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Note: This is an individual assignment. Applying what you have learned thus far, develop a community teaching proposal designed to address the needs of your community.

Select one of the following as the focus for the teaching plan:

1. Primary Prevention/Health Promotion HAND WASHING PREVENTING ILLNESS/INFECTION.  TEACHING DONE IN A RURAL HEALTH CLINIC CALLED (OMNI FAMILY HEALTH CLINIC).
2. Secondary Prevention/Screenings for a Vulnerable Population
3. Bioterrorism/Disaster
4. Environmental Issues

Complete the “Community Teaching Work Plan Proposal.” This will help you organize your plan and create an outline for the written assignment.

1. After completing the teaching proposal, review the teaching plan with a community health and public health provider in your local community.
2. Request feedback (strengths and opportunities for improvement) from the provider.
3. Complete the “Community Teaching Experience” form.

APA format is required for essays only. Solid academic writing is always expected. For all assignment delivery options, documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to Turnitin.

Case Study 1:

Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:

• Atenolol 12.5 mg daily
• Doxazosin 8 mg daily
• Hydralazine 10 mg qid
• Sertraline 25 mg daily
• Simvastatin 80 mg daily

Case Study 2:

Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following:

• Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
• Aspirin 81 mg daily
• Metformin 1000 mg po bid
• Glyburide 10 mg bid
• Atenolol 100 mg po daily
• Motrin 200 mg 1–3 tablets every 6 hours as needed for pain

Case Study 3:

Patient CB has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed include the following:

• Glipizide 10 mg po daily
• HCTZ 25 mg daily
• Atenolol 25 mg po daily
• Hydralazine 25 mg qid
• Simvastatin 80 mg daily
• Verapamil 180 mg CD daily

To prepare:

• Review this week’s media presentation on hypertension and hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson text.
• Select one of the three case studies, as well as one the following factors: genetics, gender, ethnicity, age, or behavior factors.
• Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
• Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
• Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

With these thoughts in mind:

By Day 3

Post an explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you selected. Then, describe how changes in the processes might impact the patient’s recommended drug therapy. Finally, explain how you might improve the patient’s drug therapy plan.

Case Studies 1–3

Respiratory disorders such as pneumonia and asthma are among the leading causes of hospitalization in pediatric patients (U.S. Department of Health and Human Services, 2011). With such severe implications associated with many respiratory disorders, advanced practice nurses must be able to quickly identify symptoms, diagnose patients, and recommend appropriate treatment. For this Discussion, consider potential diagnoses and treatments for the patients in the following three case studies.

Case Study 1:

A 14-month-old female presents with a 4-day history of nasal congestion and congested cough. This morning, the mother noted that her daughter was breathing quickly and “it sounds like she has rice cereal popping in her throat.” Oral intake is decreased. Physical examination reveals the following: respiratory rate is 58, lung sounds are diminished in the bases, she has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields, and her tympanic membranes are normal. There is moderate, thick, clear rhinorrhea and postnasal drip. Her capillary refill is less than 3 seconds, and she is alert and smiling. Her RSV rapid antigen test is positive.

Case Study 2:

Brian is a 14-year-old known asthmatic with a 2-day history of worsening cough and shortness of breath. He reports using a short-acting beta agonist every 3 hours over the previous 24 hours. He has a long-acting inhaled corticosteroid, but the prescription ran out, and he forgot to get it refilled. He says he came today because he woke up at 2 a.m. coughing and couldn’t stop, thus preventing him from going back to sleep. Over-the-counter cough suppressants don’t help. He denies cigarette smoking, but his clothing smells like smoke. His respiratory rate is 18 and he has prolonged expiration and expiratory wheezes in all lung fields. There are no signs of dyspnea. All other exam findings are normal.

Case Study 3:

A father presents his 9-year-old with a 3-day history of cough. Dad states that his son is coughing up yellow mucus. The boy is afebrile and is sleeping through the night, but the father’s sleep is disturbed listening to his son coughing. Dad says he thinks his son has bronchitis and is requesting treatment. Physical examination reveals the following: respiratory rate is 18, lungs are clear to auscultation, patient is able to take deep breaths without coughing, there is no cervical adenopathy, nasal turbinates are slightly enlarged, and there is moderate clear rhinorrhea.

Case Studies 4–6

Assessing, diagnosing, and treating pediatric patients for many cardiovascular and genetic disorders can be challenging. As an advanced practice nurse who facilitates care for patients presenting with these types of disorders, you must be familiar with current evidence-based clinical guidelines. Because of the clinical implications, you have to know when to treat patients with these disorders and when to refer them for specialized care. In this Discussion, you examine the following case studies and consider appropriate treatment and management plans.

Case Study 4:

Miguel is a 15-year-old male who presents for a sports physical. He is a healthy adolescent with no complaints. He plays basketball. He is 6 feet 5 inches tall and weighs 198 pounds. You note long arms and long thin fingers. He has joint laxity in his wrists, shoulders, and elbows.

Case Study 5:

Trina is a 9-year-old female who weighs 110 pounds. Vital signs are as follows: BP 122/79, P 98, R 20. Her mother reports she is a picky eater and refuses to eat fruits and vegetables. Her physical activity includes soccer practice for 1 hour a week with one game each weekend from September through November. Family history is negative for myocardial infarction, but both parents take medication for dyslipidemia.

Case Study 6:

You see a 2-month-old for a well-child visit. She is breastfed and nurses every 2 to 3 hours during the day, but her mother reports she is not nursing as vigorously as before. She sleeps one 4-hour block at night. Birth weight was 7 pounds 5 ounces. Weight gain over the last 2 weeks reveals gain of 5 ounces per week. Physical examination reveals the following: HEENT exam is benign, lung sounds are clear, a new III/VI systolic ejection murmur is noted along the left lower sternal border, cap refill is brisk, skin is pink and moist, and abdominal exam is benign.

To prepare:

• Review “Respiratory Disorders,” “Cardiovascular Disorders,” and “Genetic Disorders” in the Burns et al. text.
• Review and select one of the six provided case studies. Analyze the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
• Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the respiratory, cardiovascular, and/or genetic disorder.

Gynecologic conditions can be difficult to diagnose for a variety of reasons, including overlapping symptoms, lack of patient knowledge, or even patient fear or embarrassment about sharing information. Your role provides you the opportunity to develop a relationship of trust and understanding with these patients so that you can gather the appropriate details related to medical history and current symptoms.

When caring for this patient population, it is important to make these women an integral part of the process and work collaboratively with them to diagnose and develop treatment and management plans that will meet their individual needs. For this Discussion, consider diagnosis, treatment, and management strategies for the patients in the following four case studies:

Case Study 1:

A 32-year-old African American female is concerned about increasing dysmenorrhea over the past three years. In the past year, this was associated with painful intercourse. She has been in a monogamous relationship with one male partner for the past five years. They tried to have children without success. Menarche was at age 10; menstrual cycles are 21 days apart and last for 6–7 days. The first day of her last menstrual period was 10 days ago and was normal. She denies vaginal itching or discharge. On gynecologic exam there was no swelling, external lesions, or erythema, urethral swelling, or vaginal discharge. Cervix is pink without lesions or discharge. Uterus was small, retroverted, and non-tender. Adnexa were small and non-tender. Nodules are noted along the cul de sac.

Case Study 2:

A 42-year-old African American female is in the clinic for a routine gynecologic exam. When asked, she admits to noticing bleeding in between her menstrual periods for the past several months. She has been pregnant three times and has three children. She is sexually active with one male sex partner in a monogamous relationship. During her bimanual exam, you note an irregular intrauterine non-tender mass about 4 cm in diameter. The mass is palpable abdominally. The remainder of her gynecologic exam was normal.

Case Study 3:

A 48-year-old Caucasian female is in the clinic concerned about prolonged menstrual bleeding for three weeks now. Her prior menstrual periods have been irregular for the past eight months, lasting no more than three days each. There have been one to two months when she had no menstrual cycles at all. She reports occasional hot flushes and mood swings.

Case Study 4:

A 16-year-old Caucasian female comes to the clinic concerned because she has not had a menstrual period for three months. She’s a junior in high school and active in sports. She has lost about 10 lbs. in the past two months. She is currently 5 ft. 4 in. and weighs 100 lbs.

To prepare:

Review Chapter 26 of the Schuiling and Likis text and Chapter 7 of the Tharpe et al. text.

Review and select one of the four provided case studies. Analyze the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

Consider strategies for educating patients on the treatment and management of the sexually transmitted infection you identified as your primary diagnosis.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Provide a minimum of three possible diagnoses and list them from highest priority to lowest priority. Explain which is the most likely diagnosis for the patient and why. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients on the disorder.

Assign CPT code(s) and appropriate modifiers to each statement.

1)      After performing an emergency cesarean section, the physician noticed that the appendix was distended, resulting in medical necessity for an appendectomy performed during the same operative session.

2)      The physician freed intestinal adhesions.

3)      The physician resected two segments of small intestine and performed an anastomosis between the remaining intestinal ends. An open approach was used for this surgery.

4)      The physician repaired a defect in the mesentery with sutures.

5)      The physician performed a laparoscopic partial colectomy with end colostomy and closure of the distal segment.

6)      The physician drained a pelvic abscess through the rectum.

7)      The physician removed a portion of the rectum through combined abdominal and transsacral approaches.

8)      The physician performed rigid proctosigmoidoscopy and obtained brushings.

9)      The physician performed a flexible sigmoidoscopy and removed a polyp. The physician inserted the sigmoidoscope through the anus and advanced the scope into the sigmoid colon. The lumen of the sigmoid colon and rectum were well visualized, and the polyp was identified and removed with hot biopsy forceps. The sigmoidoscope was withdrawn upon completion of the procedure.

10)  The physician inserted a colonscope through the anus and advanced the scope past the splenic flexure. Two polps were identified and removed by hot biopsy forceps.

1)      Hepatotomy for open drainage of abscess or cyst, 1 stage.

2)      Surgeon removed segments II, III, and IV (the whole left lobe) of the liver from a living donor.

3)      The physician performed radiofrequency ablation of a liver tumor via open laparotomy.

4)      The physician removed the gallbladder and performed a common bile duct exploration through the laparoscope.

5)      The physician performed a cholecystostomy with removal of calculus.

6)      Subsequent to previous peritoneocentesis (performed at a different operative session), the physician withdrew fluid and performed infusion and drainage of fluid from the abdominal cavity (peritoneal lavage).

7)      The physician reopened a recent laparotomy incision, before the incision had fully healed, to drain a postoperative infection.

8)      The physician performed laparoscopic repair of an initial inguinal hernia.

9)      The physician performed a reducible ventral hernia (initial) repair and inserted mesh implantation.

10)  The physician repaired an initial reducible, inguinal hernia with hydrocelectomy in a 5 month old infant.  

1)      Physician made an open incision and inserted multiple drain tubes to drain an infection (abscess) from the kidney.

2)      The physician pulverized a kidney stone (renal calculus) by directing shock waves through a water cushion that was placed against the left side of the patient’s body at the location of the kidney stone.

3)      The physician removed a kidney stone (calculus) by making an incision in the right kidney.

4)      The interventional radiologist inserted a percutaneous nephrostomy catheter into the right renal pelvis for drainage. Fluoroscopic guidance was provided.

5)      The physician performed a laparoscopic ablation of a solid mass from the posterior hilum of the left kidney.

6)      The physician made an incision in the left ureter through the abdominal wall for examination of the ureter and insertion of a catheter for drainage.

7)      The physician examined the patient’s right and left renal and ureteral structures with an endoscope, which passed through an established opening between the skin and the ureter (ureterostomy). He also inserted a catheter into the ureter.

8)      The physician revised a surgical opening between the skin and the right ureter.

9)      The physician injected contrast agent through an opening between the skin and the left ureter (ureterostomy) for ureterography (study of renal collecting system).

10)  The physician made an incision in the left ureter (ureterotomy) to insert a catheter (stent) into the ureter.

11)   The physician performed a transurethral resection of a postoperative bladder neck contracture using a resectoscope.

12)  The physician inserted a special instrument through the cystourethroscope to fragment a calculus in the ureter using electrohydraulics.

13)   The physician inserted a cystourethroscope through the urethra to drain an abscess on the prostate.

14)  The physician made an incision through the abdominal wall into the urinary bladder and inserted a suprapubic catheter to withdraw urine.

15)  The physician performed a cystourethroscopy with fulguration of the bladder neck and then removed a calculus from the ureter.

16)  The physician performed a sling procedure using synthetic material to treat a male patient’s urinary incontinence.

17)  The physician made an initial attempt to treat a male patient’s urethral stricture using a dilator.

18)  The physician, in the first two stages to reconstruct the urethra identified the area of stricture by urethrography and marked it with ink.

19)  The physician performed a transurethral destruction of the prostate using microwave therapy.

 The physician excised a specimen of tis