Competencies for Nurse Practitioners
The Consensus Model for APRN Regulation has brought about changes in the competencies for nurse practitioners. There are Core Competencies for all nurse practitioner populations and include both MSN and DNP degrees. Review your Learning Resources Page to examine the Core Competencies. NURS 6531 Week 1 Discussion – Competencies for Nurse Practitioners
- Family/Across the Lifespan competencies
- Adult-Gerontology NP competencies
- The major categories of family/across the lifespan competencies include the following: Scientific Foundation; Leadership; Quality; Practice Inquiry; Technology and Information Literacy; Policy; Health Delivery System; Ethics; and Independent Practice. In this Discussion, you explore the nine competencies, and their application to the clinical setting. NURS 6531 Week 1 Discussion – Competencies for Nurse Practitioners
- The adult-gerontology NP competencies are different and students in that specialty should become familiar with them. NURS 6531 Week 1 Discussion – Competencies for Nurse Practitioners
To prepare for NURS 6531 Week 1 Discussion – Competencies for Nurse Practitioners:
Review this week’s media presentation with Dr. Terry Buttaro, as well as the “Nurse Practitioner Self-Appraisal Guide” in the Learning Resources. Review the Consensus Model for APRN Regulation and the National Organization for Nurse Practitioner Faculties Core Competencies and population foci competencies. NURS 6531 Week 1 Discussion – Competencies for Nurse Practitioners
Consider the following nine competencies (Note: By Day 1 of this week, your Instructor will assign you to post on one of these nine competencies):
- Scientific Foundation
- Practice Inquiry
- Technology and Information Literacy
- Health Delivery System
- Independent Practice
Reflect on the category that was assigned to you by the Course Instructor. Think about how you would implement this competency in a clinical setting. Consider evidence-based clinical practice.
Post on or before Day 3 a brief description of the competency that was assigned to you. With your competency description in mind, explain how you would implement it in a clinical setting. Support your rationale with evidence from current research. NURS 6531 Week 1 Discussion – Competencies for Nurse Practitioners.
NURS 6531 Week 2 Discussion Diagnosing Skin, Eye, Ear, and Throat Disorders
When entering examination rooms, advanced practice nurses often immediately begin assessing patients by looking for external abnormalities such as skin irritations or cloudy eyes. By making these simple observations, they can determine how to proceed with their patient evaluations. During the patient evaluation, advanced practice nurses will use initial observations to guide them in acquiring the necessary medical history, performing additional assessments, and ordering the appropriate diagnostics. The information obtained during this evaluation process will help in the development of a differential diagnosis. Once a diagnosis is made, the advanced practice nurse can consider potential treatment options and work with the patient to develop a plan of care. For this Discussion, consider the following four case studies of patients presenting with skin, eye, ear, and throat disorders.
Case Study 1:
A 46-year-old male presents to the office complaining of a pruritic skin rash that has been present for a few weeks. He initially noted the rash on his chest, but it then spread to his back and arms. He notes that it does not seem to be on his legs. He recently came home from a trip to Florida, but denies fever, chills, new soaps or detergents, other travel, or known insect bites. He takes occasional ibuprofen for knee pain, but denies taking other medications or having other health problems. He has no known drug allergies. The physical examination reveals a male with a deep tan and notable scattered 1–1.5-centimeter, flat, circular, light-colored patches on his chest, back, and upper extremities.
Case Study 2:
An 86-year-old widowed female is brought to the office by her daughter-in-law. The patient complains of constant tearing and an itchy, burning sensation in both eyes. The patient states this is not a new problem, but it has worsened in the past week and is affecting her vision. The patient complains that her eyes are dry. She thinks the problem must be caused by one of her medications. Her patient medical history is positive for hypertension, atrial fibrillation, and heart failure. She has an allergy to erythromycin that causes rash and elevated liver enzymes. Medications currently prescribed include Furosemide 40 milligrams po twice a day, diltiazem 240 milligrams po daily, lisinopril 20 milligrams po daily, and warfarin 3 milligrams po daily. The physical examination reveals a frail older female with some facial dryness and slight scaling. Her visual acuity is 20/60 OU, 20/40 OD, 20/60 OS. The eyelids are erythematous and edematous with yellow crusting around the lashes. Sclera are injected, conjunctiva are pale, and pupils are equal and reactive to light and accommodation.
Case Study 3:
A middle-aged male presents to the office complaining of a two-day history of a left earache. The onset was gradual, but has steadily been increasing. It has been constantly aching since last night, and his hearing seems diminished to him. Today he thinks the left side of his face may even be swollen. He denies upper respiratory infection, known fever, or chills. His patient medical history is positive for Type 2 diabetes mellitus, hypertension, and hyperlipidemia. The patient has a known allergy to Amoxicillin that results in pruritus. Medications currently prescribed include Metformin 1,000 milligrams po twice a day, lisinopril 20 milligrams po daily, Aspirin 81 milligrams po daily, and simvastatin 40 milligrams po daily. The physical exam reveals a middle aged male at a weight of 160 pounds, height of 5’8”, temperature of 98.8 degrees Fahrenheit, heart rate of 88, respiratory rate of 18, and blood pressure of 138/76. Further examination reveals the following:
Face: Faint asymmetry with left periauricular area slightly edematous
Eyes: sclera clear, conj wnl
L ear: + tenderness L pinna, + edema, erythema, exudates left external auditory canal, TM not visible
R ear: no tenderness, R external auditory canal clear without edema, erythema, exudates
+ tenderness L preauricular node, otherwise no lymphadenopathy
Cardiac: S1 S2 regular. No S3 S4 or murmur.
Lungs: CTA w/o rales, wheezes, or rhonchi.
Case Study 4:
A middle-aged female presents to the office complaining of strep throat. She states she suddenly developed a sore throat yesterday afternoon, and it has gotten worse since then. During the night she felt like she was chilled and feverish. She denies known recent contact with anyone else who had strep throat, but states she has had strep before and it feels like she has strep now. She takes no medications, but is allergic to penicillin. The physical examination reveals a slender female lying on the examination table. She has a temperature of 101 degrees Fahrenheit, heart rate of 112, respiratory rate of 22, and blood pressure of 96/64. The head, eyes, ears, nose, and throat evaluation is positive for bilateral tonsillar swelling without exudates. Her neck is supple with bilateral, tender, enlarged anterior cervical nodes.
Review this week’s media presentations and Parts 5–8 of the Buttaro et al. text.
Select one of the four case studies provided. Reflect on the provided patient information including history and physical exams.
Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
Reflect on potential treatment options based on your diagnosis.
Post on or before Day 3 an explanation of the differential diagnosis for the patient in the case study that you selected. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.
NURS 6531 Week 3 Discussion Hypertension
In clinical settings, advanced practice nurses frequently use various strategies to treat and manage patients with hypertension and other cardiovascular disorders. These strategies often include pharmacologic and nonpharmacologic therapies, natural remedies, and/or changes in patient behavior. For hypertension patients, behavioral changes including increased exercise, healthier diet, and smoking cessation have proven to be particularly beneficial. However, it is important to recognize that treatment and management plans centered around changes in behavior often require greater patient commitment. This creates the need for patient-provider collaboration, as well as appropriate patient education. When patients are actively involved in their own care and better understand implications of their disorders, they are more likely to adhere to treatment plans.
Review Part 11 of the Buttaro et al. text and the National Heart Lung Blood Institute article in this week’s Learning Resources.
Reflect on your Practicum Experiences and observations. Select a case from these experiences that involves a patient who presented with a hypertension problem. When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.
Think about the patient’s history including drug treatments and behavioral factors such as diet, exercise, smoking, etc.
Review the National Heart Lung Blood Institute article in the Learning Resources. Reflect on health promotion strategies for the patient. Consider ways to reinforce hypertension management.
Post on or before Day 3 a description of a patient who presented with a hypertension problem during your Practicum Experience. Explain the patient’s history including drug treatments and behavioral factors. Then, suggest two health promotion strategies for the patient. Include suggestions for reinforcing hypertension management.
NURS 6531 Week 4 DQ1 Blood Clots
Blood clots form in various locations of the body and are not unique to any specific age group or gender. While there are certain risk factors that may make a patient more likely to develop blood clots, essentially any patient is a potential candidate. Unfortunately, blood clots often go unrecognized until something happens. Even if the patient identifies a problem and seeks medical care, blood clots are frequently misdiagnosed resulting in serious medical complications and sometimes death. Why does this happen? How can you, as the advanced practice nurse, protect your patients from misdiagnosis?
Consider the following case studies:
Case Study 1:
A 44-year-old African American male had a partial colectomy to have a cancerous tumor removed. The patient did really well after surgery and was discharged from post-op recovery to the surgical unit at a medical center. Approximately one hour after surgery, the patient complained of gas pains and shortness of breath. The patient continued to complain of gas pains after administration of morphine sulfate. Providers failed to diagnose a pulmonary embolism that resulted in the loss of the patient’s life.
Case Study 2:
A 50-year-old white male went to the emergency department with complaints of right leg pain. The patient is an avid runner, and knowing this, the provider diagnosed the patient with a right leg muscle strain. The patient was sent home with Flexeril as needed and Motrin 800 mg q8h as needed. One week later, the patient followed up with his primary care doctor with continued right leg pain. His doctor instructed him to continue to take the muscle relaxant and Motrin, and advised that the pain should subside in 5–10 days. The following day the right leg pain increased, prompting the patient to return to the emergency department. Multiple providers failed to diagnose a blood clot in the patient’s right leg.
Review Part 11 of the Buttaro et al. text in this week’s Learning Resources.
Select one of the cased studies provided. Reflect on what went wrong in this case study, as well as why patient blood clots continue to be misdiagnosed.
Think about how you might have prevented the misdiagnosis of the patient the case study. Consider strategies for obtaining patient history, ordering diagnostics, and recommending potential treatment options.
Post on or before Day 3 a description of what went wrong in the case study that you selected, as well as why patient blood clots continue to be misdiagnosed. Then, explain how you might have prevented the misdiagnosis of the patient in the study. Include strategies for obtaining patient history, ordering diagnostics, and recommending potential treatment options.
NURS 6531 Week 4 DQ2 Types of Anemia
In clinical settings, patients often present with many different types of anemia. Each type of anemia has its own causes and implications. For this reason, you must be able to differentiate between types of anemia as well as identify factors that put patients at greater risk of experiencing related complications. As you prepare for this Discussion, consider the following patient case studies:
Case Study 1:
An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia. Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily. There are no known drug allergies. The physical exam reveals a 5’2” older female. Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98%. Further examination reveals the following:
Eyes: + pallor conjunctiva
Cardiac: irregular rhythm. No S3 S4 or M. NO JVD
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: soft, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding
Rectal: no stool in rectal vault
Case Study 2:
A 28-year old female presents for a routine physical. She has no complaints. Her personal medical history reveals asthma that is well controlled with an albuterol inhaler prn and Advair 250/50 1 puff BID. Social history reveals she is a nursing student who is a non-smoker, rarely uses alcohol, and is mostly vegetarian. Her physical exam is negative, and she is sent for a CBC/differential and lipid profile. Laboratory results reveal the following: Hemoglobin 10, Hematocrit 30.1, MCV increased.
Case Study 3:
A 78-year-old female presents to the emergency room after a fall 3 days ago. She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell. She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell. Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals. There are no known drug allergies. The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24. The MCV is normal.
Review Chapter 213 in Part 18 of the Buttaro et al. text.
Select one of the three case studies. Reflect on the provided patient information including history, physical exams, and lab reports.
Think about a differential diagnosis. Consider the role the patient history, physical exam, and lab reports played in the diagnosis.
Reflect on the pathophysiology of the type of anemia that you diagnosed, as well as potential treatment options. Consider the causes of this type of anemia. Think about whether the patient should be referred for specialized care.
NURS 6531 Week 5 Discussion Examining Chest X-Rays
Chest x-rays are an invaluable diagnostic tool as they can help identify common respiratory disorders such as pneumonia, pleural effusion, and tumors, as well as cardiovascular disorders such as an enlarged heart and heart failure. As an advanced practice nurse, it is important that you are able to differentiate a normal x-ray from an abnormal x-ray in order to identify these disorders. The ability to articulate the results of a chest x-ray with the physician, radiologist, and patient is an essential skill when facilitating care in a clinical setting. In this Discussion, you practice your interprofessional collaboration skills as you interpret chest x-rays and exchange feedback with your colleagues.
Consider the four patient x-rays (Note: By Day 1 of this week, your Instructor will assign you to post on one of these x-rays):
Note: Please view the Week 5 Discussion area to view the image for X-ray 1.
Note: Please view the Week 5 Discussion area to view the image for X-ray 2.
Note: Please view the Week 5 Discussion area to view the image for X-ray 3.
Note: Please view the Week 5 Discussion area to view the image for X-ray 4.
Review Part 10 of the Buttaro et al. text in this week’s Learning Resources, as well as the provided x-rays.
Reflect on what you see in the x-ray assigned to you by the Course Instructor.Consider whether the patient in your assigned x-ray has an enlarged heart, enlarged blood vessels, fluid in the lungs, and/or pneumonia in the lungs.
NURS 6531 Week 6 Discussion: Diagnosing Gastrointestinal Disorders
In primary care settings, patients often present with abdominal pain. Although this is frequently a sign of a gastrointestinal (GI) disorder, abdominal pain could also be the result of other systemic disorders, making this type of pain difficult to assess. While abdominal pain is most common, many other GI symptoms also overlap multiple disorders, further increasing the difficulty in diagnosing and treating patients. This makes provider-patient communication essential. You must be able to formulate questions that will prompt the patient to provide the necessary information, as this will guide your assessment and diagnosis. For this Discussion, consider potential diagnoses for the patients in the following case studies.
Case Study 1:
A 49-year-old man presents to the office complaining of vague abdominal discomfort over the past few days. He states he does not feel like eating and has not moved his bowels for the last 2 days. His patient medical history includes an appendectomy at age 22 and borderline hypertension, which he is trying to control with diet and exercise. He takes no medications and has no known allergies. Positive physical exam findings include a temperature of 99.9 degrees Fahrenheit, heart rate of 98, respiratory rate of 24, and blood pressure of 150/72. The abdominal exam reveals abdominal distention, diminished bowel sounds, and lower left quadrant tenderness without rebound.
Case Study 2:
A 40 year-old female presents to the office with the chief complaint of diarrhea. She has been having recurrent episodes of abdominal pain, diarrhea, and rectal bleeding. She has lost 9 pounds in the last month. She takes no medications, but is allergic to penicillin. She describes her life as stressful, but manageable. The physical exam reveals a pale middle- aged female in no acute distress. Her weight is 140 pounds (down from 154 at her last visit over a year ago), blood pressure of 94/60 sitting and 86/50 standing, heart rate of 96 and regular without postural changes, respiratory rate of 18, and O2 saturation 99%. Further physical examination reveals:
Skin: w/d, no acute lesions or rashes
Eyes: sclera clear, conj pale
Ears: no acute changes
Nose: no erythema or sinus tenderness
Mouth: membranes pale, some slight painful ulcerations, right buccal mucosa, tongue beefy red, teeth good repair
Neck: supple, no thyroid enlargement or tenderness, no lymphadenopathy
Cardio: S1 S2 regular, no S3 S4 or murmur
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: scaphoid, BS hyperactive, generalized tenderness, rectal +occult bloo
Case Study 3:
A 52-year-old male presents to the office for a routine physical. The review of symptoms reveals anorexia, heartburn, and weight loss over the past 6 months. The heartburn is long standing, occurring most days during the week. He takes TUMS or Rolaids to relieve the discomfort. The patient describes occasional use of ibuprofen for back pain, but denies other medications including herbals. He has no known allergies. He was adopted so does not know his family history. Social history reveals that, although he stopped smoking ten years ago, he smoked for 20 years. He occasionally consumes alcohol on the weekends only. The only positive physical exam finding for this patient was slight epigastric tenderness. The remainder of his exam was negative and the rectal exam was negative for blood.
Review this week’s media presentations and Part 12 of the Buttaro et al. text in the Learning Resources.
Select one of the three case studies listed above. Reflect on the provided patient information including history and physical exams.
Think about a differential diagnosis. Consider the role the patient history and physical exam played in diagnosis.
Reflect on potential treatment options based on your diagnosis.
NURS 6531 Week 7 Discussion: Urinary Frequency
Urinary frequency is a genitourinary disorder that presents problems for adults across the lifespan. It can be the result of various systemic disorders such as diabetes, urinary tract infections, enlarged prostates, kidney infections, or prostate cancer. Many of these disorders have very serious implications requiring thorough patient evaluations. When evaluating patients, it is essential to carefully assess the patient’s personal, medical, and family history prior to recommending certain physical exams and diagnostic testing, as sometimes the benefits of these exams do not outweigh the risks. In this Discussion, you examine a case study of a patient presenting with urinary frequency. Based on the provided patient information, how would you diagnose and treat the patient?
Consider the following case study:
A 52-year-old African American male presents to an urgent care center complaining of urinary frequency and nocturia. The symptoms have been present for several months and have increased in frequency over the past week. He has been unable to sleep because of the need to urinate at least hourly all day and night. He does not have a primary care provider and has not seen a doctor in more than 10 years. His father died when he was a child in an automobile accident, and his mother is 79 years old and has hypertension. The patient has no siblings. His social history includes the following: banker by profession, divorced father of two grown children, non-smoker, and occasionally consumes alcohol on weekends only.
Review Part 13 of the Buttaro et al. text in this week’s Learning Resources.
Review the case study and reflect on the information provided about the patient.
Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation.
Consider types of physical exams and diagnostics that might be appropriate for evaluation of the patient in the study.
Reflect on a possible diagnosis for the patient.
Review the Marroquin article in this week’s Learning Resources. If you suspect prostate cancer, consider whether or not you would recommend a biopsy.
Think about potential treatment options for the patient.
Post on or before Day 3 a description of the history that you need to obtain from the patient in the case study. Include a list of questions that you might ask the patient. Then, describe types of physical exams and diagnostics that might be appropriate for evaluation of the patient. Finally, explain a possible diagnosis, as well as potential treatment options for the patient based on this diagnosis.
NURS 6531 Week 8 Discussion: Electrolyte Disorders
When an electrolyte disorder occurs, it disrupts the balance of ionized salts in the blood. Since electrolytes regulate physiological functions in the body, if left untreated, electrolyte disorders can cause harm to multiple body systems. This results in a variety of symptoms which are sometimes severe and life threatening. In this Discussion, you explore common electrolyte disorders and their potential causes, as well as the impact of the disorders on patients.
Review Chapters 207, 208, and 241 of the Buttaro et al. text, as well as the Adams et al. and Assadi articles in this week’s Learning Resources.
Select one of the following electrolyte disorders: hyperkalemia and hypokalemia; hypercalcemia and hypocalcemia; hypernatremia and hyponatremia; hypermagnesemia and hypomagnesemia. Reflect on signs and symptoms of this disorder.
Consider potential causes of the disorder that you selected. Reflect on whether that disorder is iatrogenic or a result of prescribed drugs.
Think about the impact of this electrolyte disorder on patients. Consider how the disorder affects other body systems.
Post on or before Day 3 a description of the electrolyte disorder that you selected as well as signs and symptoms. Then, explain potential causes of the disorder including whether it is iatrogenic or a result of prescribed drugs. Finally, describe the impact of the disorder on patients and their body systems.
NURS 6531 Week 9 Discussion: Chronic Back Pain
Patients frequently present with complaints of pain such as chronic back pain. They often seek medical care with the intent of receiving drugs to manage the pain. Typically, for this type of pain, narcotic drugs are often prescribed. This can pose challenges for you as the advanced practice nurse prescribing the drugs. While there is a process for evaluating back pain, it can be difficult to assess the intensity of a patient’s pain because pain is a subjective experience. Only the person experiencing the pain truly knows whether there is a need for drug treatments. This makes it important for you, as the prescriber, to watch for red flags and warning signs of abuse. In this Discussion, you explore the ethical implications of prescribing narcotics to patients with chronic back pain.
Review this week’s media presentation on evaluating back pain, as well as Chapter 15 of the Buttaro et al. text in the Learning Resources. Reflect on the evaluation process for a patient with a history of back pain.
Consider how you might evaluate a patient that presents with back pain. Think about potential red flags and warning signs of drug abuse.
Reflect on the ethical implications of prescribing narcotics for chronic back pain.
Think about what you would prescribe and why.
Post on or before Day 3 a description of how you might evaluate a patient who presents with back pain. Then, describe potential red flags and warning signs of drug abuse. Explain the ethical implications of prescribing narcotics for chronic back pain. Finally, explain what you would prescribe for patients and why.
NURS 6531 Week 10 Discussion: Stroke Prevention Media
Note: You will complete this week’s Discussion after you complete this week’s Assignment
In this Discussion, you provide and receive feedback on the stroke prevention media created in this week’s Assignment. This exchange between you and your colleagues is an opportunity to practice your interprofessional collaboration skills, which are an essential rudiment of nursing practice. In clinical settings, you must be able to articulately express your thoughts and communicate with colleagues. This Discussion is designed to help you improve this skill, as well as encourage you to listen to your colleagues and acknowledge that all views are valid and worthy of consideration. As you review the stroke prevention media piece created by your colleagues, keep the best interests of the specific patient population in mind. Use the feedback you receive to refine your own stroke prevention media prior to submitting the final Assignment in Week 11.
Post on or before Day 4 a description of the stroke prevention media piece that you created. Include the details of your educational media, and if possible, a copy of the actual media piece. Explain why you selected the particular type of media and how and why it is suitable for your patient population.
NURS 6531 Week 11 Discussion: Diabetes
In the United States, 25.6 million adults age 20 years or older have diabetes (American Diabetes Association, 2011). If not properly treated and managed, these millions of diabetic patients are at risk for several alterations including heart disease, stroke, kidney failure, neuropathy, and blindness. Proper treatment and management is the key for diabetic patients, and as the advanced practice nurse providing care for these patients, it is your responsibility to facilitate this process. Patient education is critical, as is working with patients to establish a regular pattern for daily activities such as eating and taking medications. When developing care plans for patients, you must keep the projected outcomes of treatment in mind, as well as patient preferences and other factors that might impact adherence to treatment and management plans. In this Discussion, you draw from your Practicum Experience and consider factors that impact the education and treatment of patients with diabetes.
Review Chapter 205 in Part 17 of the Buttaro et al. text.
Reflect on the clinical presentation of diabetes, as well as your Practicum Experiences and observations. Select a case from these experiences that involve a diabetic patient. When referring to the patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.
Recall the medical details of the patient in the case that you selected including patient history, clinical presentation, physical exams, diagnostics, and the recommended treatment plan.
Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how this factor might impact the treatment plan and patient education strategies.
Post on or before Day 3 a description of the case that you selected including the diabetic patient’s medical details. Then, explain how the factor that you selected might impact the treatment plan and patient education strategies.