NR 603 Assignment – Post Concussive Syndrome and Traumatic Brain Injuries
NR 603 Assignment – Post Concussive Syndrome and Traumatic Brain Injuries**HINT: when you are doing this assignment, you need to be thinking in terms of a clinic patient, they have walked (or have been wheeled) into your clinic…this is not a hospital setting. So your exam and diagnostics need to reflect that, for example would a GCS be the best assessment for PCS in the clinic setting? Probably not, there are more specific test that are more appropriate. So, when you are writing up your assignment, keep in mind that you are preparing to be family practice NPs.**
A comparison and contrast assignment\’s focus is to identify and explore similarities and differences between two similar diseases. The goal of this exploration is to bring about a better understanding of both diseases. You will research the two areas of content assigned to you and compare and contrast them in a discussion post. NOTE: A comparison and contrast assignment is not about listing the info regarding each disease separately but rather looking at each disease side by side and discussing the similarities and differences given the categories below. Consider how each patient would actually present to the office. Paint a picture of how that patient would look, act, what story they would tell. Consider how their history would affect their diagnosis, etc. Evaluation of mastery is focused on the student\’s ability to demonstrate specific understanding of how the diagnoses differ and relate to one another. Address the following topics below in your own words:
• Presentation (demographics, onset of symptoms, associated risk factors) • Pathophysiology (knowledge demonstrated in original dialogue) • Assessment (physical assessment, diagnostic testing) • Diagnosis • Treatment Evidence Based References: Discussion post supported by evidence from appropriate sources published within the last five years. Focus of journal articles represents a logical link between the article content and the case study information. In-text citations and full references are provided. NR 603 Assignment – Post Concussive Syndrome and Traumatic Brain Injuries.
NR603 Advanced Clinical Diagnosis and Practice Across the Lifespan
Week 1 Discussion
Compare and Contrast Assignment
Compare and contrast the following diagnoses as assigned:
Student Last Name -Topic
(Find the corresponding first letter of your last name to find your topic assignment for this discussion)
A-I – Compare and Contrast Dementia and Delirium
J-Q = Compare and Contrast Post Concussive Syndrome and Traumatic Brain Injury
R-Z = Migraine Headache and Post Concussive Syndrome
Week 2 Discussion
Case Discussion: Pulmonary Part One
Setting: A free medical clinic that provides health care for the under-insured.
Your next patient, Michelle G., age 40, is a regular of the clinic and the last patient of the day. The chart states she is here for recent episodes of shortness of breath.
You enter the room and Michelle G is dressed in work clothes, standing up looking at a health poster on the wall. You introduce yourself and ask her what brings her to the clinic today. “I think I may have a cold. I’ve been having a hard time breathing on and off lately.”
HPI: “I notice I’m short of breath mostly at work but by the time I get home feel fine. No episodes of shortness of breath on the weekends that I can recall. But a few hours back at work and I start to feel like I cannot catch my breath again. A few months ago this happened and it was so bad I left work and went to urgent care where they gave me a breathing treatment of some kind and sent me home on an antibiotic. I would like you to give me another antibiotic. She denies sputum. No new allergy triggers noted. She denies heartburn. NR 603 Assignment – Post Concussive Syndrome and Traumatic Brain Injuries.
PMHx: Michelle G. reports her overall health as good.
Childhood/previous illnesses: eczema as a child
Chronic illnesses: Has seasonal allergies, spring is her worst season. Was seen by an allergy specialist ten years ago, Took allergy shots for five years with great results, now only takes Zyrtec when needed.
Surgeries: Tonsillectomy, Cholecystectomy
Hospitalizations: childbirth x 3.
Immunizations: up-to-date on all vaccinations.
Allergies: Strawberries-Rash; erythromycin- severe GI upset.
Blood transfusions: none
Drinks alcohol socially, smoked 1 pack per week for 3 years in her 20’s. Denies illicit drug use.
Sleeps 6 to 7 hours a night. Exercises four to five days per week.
Current medications: Multivitamin, Zyrtec
Social History: Married, lives with husband and 3 children. Worked in advertising up until 18 months ago when she got laid off. In order to help with the household finances she took a job as a Baker’s assistant at an Artisan Bread Bakery. She arrives at 4 a.m. every morning to begin baking breads/pastries for the day.
Family History: Children are healthy- daughter currently has a sinus infection. Parents are deceased. Mother at age 80 from congestive heart failure. Father died at age 82 from lung cancer, diagnosed when metastasized to brain. PGM: died from unknown causes, PGF: Stroke at age 82. MGM: died at 83, had HTN, atherosclerosis and many heart attacks. PGF: died at 71 from complications of COPD.
PE: Height 5’10”, Weight 140 pounds
Vital signs : BP 130/70, T 98.0, P 75, R 18 Sao2 98% on RA
General: 40-year-old Caucasian female appears stated age in no apparent distress. Alert, oriented, and cooperative. Able to speak in full sentences and does not appear breathless. Skin: Skin warm, dry, and intact. Skin color is pale pink, no cyanosis or pallor.
HEENT: Head normo-cephalic. Hair thick and distribution even throughout scalp.
Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact.
Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus non-tender
Nose: Nares patent with thin white exudate noted. Mucosa appears boggy and pale. Deviated septum noted. Sinuses non-tender to palpation.
Throat: Oropharynx pink, moist, no lesions or exudate. Tonsils 1+ bilaterally. Teeth in good repair, no cavities noted. Tongue smooth, pink, no lesions, protrudes in midline. Neck supple. No cervical lymphadenopathy or tenderness noted. Thyroid midline, small and firm without palpable masses. NR 603 Assignment – Post Concussive Syndrome and Traumatic Brain Injuries.
Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. Slight wheezing noted inspiration and on forced expiration. Wheezing does not clear with forced cough.
CV: Heart S1 and S2 noted, RRR, no murmurs noted, no displaced PMI. Peripheral pulses equal bilaterally, no peripheral edema
Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organo-megaly noted.
Diagnostic Testing:
Review of the patient’s EMR reveals an old CXR from last winter when she had Bronchitis.
CXR Report: 11/7/2016
This is a PA and lateral chest radiograph on Ms. Michelle X, performed on 11/7/16. Clinical information: low grade fever, productive cough, malaise.
Findings: Cardio-mediastinal silhouette is normal. B/L lung fields are clear. There are no effusions. The bony thorax appears normal. No opacities or fluid. Diaphragm normal.
Impression: Normal chest radiograph without pathology.
Click here to view CXR (Links to an external site.)Links to an external site.
You suspect an obstructive/restrictive process and order Pulmonary Function Testing
Pre-Bronchodilator Challenge- FEV1/FVC 60%, FVC decreased
Post Bronchodilator Challenge- FEV1/FVC 75%
Discussion Questions Part One:
What is your primary diagnosis for Michelle given the pattern of occurrence of symptoms, exam results, and recent history? Include the rationale and a reference for your diagnoses.
What is your first-line treatment plan for Michelle including medications, labs, education, referrals, and follow-up? Identify the drug class of each medication you prescribe and exactly what symptom it is targeted to address. NR 603 Assignment – Post Concussive Syndrome and Traumatic Brain Injuries.
Address Michelle’s request for an antibiotic.
NR 603 Assignment – Post Concussive Syndrome and Traumatic Brain Injuries
Week 3 Discussion
Case Discussion: Cardiovascular Part One
Week 3: PBL Case Discussion: Cardiovascular
Setting: large rural clinic; family practice clinic that employs physicians and nurse practitioners
You open the chart to review for your next patient, and you see it is Larry M. Larry is a 60 year-old African American male with a history of hypertension. You note he is not due for a follow up at this time, so you look at the chief complaint.
CC: chest pain three days ago
You enter the room and introduce yourself. Larry M. is sitting in the chair. You ask what brings him in today. Larry M. smiles, shaking his head and says “My wife made me come, I feel fine.” Three days ago Larry M. felt short of breath, had this heavy feeling in his chest, and he got kind of nauseous and sweaty. It lasted only about 3 minutes, and it has not happened again, but he does feel a little more tired. “It could be that I have not worked out since it happened.”
PMHx: Reports general health as good. He had been feeling great since starting to work out and lost weight. Had lots of energy and felt great until this episode three days ago. Now he is a little concerned because he feels a little more tired when he works out. He has not done as much strenuous running and has not worked out since the episode.
Childhood/previous illnesses: chicken pox.
Chronic illnesses: Hypertension- lifestyle changes recommended. Elevated cholesterol, lifestyle management was initiated.
Surgeries: T and A, cholecystectomy, vasectomy
Hospitalizations: None aside from surgeries listed above
Immunizations: Does not receive the flu shot.
Allergies: NKDA
Blood transfusions: None
Enjoys a beer or a glass of whiskey and the occasional cigar when playing poker with his buddies
Current medications: None
Social History: Married for 20 years, works as an architect.
Family History: Parents are deceased. Father had lung cancer and mother died from complications of a stroke. Brother died at 44 from malignant melanoma. Other sister and brother are healthy.
PE:
Height: 5’8” weight: 220 pounds; BMI 33.5 vital signs: BP 146/90 P 70 Sao2 97%
General: African American male in NAD. Alert, oriented, and cooperative. Pain: 0/10 at present
Skin: Skin warm, dry, and intact. Skin color is light skinned brown, no cyanosis or pallor.
HEENT: Head normo-cephalic. Hair thick and distribution even throughout scalp.
Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact. No AV nicking noted.
Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus non-tender
Nose: Nares patent without exudate. Sinuses non-tender to palpation, Right-sided Deviation
Throat: Oropharynx moist, no lesions or exudate. Teeth in poor repair, gums reddened and receding, filled cavities noted. Tongue smooth, pink, no lesions, protrudes in midline.
Neck supple. No cervical lymphadenopathy or tenderness noted. Thyroid midline, small and firm without palpable masses. Mild JVD in recumbent position
Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. No rashes or vesicles noted on chest. CV: Heart S1 and S2 noted, RRR, no murmurs, noted. No parasternal lifts, heaves, and thrills. Peripheral pulses equally bilaterally. PMI 5th ICS displaced 4cm laterally. No edema in lower extremities. NR 603 Assignment – Post Concussive Syndrome and Traumatic Brain Injuries.
Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organomegaly noted.
Labs from 3 months ago:
Total Cholesterol: 230
Ldl 180
Hdl 38
EKG In office TODAY: ST depression
Click here to access the EKG (Links to an external site.)Links to an external site.
Discussion Questions:
What is your primary diagnosis causing Larry M.’s chest pain? Include ICD 10 codes (no differentials)
List any relevant labs/diagnostic tests and link them to Larry’s specific case. Remember to include evidence-based support for any testing you order along with rationale if you feel no testing is warranted.
What leads demonstrate the ST depression?
What other secondary diagnoses does Larry M. have that need to be addressed?
Include the rationale and a reference for your diagnoses
Based on JNC 8 guidelines, is Larry M. hypertensive?
Review the ACA 2017 Recommendations for Antihypertensive Therapy and design a plan for Larry M. Please discuss the pharmacological properties of the therapy you chose including rationale for why this is the best choice for Larry M.
Plan for your primary diagnosis (Include referral, education and follow up) based on one current evidence-based journal article. NR 603 Assignment – Post Concussive Syndrome and Traumatic Brain Injuries.
Further diagnostic work-up not included above
Medications
Week 5 Discussion
DQ1 APEA Predictor Assignment Part One
Step 1. Review your Week 4 APEA Predictor Exam Results and focus on the “Percent Correct By Knowledge Area” Choose a Knowledge Area on which you scored the lowest to work on this week.
Step 2. Once you’ve chosen the subject, research and work up a common chief complaint from that system and present your findings in the discussion by Wednesday, 11:59 p.m. MT of Week 5.
Work up includes:
-Chief complaint
-Associated risk factors/demographics that contribute to the chief complaint
-Three common differential diagnoses represented by the CC including pathophysiology and rationale
-Discuss how the 3 diff dx differ from each other in: occurrence, pathophysiology and presentation (NOTE: Simply listing the diagnoses and their occurrence, patho and presentations separately does not confer an understanding of how they differ. Your discussion should compare and contrast these items against each other among the three differentials chosen)
-relevant testing required to diagnose/evaluate severity of the three differential diagnoses
-Review of relevant National Guidelines related to the Diagnosis, Diagnostic testing and/or treatment of the final diagnosis.
DQ2 APEA Predictor Part Two
Post the first line treatment plan based on one diagnosis from your differential list in SOAP format.
Week 6 Discussion – Mental Health Clinical Presentation Part 1
The purpose of this assignment is for learners to:
Have the opportunity to integrate knowledge and skills learned throughout all core courses in the FNP track and previous clinical courses.
Demonstrate an advancing understanding of the patient with a mental health disorder in primary care.
Demonstrate the ability to analyze the literature/ previous patients seen in the clinical setting be able to perform an evidenced-based review of their case, diagnosis, and plan, while guiding and taking feedback from peers regarding the case.
Demonstrate professional communication and leadership, while advancing the education of peers.
Course Outcomes
4 Develop management plans based on current scientific evidence and national guidelines.
6 Prioritize treatment based on relevant clinical presentation.
Requirements
For Week 6 of the course there will not be a case study given to you by the faculty. Instead you will be assigned a mental health disorder commonly seen in primary care and you will create a case study based on that disorder. You may create a case study either from a previous clinical patient experience or if you have not had a patient in clinical that represents your assigned topic you may research your disease using the week’s classroom material and the evidence-based literature in the field. The case should be clear and include all elements of a normal case that might be presented in class (subjective, objective, assessment, and full 5 point plan). The clinical practicum documentation will be helpful for this process, or notes you have taken in clinical regarding cases. The case should be clear, organized, and meet the following guidelines:
Week 6 Part One:
This part goes in part one and should begin with subjective and objective data just like we do in your weekly case study discussion. Do not put diagnosis until your peers respond.
WEEK 6 Part One: The case should lead the class toward the mental health diagnosis assigned to you by your instructor.
WEEK 6 Part One Specific Guidelines:
If this is an actual patient from clinical- Include their actual chief complaint, demographic data, HPI, PMHX, PSHX, medications, allergies, subjective and objective findings without identifying the patient’s name.
If this is a fictitious case you’ve created from the literature/readings you should design an example patient and include chief complaint, demographic data, HPI, PMHX, PSHX, medications and allergies, subjective and objective findings. Be mindful that the background data for the case should bear some relevance to the diagnosis.
The case should not be overly simple. Like your weekly case studies, it should include subjective data that loosely represents the diagnosis you have been given, but includes some elements of the pathophysiology/presentation of the disease.
You must include the following elements in part one: subjective: chief complaint/HPI, demographic data, HPI, PMHX, PSHX, subjective and objective findings. NR 603 Assignment – Post Concussive Syndrome and Traumatic Brain Injuries.
NEXT:
Leading the discussion in part one: You must respond to any student who posts regarding your case with a substantial response, either answering their questions or noting their response and acting as leader. You also must respond to any faculty responses to your initial posting. Use references to support your responses. Remember: Your response to your peers is part of where you demonstrate your knowledge of the disease you were assigned. You should be discussing hallmark symptoms, diagnostic tools etc along with discussing the student’s impressions and conclusions. Once your peers respond you can share the primary diagnosis and treatment plan that actually occurred if it is a live patient, and the ideal treatment plan if it is an invented case. Your treatment plan should address any national guidelines as appropriate for the diagnosis.
Participating in part one: As a student you will be required to respond to at least one other student, whom has no responses to their posting**. In your response to your peer you must include the following: Your top three (3) differentials based on the information provided, the primary diagnosis you are leaning toward, and first line treatment for how you would treat that diagnosis. Use references to support your response. *DEADLINE – YOUR ONE REPSONSE TO A STUDENT IN DISCUSSION #1 IS DUE BY THURSDAY AT 11:59 p.m. MT SO THAT THE STUDENT CAN INTERACT WITH YOU AS WE DO IN OTHER CASES. **If all students have a response, then choose the student with the least responses to their posting.
Week 8 Discussion – Reflection
Reflect back over the past eight weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #4, the MSN Essential IV, and the Nurse Practitioner Core Competencies # 7.
Program Outcome #4: Integrate professional values through scholarship and service in health care. (Professional identity)
MSN Essential IV: Translating and Integrating Scholarship into Practice Recognize that the master’s-prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results.
Nurse Practitioner Core Competencies # 7
Health Delivery System Competencies
1. Applies knowledge of organizational practices and complex systems to improve health care delivery.
2. Effects health care change using broad based skills including negotiating, consensus-building, and partnering.
3. Minimizes risk to patients and providers at the individual and systems level.
4. Facilitates the development of health care systems that address the needs of culturally diverse populations, providers, and other stakeholders.
5. Evaluates the impact of health care delivery on patients, providers, other stakeholders, and the environment.
6. Analyzes organizational structure, functions and resources to improve the delivery of care.
7. Collaborates in planning for transitions across the continuum of care. NR 603 Assignment – Post Concussive Syndrome and Traumatic Brain Injuries
Week 2 Case Study Summary Discussion Pulmonary Part Two
Write up the full SOAP note, including the final treatment plan for Michelle incorporating all the learning and guidance from faculty during the week as you would in clinic in SOAP format.
The treatment plan should include:
Specific Diagnosis
ICD 10 code
Prescriptions
Education
Activity
Follow up
Referrals
Week 3 Case Study Summary Cardiovascular Part Two
This assignment was locked Feb 2 at 11:59pm.
Write up the full SOAP note, including the final treatment plan for Larry M. incorporating all the learning and guidance from faculty during the week as you would in clinic in SOAP format.
The treatment plan should include:
Specific Diagnosis
ICD 10 code
Prescriptions
Education
Activity
Follow up
Referrals
Week 6 Mental Health Final SOAP/Analysis – Part 2
Please see Couse Resources for Week 6 Mental Health Presentation Rubric
The final SOAP will include your case with diagnosis and treatment plan in SOAP format. After you write out the SOAP include the following sections in a large area called ANALYSIS:
Pathophysiology and Pharmacology: For the primary diagnoses in the case, write a brief summary of the underlying pathophysiology and tie pharmacological treatment chosen in the reversal or control of that pathology.
Additional analysis of the case: This includes national guidelines that were or should have been used to make diagnosis or treatment and review how they applied or how care was unique but based in guidelines. NR 603 Assignment – Post Concussive Syndrome and Traumatic Brain Injuries.
Follow-up: This means how the patient was doing when seen a second time if this applies. This would be their response to your plan of care.
Quality: Include anything that should have been considered in hindsight or changes you would make in seeing similar patients in the future with the same complaint, history, exam, or diagnosis. Add anything you learned from discussion in the class that shed new light on this patient.
Coding and Billing. Any or all CPT and ICD-10 codes that should have been used (List them and name them only.