Assignment: Shadow Health Respiratory Assessment

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Assignment: Shadow Health Respiratory Assessment

Assignment: Shadow Health Respiratory Assessment

 

Subjective Data Collection: 19 of 21 (90.5%)
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Hover over the Patient Data items below to reveal important information, including Pro Tips and Example Questions.
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Experts selected these topics as essential components of a strong, thorough interview with this patient.
Patient Data
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A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.
Chief Complaint
•
Finding:
Established chief complaint
•
Finding:
Reports increased breathing problems and shortness of breath
(Found)
Pro Tip: Foundational questions about general well-being are important in assessing how a patient feels at the current moment. This creates a space for Tina to contextualize her current feeling in relation to a chief complaint.
Example Question:
What brings you in today?
•
Finding:
Reports decreased effectiveness of inhaler
(Found)
Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with.
Example Question:
Why did you decide to seek treatment? Assignment: Shadow Health Respiratory Assessment
History of Presenting Illness
•
Finding:
Asked about onset of symptoms
•
Finding:
Reports symptoms began two days ago
(Found)
Pro Tip: Determining the onset of a health problem is the first step to understanding if the underlying condition is acute or chronic.
Example Question:
How long have you had breathing problems?
•
Finding:
Asked about frequency and duration of SOB episodes
•
Finding:
Reports exacerbations lasting several minutes
(Found)
Pro Tip: Knowing the duration of an asthma or shortness of breath episode will give you insight into how effective the patient’s interventions are, and how severe the episode is.
Example Question:
How long do your asthma episodes last?
•
Finding:
Reports exacerbated breathing about every 4 hours since original episode
(Available)
Pro Tip: The frequency of asthma episodes or shortness of breath might vary over time. Asking Tina about her recent experience will expound upon her current condition.
Example Question:
How many times have you had breathing problems in the past two days?
•

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Finding:
Reports waking up twice a night with asthma the past 2 nights
(Available)
Pro Tip: Many patients with asthma report trouble sleeping. Asking Tina if she has trouble sleeping can indicate the severity of her asthma.
Example Question:
How many times in the past two nights did asthma wake you up?
•
Finding:
Asked about severity of symptoms
•
Finding:
Describes asthma severity as “not full attack,” but worse than usual
(Found)
Pro Tip: Asthma severity might change over time for a variety of reasons. Asking Tina about the severity of her asthma will allow her to assess her condition.
Example Question:
How severe is your asthma?
•
Finding:
Reports asthma has been interfering with activities of daily life
(Available)
Pro Tip: Severe asthma can interfere with daily life. Asking Tina the degree to which asthma impacts her daily life can be illustrative of the relative severity of her asthma.
Example Question:
Is there anything you can’t do because of your asthma?
•
Finding:
Asked about character of symptoms
•
Finding:
Reports recent wheezing
(Found)
Pro Tip: Some people who experience chronic asthma may be accustomed to wheezing and, as a result, might not volunteer this information. Asking Tina if she’s been wheezing illustrates how her asthma is presenting.
Example Question:
Do you wheeze during an asthma exacerbation?
•
Finding:
Reports chest tightness
(Found)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina to describe what happens when her asthma acts up will indicate how her individual symptoms manifest.
Example Question:
What happens when your asthma acts up?
•
Finding:
Denies chest pain
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina whether she experiences chest pain during an attack will indicate how her individual symptoms manifest.
Example Question:
Are the shortness of breath episodes associated with chest pain?
•
Finding:
Asked about cough
•
Finding:
Reports cough
(Found)
Pro Tip: A shallow history of a patient’s condition can provide a comparative baseline for juxtaposing an attack, exacerbation, and more regular breathing. Soliciting this information from Tina allows her to explain any recent developments with her asthma.
Example Question:
Have you been coughing?
•
Finding:
Cough has persisted since original asthma exacerbation 2 days ago
(Available)
Pro Tip: Some people who experience chronic asthma may be accustomed to coughing and thus might not volunteer this information. Asking Tina how long she has been coughing illustrates how her asthma is presenting.
Example Question:
How long have you had a cough?
•
Finding:
Describes cough as “dry”
(Found)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina to describe her cough specifies the way her individual symptoms manifest.
Example Question:
How would you describe your cough?
•
Finding:
Describes cough as “small” and not severe
(Found)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina to describe her cough specifies the way her individual symptoms manifest.
Example Question:
How severe is your cough?
•
Finding:
Reports cough slightly relieved by drinking water
(Available)
Pro Tip: Coughing can be a symptom of a constricted airway. Assessing what relieves Tina’s cough can open up a conversation about asthma management.
Example Question:
What makes your cough better?
•
Finding:
Has not treated cough with medication or home remedies
(Available)
Pro Tip: Some people who experience chronic asthma may be accustomed to coughing and thus might not treat this symptom. Asking Tina how she is treating her cough might reveal her current symptom management and health literacy.
Example Question:
Have you tried to treat your cough?
•
Finding:
Asked about aggravating factors
•
Finding:
Reports symptoms worse at night
(Found)
Pro Tip: Sometimes a condition will fluctuate during the course of the day. By asking Tina how her asthma differentially impacts her both during the day and at night, you are assessing an important change over time.
Example Question:
Is your asthma worse at night?
•
Finding:
Reports symptoms increase when lying flat on back
(Found)
Pro Tip: Asthma can be aggravated by movements that constrict the respiratory airways. By asking Tina if lying down causes shortness of breath, you’re assessing which positions might cause exacerbation.
Example Question:
Does lying down make your asthma worse?
•
Finding:
Reports symptoms aggravated by movement
(Available)
Pro Tip: Asthma can be aggravated by movements that constrict the respiratory airways. Inquiring into what activities make Tina short of breath can indicate possible triggers.
Example Question:
Is there anything you can’t do because of your asthma?
Medical History
•
Finding:
Confirmed use of medications
•
Finding:
Confirms medications (no new medications reported)
(Found)
Pro Tip: Determining what, if any, medications a patient is taking is a crucial element of a thorough health history and will help you avoid unwanted drug interactions.
Example Question:
What medications do you take?
•
Finding:
Followed up about inhaler use
•
Finding:
Uses an inhaler to treat asthma symptoms
(Found)
Pro Tip: It’s essential to ask specifically what medications a patient is using to treat her current complaint or any ongoing medical conditions.
Example Question:
Do you use an inhaler for your asthma?
•
Finding:
Inhaler is Proventil
(Available)
Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina what medication she takes for her asthma will indicate her treatment plan and the degree to which she complies with it.
Example Question:
What is the name of the inhaler you are currently using?
•
Finding:
Reports most recent inhaler use was this morning
(Available)
Pro Tip: Soliciting a shallow history of a patient’s medication history can reveal recent exacerbation. Asking Tina when she last used her inhaler will indicate when her symptoms most recently required medical treatment.
Example Question:
When did you last use your inhaler?
•
Finding:
Reports using inhaler every 4 hours or so since exacerbation
(Found)
Pro Tip: After an asthma exacerbation, patients often will become more reliant on medical tools like inhalers. Asking Tina how many times she’s used her inhaler in the past two days will point to the severity of her recent exacerbation.
Example Question:
How many times have you used your inhaler in the past two days?
•
Finding:
Prescribed usage is 2 puffs
(Found)
Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina how many puffs of her inhaler she’s prescribed will indicate her treatment plan and the degree to which she complies with it.
Example Question:
How many puffs of your inhaler are you prescribed?
•
Finding:
Reports needing more than 2 puffs to resolve asthma symptoms
(Found)
Pro Tip: Inhaler effectiveness can vary over time for a variety of reasons. Asking Tina about the number on inhaler puffs she needs to resolve symptoms can indicate whether her asthma has worsened or point to potential problems like poor inhaler technique.
Example Question:
How many inhaler puffs do you need?
•
Finding:
Confirmed allergies
•
Finding:
Confirms allergies (no new allergies reported)
(Found)
Pro Tip: It’s best practice to ask a patient about her allergies each visit, even with an established patient, to uncover any new allergy triggers or symptoms.
Example Question:
Do you have any new allergies?
•
Finding:
Followed up on exposure to allergy and asthma triggers
•
Finding:
Reports cat allergy triggered recent episodes
(Found)
Pro Tip: Questions about what factors might have caused an illness can point to a patient’s environmental stressors, habits, and general wellbeing. Asking Tina what caused her asthma might indicate her health literacy and understanding of what factors impact her breathing.
Example Question:
What started your recent asthma problems?
•
Finding:
Reports dust as a known trigger
(Available)
Pro Tip: Environmental factors can often be primary allergy triggers. Asking whether Tina has a dust allergy can reveal one such trigger.
Example Question:
Does being around dust trigger your asthma?
•
Finding:
Reports activity such as walking up stairs as a known trigger
(Found)
Pro Tip: Shortness of breath or asthma can be exercise-induced. Asking whether climbing stairs can be a trigger for Tina might reveal a possible provocation.
Example Question:
Does climbing stairs trigger your asthma?
•
Finding:
Denies seasonal pattern
(Available)
Pro Tip: Discerning what’s making Tina’s asthma worse can point to possible triggers like environmental factors, bodily positions, or movement that may have a bearing on Tina’s breathing. Asking Tina whether she has seasonal triggers will indicate, in part, Tina’s health literacy.
Example Question:
Do you have seasonal asthma triggers?
•
Finding:
Denies changes in weather as a trigger
(Available)
Pro Tip: For some patients, weather changes can be asthma irritants. Asking Tina if the weather impacts her asthma will indicate if weather is an irritant for Tina’s condition.
Example Question:
Do changes in weather make your asthma worse?
•
Finding:
Reports minimal exposure to asthma triggers at work
(Available)
Pro Tip: Environmental factors at home or work can often be primary allergy triggers. Asking Tina about possible allergens at work might indicate a relevant factor in her recent exacerbation.
Example Question:
Does anything at work make your asthma worse?
•
Finding:
Asked detailed questions about asthma history

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•
Finding:
No current asthma doctor
(Available)
Pro Tip: Seeing a specialist, like an asthma doctor, can help patients to manage symptoms. Asking whether Tina is seeing an asthma

Assignment Shadow Health Respiratory Assessment

Assignment Shadow Health Respiratory Assessment

doctor will allow you to assess her current treatment plan and healthcare access.
Example Question:
Do you have an asthma doctor?
•
Finding:
Diagnosed with asthma in childhood
(Found)
Pro Tip: By determining the onset of asthma you can get a sense for Tina’s asthma history, instance, and frequency of exacerbation.
Example Question:
How long have you had asthma?
•
Finding:
Age of diagnosis was 2 1/2 years old
(Found)
Pro Tip: By determining the onset of asthma you can get a sense for Tina’s asthma history, instance, and frequency of exacerbation.
Example Question:
How old were you when you were diagnosed with asthma?
•
Finding:
Asked about hospitalizations for asthma
•
Finding:
Reports prior hospitalizations for asthma
(Found)
Pro Tip: Hospitalization for a condition, like asthma, can reveal its severity. By asking Tina if she’s been hospitalized, you are soliciting information about the history and severity of her condition.
Example Question:
Have you ever been hospitalized for asthma?
•
Finding:
Reports last hospitalization was age 16
(Found)
Pro Tip: Hospitalization for a condition, like asthma, can reveal its severity. By asking Tina when she was last hospitalized, you are soliciting information about the history and severity of her condition.
Example Question:
When was your last hospitalization for asthma?
•
Finding:
Estimates 5 total hospitalizations for asthma
(Available)
Pro Tip: Hospitalization for a condition, like asthma, can reveal its severity. By asking Tina the number of times she’s been hospitalized, you are soliciting information about the history and severity of her condition.
Example Question:
How many times have you been to the hospital?
•
Finding:
Reports she has never been intubated
(Found)
Pro Tip: Intubation for a condition, like asthma, can reveal its severity. By asking Tina if she’s been intubated, you are soliciting information about the history and severity of her condition.
Example Question:
Have you ever been put on a breathing tube?
•
Finding:
Followed up about non-medication forms of asthma management
•
Finding:
Denies record keeping of asthma exacerbation or shortness of breath episodes
(Available)
Pro Tip: For some patients, keeping records of asthma exacerbation allows them to monitor their conditions. Soliciting this information from Tina will show health literacy.
Example Question:
Do you use a chart to monitor your asthma?
•
Finding:
Denies using peak flow meter
(Found)
Pro Tip: A peak flow meter measures how well a patient’s lungs can expel air. By asking whether Tina uses a peak flow meter, you are asking about her health literacy and what kind of medical tools she uses to manage her asthma.
Example Question:
Do you check your peak flow regularly?
•
Finding:
Denies nebulizer use
(Available)
Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina if she uses a nebulizer for her asthma will indicate her treatment plan and the degree to which she complies with it.
Example Question:
Do you use a nebulizer?
Social History
•
Finding:
Asked about exercise and activity level
•
Finding:
Reports general low activity level
(Available)
Pro Tip: Learning about a patient’s typical exercise habits helps
Example Question:
Do you exercise?
•
Finding:
Reports diminished activity due to asthma
(Found)
Pro Tip: Asking a patient if her current complaint affects her exercise level or (vice version) helps you understand if there is a causal relationship in symptoms.
Example Question:
Have you been able to exercise?
•
Finding:
Asked about environmental control
•
Finding:
Reports living situation is tidy and free of dust
(Available)
Pro Tip: Environmental factors at home or work can often be primary allergy triggers. Asking Tina about possible allergens at home might indicate a relevant factor in her recent exacerbation.
Example Question:
Have you noticed anything at home that aggravates your asthma?
•
Finding:
Reports hypoallergenic bedding hygiene
(Found)
Pro Tip: Bedding provides the perfect environment for dust mites and other allergens. By asking Tina if she regularly changes her bedding, you’re soliciting information about environmental factors that might exacerbate her condition. Hypoallergenic bedding can provide relief to those who suffer from sensitivity to dust mites, allergies, or asthma. Discovering that Tina uses hypoallergenic bedding can indicate a reason why she might feel asthma relief at night.
Example Question:
Do you change your bedding regularly?
•
Finding:
Avoids animals and has no pets at home
(Found)
Pro Tip: Environmental factors can often be primary allergy triggers. Asking whether Tina has any pets can reveal one such trigger.
Example Question:
Do you have pets at home?
•
Finding:
Avoids exposure to secondhand smoke
(Found)
Pro Tip: Secondhand smoke can be particularly triggering for asthmatics. Asking whether anyone in Tina’s household smokes might indicate a proximate environmental trigger.
Example Question:
Does anyone in your house smoke?
•
Finding:
Asked about possible contributing factors in health history
•
Finding:
Denies history of eczema
(Available)
Pro Tip: Children with eczema are often at a higher risk of developing asthma. In soliciting a medical history from Tina, you are getting a sense for the history of Tina’s asthma and related conditions.
Example Question:
Have you had eczema?
•
Finding:
Denies history of sinus problems
(Available)
Pro Tip: People with asthma are likely to also experience sinus problems. It is important to determine whether Tina has sinus problems as they can cause complicating symptoms in patients who also experience asthma.
Example Question:
Do you have a history of sinus problems?
•
Finding:
Denies history of GERD, heartburn, or indigestion
(Available)
Pro Tip: People with asthma are almost twice as likely to also experience GERD. It is important to determine whether Tina has GERD as GERD can cause shortness of breath in patients who also experience asthma.
Example Question:
Do you have gastroesophageal reflux disease?
•
Finding:
Denies history of COPD or emphysema
(Available)
Pro Tip: For a patient with a known history of COPD or emphesyma, the symptoms of cough or shortness of breath could be caused by that disease. Assignment: Shadow Health Respiratory Assessment
Example Question:
Have you ever been diagnosed with COPD?
•
Finding:
Asked about smoking, inhalants, or tobacco
•
Finding:
Denies history of tobacco use, including cigarettes
(Found)
Pro Tip: Smoking or inhaling substances can have adverse respiratory effects. Asking Tina is she ever smoked cigarettes can help you to discern whether smoking was an exacerbating factor for Tina’s asthma.
Example Question:
Have you ever smoked cigarettes?
•
Finding:
Reports past history of marijuana use
(Found)
Pro Tip: Smoking or inhaling substances can have adverse respiratory effects. Asking Tina is she ever smoked marijuana can help you to discern whether smoking was an exacerbating factor for Tina’s asthma.
Example Question:
Have you ever smoked marijuana?
•
Finding:
Last use of marijuana was age 20 or 21
(Found)
Pro Tip: Smoking or inhaling substances can have adverse respiratory effects. Asking Tina is she ever smoked marijuana can help you to discern whether smoking was an exacerbating factor for Tina’s asthma.
Example Question:
When was the last time you smoked marijuana?
•
Finding:
Denies inhaling substances
(Available)
Pro Tip: Smoking or inhaling substances can have adverse respiratory effects. Asking Tina when she quit smoking marijuana can help you to discern whether smoking recently exacerbated Tina’s asthma.
Example Question:
Have you ever experimented with inhaling substances?
Review of Systems
•
Finding:
Asked about general symptoms
•
Finding:
Denies recent respiratory or other illness
(Available)
Pro Tip: Broad, open questions will allow Tina to describe, in her own words, the specific pain and discomfort that she is experiencing.
Example Question:
Have you been sick recently?
•
Finding:
Denies fever
(Available)
Pro Tip: The presence or absence of fever can indicate if an infection is approaching sepsis, a life-threatening condition.
Example Question:
Have you had any fever symptoms?
•
Finding:
Denies nausea or vomiting
(Found)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like nausea, details the way her individual symptoms and pain manifest.
Example Question:
Have you had nausea or vomiting?
•
Finding:
Denies chills
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like getting chills, details the way her individual symptoms and pain manifest.
Example Question:
Have you had chills?
•
Finding:
Reports low energy level
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like fatigue, details the way her individual symptoms and pain manifest.
Example Question:
Are you fatigued?
•
Finding:
Denies night sweats
(Available)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her injury, like night sweats, details the way her individual symptoms and pain manifest.
Example Question:
Have you had night sweats?
•
Finding:
Asked review of systems for respiratory
•
Finding:
Denies phlegm or sputum
(Available)
Pro Tip: A productive asthma cough can expel sputum from the lungs. By asking whether Tina has been coughing up phlegm or sputum you are discovering the nature of Tina’s cough since exacerbation.
Example Question:
Have you been coughing anything up?
•
Finding:
Denies sore throat, swelling, or difficulty swallowing
(Available)
Pro Tip: Difficulty swallowing could indicate a more severe allergic reaction, or a physical problem with the throat.
Example Question:
Do you have any problems swallowing?
•
Finding:
Denies nasal drainage
(Available)
Pro Tip: Nasal drainage could suggest that the patient’s symptoms are caused by a viral or bacterial infection, or an allergy attack.
Example Question:
Do you have any nasal drainage?
Family History
•
Finding:
Asked about relevant family history
•
Finding:
Reports no recent illnesses with family members at home
(Available)
Pro Tip: For people with asthma, getting sick can increase their risk for exacerbation. If Tina’s had any family members recently sick, that might have caused her recent exacerbation.
Example Question:
Has anyone at home been sick?
•
Finding:
Reports younger sister as only family with asthma
(Found)
Pro Tip: Soliciting a family history helps you to determine which, if any, conditions are inherited. In asking Tina whether anyone in her family has asthma, you’re ascertaining whether Tina’s condition is inherited.
Example Question:
Does anyone in your family have asthma?
•
Finding:
Reports younger sister as only family member with allergies
(Found)
Pro Tip: A family history of allergies is an important factor to determine whether a patient is at risk for developing allergies.
Example Question:
Does anyone in your family have allergies?
•
Finding:
Reports no family history of eczema
(Available)
Pro Tip: People with a family history of eczema are often at a higher risk of developing asthma.
Example Question:
Does anyone in your family have eczema?
•
Finding:
Reports no family history of chronic nasal or sinus problems
(Available)
Pro Tip: People with a family history of sinus problems are often at a higher risk for asthma. If Tina has a family history of sinus problems, this could suggest inherited sensitivity.
Example Question:
Do you have a family history of sinus problems?
•
Finding:
Reports no family history of COPD or emphysema

Document: Provider Notes

SUBJECTIVE

HPI: Ms. Jones is a pleasant 28-year-old African American woman who presented to the clinic with complaints of shortness of breath and wheezing following a near asthma attack that she had two days ago. She reports that she was at her cousin’s house and was exposed to cats which triggered her asthma symptoms. At the time of the incident she notes that her wheezes were a 6/10 severity and her shortness of breath was a 7-8/10 severity and lasted five minutes. She did not experience any chest pain or allergic symptoms. At that time she used her albuterol inhaler and her symptoms decreased although they did not completely resolve. Since that incident she notes that she has had 10 episodes of wheezing and has shortness of breath approximately every four hours. Her last episode of shortness of breath was this morning before coming to clinic. She notes that her current symptoms seem to be worsened by lying flat and movement and are accompanied by a non-productive cough. She awakens with night-time shortness of breath twice per night. She complains that her current symptoms are beginning to interfere with her daily activities and she is concerned that her albuterol inhaler seems to be less effective than previous. Currently she states that her breathing is normal. Diagnosed with asthma at age 2.5 years. She has no recent use of spirometry, does not use a peak flow, does not record attacks, and does not have a home nebulizer or vaporizer. She has been hospitalized five times for asthma, last at age 16. She has never been intubated for her asthma. She does not have a current pulmonologist or allergist. Assignment: Shadow Health Respiratory Assessment

Social History: She is not aware of any environmental exposures or irritants at her job or home. She changes her sheets weekly and denies dust/mildew at her home. She uses a hypoallergenic pillow cover and her mattress is one year old. She denies current use of tobacco, alcohol, and illicit drugs. She did smoke marijuana for 5 or 6 years, her last use was at age 21 years. She does not exercise.

Review of Systems: General: Denies changes in weight, fatigue, weakness, fever, chills, and night sweats.
• Nose/Sinuses: Denies rhinorrhea with this episode. Denies stuffiness, sneezing, itching, previous allergy, epistaxis, or sinus pressure.
• Gastrointestinal: No changes in appetite, no nausea, no vomiting, no symptoms of GERD or abdominal pain
• Respiratory: Complains of shortness of breath and cough as above. Denies sputum, hemoptysis, pneumonia, bronchitis, emphysema, tuberculosis. She has a history of asthma, last hospitalization was age 16, last chest XR was age 16.

Objective

General: Ms. Jones is a pleasant, obese 28-year-old African American woman in no acute distress. She is alert and oriented and sitting upright on exam table. She maintains eye contact throughout interview and examination.

• Respiratory: Chest expansion is symmetrical with respirations. Normal fremitus, symmetric bilaterally. Chest resonant to percussion; no dullness. Bilateral expiratory wheezes in posterior lower lobes. Bilateral muffled words with notable expiratory wheezes in posterior lower lobes. No crackles. In office spirometry: FVC 3.91 L, FEV1/FVC ratio 80.56%. SpO2: 97%.

Assessment

Asthma exacerbation

Plan

Encourage Ms. Jones to continue to monitor symptoms and log her episodes of asthma symptoms and wheezing with associated factors and bring log to next visit.
• Obtain office oxygen saturation.
• Order PFTs to be completed after exacerbation to have baseline available for future comparison.
• Encourage to wash bedding and consider dust mite covers to decrease allergic nighttime symptoms.
• NMT in office x 1.
• Educate to increase intake of water and other fluids.
• Educate Ms. Jones on when to seek emergent care including episodes of chest pain or shortness of breath unrelieved by rest, worsening asthma symptoms or wheezing, or the sense that rescue inhaler is not helping.
• Revisit clinic in 2-4 weeks for follow up and evaluation.

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LifespanActivity Time: 107 min
Tina’s second cousin was diagnosed with asthma at age 5. What would be included in your treatment plan? What factors might concern you related to compliance?
Student Response: IN the treatment plan for this child i would treat the airways of inflammation using medication to prevent asthma attacks. In addition, short acting drugs will be used to help treat the asthmatic child. Concerning factors are that He/she would avoid triggers of asthma and will be advised to maintain normal activity
Model Note: Younger patients with asthma are treated with the same medication as adults. Some medication dosages are based on weight. She should use an inhaler with a spacer attached for proper medication administration and her caregiver should always assist her. Studies have shown that nebulizer treatments are a less efficient way to administer medication. The provider should acknowledge that she may have an asthma attack while in school, and therefore needs a note to allow her to use it as needed. The patient and her caregiver should be educated about the importance of having her inhaler close-by and how to use it.
Consider that Tina’s uncle is now 68 years old and has smoked heavily every day since he was fifteen. What would you expect to find in his respiratory assessment? How would this affect your oxygenation goals for this patient?
Student Response: in the respiratory assessment of Tina’s uncle i expect to find increased AP diameter of the chest marked dorsal curvature, diminished chest expansion and psychosis . The weakened muscles will result in lower oxygen levels and lower elimination of carbon dioxide leading to decreased coughing capacity. His Alveolar will also lose their shape which will eventually cause dyspnea ( difficult/labored breathing ) and affect his oxygenation. it is important to inform the patient to increase exercise tolerance and treat his complication accordingly
Model Note: He likely has decreased breath sounds on auscultation due to emphysematous changes to his lungs from smoking. As alveoli get destroyed from chronic inflammation and irritation, the surface area in the lungs is decreased. This leads to less area for gas exchange and subsequent decreased oxygen saturation. As his body adjusts to chronic oxygen deprivation, attention must be given to how much supplemental oxygen is given. The goal with someone with severe COPD is to keep oxygen saturation 88% to 92%. If he is given too much oxygen his drive to breathe with be decreased and puts him at risk for death.

If Tina had mentioned that she was just diagnosed with pneumonia, what would you have expected to find during percussion?
Incorrect: Dull percussion sounds are expected over the areas of diffuse infiltrate (accumulation of fluid and by products of inflammation) in a patient with pneumonia.
• Hyperresonance (Student Response)
• Tympany
• Resonant
• Dullness (Correct Response)
If the results of Tina’s pulse oximetry had been 97%, which of the following would have been true?
Correct: Pulse oximetry measures the percent of hemoglobin molecules that are filled with oxygen. Oxygen-saturated hemoglobin absorbs light wavelengths differently than unsaturated hemoglobin. The oximeter emits a light and reads the extent of wavelength absorption.
• Partial pressure O2 = 97%
• Unbound oxygen level = 97%
• PaO2 = 97%
• Arterial hemoglobin saturation = 97% (Correct Response)
Suppose that, during your lung exam on Tina, you had heard bronchial breath sounds in the left lower lung posteriorly. What would you have suspected based on this finding?
Incorrect: Increased breath sounds are indicative of lung consolidation (fluid-filled alveoli) or pleural effusion (fluid accumulation in the pleural space) because fluid transmits sounds better than air. This finding is usually accompanied by abnormal transmitted voice sounds and increased tactile fremitus.
• Normal lung exam
• Atelectasis (Student Response)
• Fluid filled region of the lung (Correct Response)
• Narrowed upper airways secondary to asthma
Suppose that while auscultating, you assessed a few scattered expiratory wheezes. Why would this be an expected finding for a patient with Tina’s history?
Student Response: she would have been expected to have a milder obstruction of the airway
Model Note: Scattered wheezes are to be expected because of Tina’s history of asthma. Asthma is a chronic condition in which hyperreactive airways become narrowed by recurring inflammation and excess mucus production which results in wheezing.
When you observe a patient like Tina throughout an exam, there are many ways to determine whether a patient is experiencing respiratory distress. Identify one indicator of respiratory distress that can be assessed through observation alone.
Student Response: bluish color seen around the mouth,lips and fingernails, Nasal flaring , use of accessory muscle to breath
Model Note: Observable signs of respiratory distress include accessory muscle use, audible respirations, grunting or wheezing, increased respiratory rate, bluish coloration around the lips or fingernails, nasal flaring, chest retractions, sweating, tripod body positioning, and inability to speak in full sentences.
Describe how you would assess Tina for dyspnea.
Student Response: To access for dyspena i would conduct both subjective and objective data. I will inquire a complete history including onset, effect of positioning , allergy history, and any associated symptoms. For physical assessment i will note any dullness to percussion, decreased tactile femitus, elevated venous jugular pressure and observe for labored breathing and use of accessory muscle
Model Note: Dyspnea is a subjective complaint that must be elicited by asking the patient about her breathing. Ask your patient, “Do you ever have shortness of breath or difficulty breathing?” If dyspnea is detected, be sure to ask about onset, environmental or physical factors related to exacerbations, duration, body positioning, sleep disturbances, and relieving factors.
Self-ReflectionActivity Time: 9 min
Explicitly describe the tasks you undertook to complete this exam.
Student Response: i first had to inquire a complete history of the patient by collecting subjective data. I then conducted a physical assessment of the patient’s respiratory systems and collected objective data. After that, i determined a plan that would be beneficiary to the patient’s current health condition
Explain the clinical reasoning behind your decisions and tasks.
Student Response: My clinical reasoning behind my decision task is to rule out some certain diagnosis and focus on the type of asthma the patient is having. the diagnosis specifically enabled me to eliminate conditions that were suspected to have caused the frequent asthmatic attack on the patient .
Identify how your performance could be improved and how you can apply “lessons learned” within the assignment to your professional practice.
Student Response: i can improve my performance by asking the patient more of her health history. i can apply lesson learn to my professional practice by having a better understanding of the respiratory system and necessary assessment to gather a good objective data. Assignment: Shadow Health Respiratory Assessment

MN581 Interpretation of Common Diagnostic Labs in Pediatric Primary Care

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No plagiarism Please. Template will need references and intext citations.Please read instructions carefully to ensure maximum grade.Applying Current Evidence Based Practice GuidelinesAssignment: Interpretation of Common Diagnostic Labs in Pediatric Primary CareNurse practitioners routinely order labs for a variety of reasons. Some labs are recommended as part of a certain wellness check. Some labs are tested at birth and repeated at regular intervals. Many labs are ordered to rule in or rule out a diagnosis or just to add to an objective data base along with physical examination, vital signs, image studies, etc. Some of the labs can be done at the point of care (POC) such as an Accu-Check®. Most all labs require a venous blood sample but may require different additives that are in the collection tube. Other samples include arterial blood, urine, sputum, spinal fluid, or exudate.You will find the “Unit 7 Assignment Template” that you will use to complete this Assignment. It is organized to include information about a common lab test that you will be completing in pediatric primary care.Please fill in the requested information.

NSG 435 Week 3 Quiz Assignment

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NSG 435 Week 3 Quiz Assignment

Select the correct answer for each question.
What position is least effective when gravity is desired to assist in fetal descent?

Lithotomy
Kneeling
Sitting
Walking

The nurse recognizes that a woman is in true labor when she states which of the following?“I passed some thick, pink mucus when I urinated this morning.”
“My bag of waters just broke.”
“The contractions in my uterus are getting stronger and closer together.”
“My baby dropped, and I have to urinate more frequently now.”

An 18-year-old pregnant woman, gravida 1, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The woman states, “My contractions are so strong, I don’t know what to do.” The nurse shouldassess for fetal well-being
encourage the woman to lie on her side
disturb the woman as little as possible
recognize that pain is personalized for each individual

A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged.  NSG 435 Week 3 Quiz Assignment.The nurse increases the woman’s IV fluid for a preprocedural bolus. Prior to initiation of the epidural the woman should be informed regarding the disadvantages of an epidural block. They include all EXCEPTability to move freely is limited
orthostatic hypotension and dizziness
gastric emptying is not delayed
higher rate of fever

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Your client is in early labor, and you are discussing the pain relief options she is considering. She states that she wants an epidural “no matter what!” What is your best response? “I’ll make sure you get your epidural.”
“You may only have an epidural if your doctor allows it.”
“You may only have any epidural if you are going to deliver vaginally.”
“The type of analgesia or anesthesia used is determined in part by the stage of your labor and the method of birth.”

A first-time mother is concerned about the type of medications she will receive during labor. She is in a fair amount of pain and is nauseated. Additionally she appears to be very anxious. You explain that opioid analgesics often are used with sedatives because of what reason?
“The two together work the best for you and your baby.”
“Sedatives help the opioid work better, and they will help relax you and relieve your nausea.”
“They work better together so you can sleep until you have the baby.”
“This is what the doctor has ordered for you.”

According to professional standards (AWHONN, 2007) the nonanesthetist registered nurse caring for a woman with an epidural is permitted to perform all actions EXCEPTmonitor the status of the woman and fetus
initiate epidural anesthesia
replace empty infusion bags with the same medication and concentrate
stop the infusion and initiate emergency measures

During anesthetic management of the morbidly obese woman in labor, the nurse must remain alert for complications specific to this type of client. Which is not a concern for the L&D nurse? Failed epidural placement
Accidental dural puncture
Inadequate pain relief
Difficult intubation

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurse’s first priority is to
change the woman’s position
notify the health care provider
assist with amnioinfusion
insert a scalp electrode

Which fetal heart rate (FHR) finding concerns the nurse during labor?Accelerations with fetal movement
Early decelerations
An average FHR of 126 beats/min
Late decelerations

What three measures should the nurse implement to provide intrauterine resuscitation? Select the best response that indicates the priority of actions that should be taken, starting with the most important. Call the provider, reposition the mother, and perform a vaginal exam.
Provide oxygen via face mask, reposition the mother, and increase IV fluid.
Administer oxygen to the mother, increase IV fluid, and notify the health care provider.
Perform a vaginal examination, reposition the mother, and provide oxygen via face mask. NSG 435 Week 3 Quiz Assignment

According to the National Institute of Child Health and Human Development (NICHD) Three-Tier System of Fetal Heart Rate Classification, category III tracings include all fetal heart rate tracings not categorized as category I or II. Which characteristics of the fetal heart rate belong in category III? (choose all that apply):
Baseline rate of 110 to 160 beats/min
Tachycardia
Absent baseline variability not accompanied by recurrent decelerations
Variable decelerations with other characteristics such as shoulders or overshoots
Absent baseline variability with recurrent variable decelerations
Bradycardia

Five essential components of any fetal heart rate (FHR) tracing must be evaluated regularly. These include (choose all that apply): Baseline rate
Baseline variability
Accelerations
Decelerations
Changes or trends over time
Frequency of contractions

Which action is correct when palpation is used to assess the characteristics and pattern of uterine contractions?
Place the hand on the abdomen below the umbilicus and palpate uterine tone with the fingertips.
Determine the frequency by timing from the end of one contraction to the end of the next contraction.
Evaluate the intensity by pressing the fingertips into the uterine fundus.
Assess uterine contractions every 30 minutes throughout the first stage of labor.

The woman in labor should be encouraged to use the Valsalva maneuver (holding one’s breath and tightening abdominal muscles) for pushing during the second stage. NSG 435 Week 3 Quiz Assignment

True

False

APN Professional Development Plan

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APN Professional Development Plan

APN Professional Development Plan

Chamberlain College of Nursing NR510 Leadership and Role of the Advanced Practice Nurse

Guidelines for Advanced Practice Nursing

Role Self-Assessment Using Benner’s Novice to Expert Model

Stage 1: Novice The Novice or beginner has no experience in the situations in which they are expected to perform. The Novice lacks confidence to demonstrate safe practice and requires continual verbal and physical cues. Practice is within a prolonged time period and he/she is unable to use discretionary judgment.
Stage 2: Advanced Beginner Advanced Beginners demonstrate marginally acceptable performance because the nurse has had prior experience in actual situations. He/she is efficient and skillful in parts of the practice area, requiring occasional supportive cues. May/may not be within a delayed time period. 

Knowledge is developing.
Stage 3: Competent Competence is demonstrated by the nurse who has been on the job in the same or similar situations for two or three years. The nurse is able to demonstrate efficiency, is coordinated and has confidence in his/her actions. For the Competent nurse, a plan establishes a perspective, and the plan is based on considerable conscious, abstract, analytic contemplation of the problem. The conscious, deliberate planning that is characteristic of this skill level helps achieve efficiency and organization. Care is completed within a suitable time frame without supporting cues. APN Professional Development Plan
Stage 4: Proficient The Proficient nurse perceives situations as wholes rather than in terms of chopped up parts or aspects. Proficient nurses understand a situation as a whole because they perceive its meaning in terms of long-term goals. The Proficient nurse learns from experience what typical events to expect in a given situation and how plans need to be modified in response to these events. The 

Proficient nurse can now recognize when the expected normal picture does not materialize. This

holistic understanding improves the Proficient nurse’s decision making; it becomes less labored because the nurse now has a perspective on which of the many existing attributes and aspects in the present situation are the important ones.
Stage 5: The Expert The Expert nurse has an intuitive grasp of each situation and zeroes in on the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnoses and solutions. The Expert operates from a deep understanding of the total situation. His/her performance becomes fluid and flexible and highly proficient. Highly skilled analytic ability is necessary for those situations with which the nurse has had no previous experience.

Source: Benner, P. (2001). From Novice to Expert: Excellence and power in clinical nursing practice.

Upper Saddle River, NJ: Prentice Hall Health.

Instructions: The levels of Benner’s Model reflect movement from reliance on past abstract principles to the concrete experience. An individual’s perception of situations change as experience is gained. To help better understand your perspective on your new role, complete the following self-assessment. Refer to the model to guide your perception.

1. What areas of your career do you most want to focus and further develop?

2. What do you look forward to most about your new role?

3. What do you fear the most about your new job?

4. What do you most hope to gain from your new experience?

5. Adapting to a new position/work setting is stressful and overwhelming. List three ways in which you cope with excessive stress.

6. What are your goals and objectives for your first, second, and third months in your new position as well as the remainder of your first year? APN Professional Development Plan

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APN Professional Development Plan

Guidelines with Scoring Rubric

Purpose

The purpose of this application is to provide the student an opportunity to explore the role of the advanced practice nurse (APN) and develop an APN professional development plan.

Course Outcomes

Through this assignment, the student will demonstrate the ability to:

CO1: Synthesize knowledge and concepts from advanced practice nursing with supporting disciplines as a foundation for APN/specialty nurse practitioner practice that is culturally competent and population-specific (PO #1).

CO3: Assimilate primary care competencies into APN/specialty nurse practitioner practice that exemplify professional values, scholarship, service, and culturally competent global awareness and support ongoing professional and personal development. (PO #5)

CO5: Contribute to the body of advanced practice nursing knowledge through participation in systematic inquiry, utilization of evidence-based practice, and dissemination of findings to support high-quality care and healthcare innovation. (PO #9)

CO9: Evaluate strategies for contract negotiation, CV/resume writing, credentialing, national board certification, hospital privileges, and reimbursement (PO #8).

CO 10: Develop visionary leadership skills that combine best evidence with nursing expertise to support quality improvement, safety, and change across healthcare organizations and systems (PO #1, 3, 8, and 9).

CO 11: Differentiate leadership strategies that strengthen interprofessional collaboration and incorporate an ethic of care, values, and ethical principles into the role of the nurse leader across healthcare organizations and systems (PO #2, 4, 5, 6, and 7).

Due Date: Sunday 11:59 p.m. MT at the end of Week 6

Total Points Possible: 200

Requirements:

1. To complete this application, you will need to access to the following databases: CINAHL, MEDLINE, Cochrane Library, and the Joanna Briggs Institute. You may access these databases through the Chamberlain College of Nursing Online Library.

2. The APN Professional Development Plan paper is worth 200 points and will be graded on quality of information, use of citations, use of Standard English grammar, sentence structure, and overall organization based on the required components as summarized in the directions and grading criteria/rubric.

3. Create your manuscript using Microsoft Word 2007 (a part of Microsoft Office 2007), which is the required format for all Chamberlain College of Nursing documents. You can tell that the document is saved as a MS Word 2007 document because it will end in “.docx” APN Professional Development Plan

4. Follow the directions and grading criteria closely. Any questions about this paper may be posted under the Q & A Forum.

5. The length of the paper is to be no less than 6 and no greater than 8 pages excluding title page and reference pages.

6. APA (2010) format is required with both a title page and reference page. Use the required components of the review as Level 1 headers (upper and lower case, centered):

a. Introduction to the APN professional development plan

b. APN Scope of Practice

c. Personal Assessment

d. Networking and Marketing Strategies

e. Conclusion

Preparing the paper

The following are best practices for preparing this paper:

1. Review Chapter 30- Role Transition: Strategies for Success in the Marketplace in

DeNisco and Barker (2015).

2. Nurse practitioners need to take into account the state rules and regulations that guide advanced practice. Research and review the Nurse Practice Act and APN scope of practice guidelines in your particular state. Identify information regarding educational requirements, licensure and regulatory requirements, as well as practice environment details. Review information regarding full, limited, or restricted practice limitations as well as prescriptive authority.

3. Review Guidelines for APN Role Transition Using Benner’s Self-Assessment Tool in Course Resources. Prior to engaging in pursuit for employment, APNs should complete a comprehensive, honest, affirmative personal assessment to identify their strengths and weaknesses as well as their goals and objectives. Research assessment tools, conduct a personal assessment, and reflect upon your strengths, weaknesses, goals, and objectives. APN Professional Development Plan

4. To complete the transition from students to expert nurse practitioners working in the healthcare field, graduating APN students will need to secure their first position. Research local and national professional organizations that advertise employment opportunities for APNs. Identify networking and marketing strategies and provide a rationale for your selections.

5. Write your Curriculum Vitae (CV). Refer to the template on pages 772-773 in DeNisco and Barker (2015). Your CV should not exceed 2 pages in length.

6. When concluding the paper, summarize important aspects of the APN professional development plan.

Category Points % Description
Introduction to the APN professional development plan 20 10% Introduces the purpose of the paper and addresses all background information elements (who, what, where, when, and why) for the APN professional development plan.
APN Scope of Practice 35 18% Provide detailed information regarding education, licensure, and regulatory requirements, as well as practice environment details. Include information regarding full, limited, or restricted practice limitations as well as prescriptive authority.
Personal Assessment 25 12% Perform a personal assessment and reflect upon your strengths, weaknesses, goals, and objectives.
Networking and Marketing Strategies 25 12% Provide detailed information regarding local and national professional organizations that advertise employment opportunities for APNs. Identify networking and marketing strategies and provide a rationale for your selections
Curriculum Vitae 35 18% Provide accurate information regarding the nurse practitioner’s abilities, skills, and accomplishments.
Conclusion 20 10% An effective conclusion identifies the main ideas and major conclusions from the body of your manuscript. Minor details should not be included. Summarize important aspects of the APN professional development plan.
Clarity of writing 20 10% Use of standard English grammar and sentence structure. No spelling errors or typographical errors. Organized around the required components using appropriate headers.
APA format 20 10% All information taken from another source, even if summarized, must be appropriately cited in the manuscript and listed in the references using APA (6th ed.) format: 

1. Document setup

2. Title and reference pages

3. Citations in the text and references.
Total  200 100 A quality assignment will meet or exceed all of the above requirements.

Chamberlain College of Nursing NR510 Leadership and Role of the Advanced Practice Nurse

2

Grading Rubric

Assignment Criteria Exceptional 

Outstanding or highest level of performance

 Exceeds 

Very good or high level of performance

 Meets Satisfactory level of performance Needs Improvement 

Poor or failing level of performance

 Developing 

Unsatisfactory level of performance
Content 

Possible Points = 130 Points
Introduction to the APN professional development plan 20 Points 18 Points 16 Points 8 Points 0 Points
Excellent introduction of APN professional development plan. Rationale is well presented and purpose fully developed. Good introduction of APN professional development plan. Rationale is presented and purpose provided. Basic information and/or limited elements addressed regarding APN professional development plan and/or inappropriate emphasis on an area. Little or very general introduction of APN professional development plan. Little to no original explanation; inappropriate emphasis on an area. No introduction of APN professional development plan provided.
APN Scope of Practice 35 Points 31 Points 28 Points 13 Points 0 Points
Provided detailed information regarding education, licensure, and regulatory requirements, as well as practice environment details per the student’s state. Included information regarding full, limited, or restricted practice limitations as well as prescriptive authority. Provided some information regarding education, licensure, and regulatory requirements, as well as practice environment details per the student’s state. Included information regarding full, limited, or restricted practice limitations as well as prescriptive authority. Provided non-state specific information regarding education, licensure, and regulatory requirements, as well as practice environment details. Included information regarding full, limited, or restricted practice limitations as well as prescriptive authority. Lacking detailed information regarding education, licensure, regulatory requirements, or practice environment. Missing information regarding practice limitations and/or prescriptive authority. Did not provide information regarding education, licensure, and regulatory requirements, as well as practice environment details per the student’s state. Not provide information regarding full, limited, or restricted practice limitations as well as prescriptive authority.
Personal Assessment 25 Points 22 Points 20 Points 10 Points 0 Points
Provided detailed information following a personal assessment and reflected upon strengths, weaknesses, goals, and objectives. Provided some detailed information following a personal assessment and reflected upon some of the strengths, weaknesses, goals, and objectives. APN Professional Development Plan Provided some detailed information following a personal assessment. Missed providing reflection upon strengths, weaknesses, goals, or objectives. Provided information following a personal assessment, but did not reflect upon strengths, weaknesses, goals, or objectives. Did not provide a personal assessment and did not reflect upon personal strengths, weaknesses, goals, or objectives.
Networking and Marketing Strategies 25 Points 22 Points 20 Points 10 Points 0 Points
Provided detailed information regarding local and national professional organizations that advertise employment opportunities for APNs. Identified networking and marketing strategies and provide a rationale for their selections. Provided some detailed information regarding local and national professional organizations that advertise employment opportunities for APNs. Identified networking and marketing strategies and provide a rationale for their selections. Provided information but lacked specific details regarding local and national professional organizations that advertise employment opportunities for APNs. Identified networking and marketing strategies and provide a rationale for their selections. Provided information regarding professional organizations that advertise employment opportunities, but missed providing information regarding networking and marketing strategies and/or a rationale for their selections. Did not provide detailed information regarding local and national professional organizations that advertise employment opportunities for APNs. Did not identify networking and marketing strategies or provide a rationale.
Curriculum Vitae 35 Points 31 Points 28 Points 13 Points 0 Points
Provided detailed information which included demographics, education, professional employment, licensure and certification, professional honors, research, scholarship, and service. Free from typographical errors. Provided detailed information. Missing 1-2 key elements. Free from typographical errors. Provided moderately detailed information. Missing 3 key elements. Free from typographical errors. Provided minimal detail. Missing 4 or more key elements. Contains 1-2 typographical errors. Information provided was inaccurate and vague. Contains 3 or more typographical errors. Did not provide curriculum vitae.
Conclusion 20 Points 18 Points 16 Points 8 Points 0 Points
Excellent summary of APN professional development plan. Conclusions are well evidenced and fully developed. Good summary of APN professional development plan. Conclusions are supported by evidence and developed. Basic and/or limited summary regarding APN professional development plan. Little or no summary of APN professional development plan; inappropriate emphasis on an area. No summary of APN professional development plan and/or conclusions were provided.
Content Subtotal _____of 160 points
Format 

Possible Points = 40 Points
Clarity of Writing 20 Points 18 Points 16 Points 8 Points 0 Points
Excellent use of standard English showing original thought. No spelling or grammar errors. Well organized with proper flow of meaning. Good use of standard English showing original thought. No more than two spelling or grammar errors. Well organized with proper flow of meaning. Some evidence of own expression and competent use of language. No more than three spelling or grammar errors. Well organized thoughts and concepts. Language needs development. Four or more spelling and/or grammar errors. Poorly organized thoughts and concepts. More than six spelling and/or grammar errors. Poorly organized thoughts and concepts
APA Format 20 Points 18 Points 16 Points 8 Points 0 Points
APA format, grammar, spelling, and/or punctuation are accurate, or with zero to one errors. Two to four errors in APA format, grammar, spelling, and syntax noted. Five to seven errors in APA format, grammar, spelling, and syntax noted. Eight to nine errors in APA format, grammar, spelling, and syntax noted. Post contains greater than ten errors in APA format, grammar, spelling, and/or punctuation or repeatedly makes the same errors after faculty feedback.
Format Subtotal _____of 40 points
Total Points __of 200 points
NR510 Directions & Rubric.docx revised 11/16 8

Apn professional development plan

14-17 minutes

Every Advanced Practice Registered Nurse (APRN) should develop a personal development plan (PDP). A PDP includes a written evaluation of the regulations and requirements needed to obtain licensure and practice in the APRNs designated geographical area. The PDP should also include a personal action plan that reflects the results of one’s self-assessment, including one’s strengths, weaknesses, goals, and objectives. In order to develop a PDP, the APRN should be aware of and understand the state in which they plan to practice educational, regulatory, and licensure requirements. This paper aims to describe the APRNs scope of practice in the state of Florida, a personal assessment using Benner’s self-assessment tool, tactics for marketing and networking, a Curriculum Vitae, and a summary of the information acquired for the PDP.

APN Scope of Practice

Every state decides the guidelines or requirements for licensure, accreditation, certification, and education, also known as LACE, by which an APRN must abide by to practice in that state. Unfortunately, not all states are equal when it comes to the requirements for LACE and how much autonomy the APRN is allowed. In Florida, the Nurse Practitioner (NP) applicant must have a valid RN license, a master’s degree or a certificate in a nurse specialty area from a post master’s program, have completed at least 500 clinical hours, and have a national advanced practice certification from an accepted nursing specialty board (FLBON, 2017).

Per the American Association of Nurse Practitioners (AANP) (2017), nursing regulations and practice laws are set by each state. There are three levels at which an NP can practice: Full practice, reduced practice, and restricted practice (AANP, 2017). Full practice means the NP works under the authority of the state board of nursing (AANP, 2017). An NP who works in a state that allows full practice can evaluate and assess patients, diagnose, set up a treatment plan and manage the treatment plan, order diagnostic testing and interpret diagnostic results, and prescribe medications (AANP, 2017). Full practice for NPs is the scope recommended by the National Council of State Boards of Nursing and by the Institute of Medicine (AANP, 2017). Reduced practice means the state reduces the NPs ability to practice by at least one element (AANP, 2017). In reduced practice states, NPs must have a collaborative agreement with a healthcare provider before they can practice (AANP, 2017). Restricted practice means the state restricts the NP in at least one element of practice and it requires the delegation, supervision, and/or team management by a healthcare provider (most often a physician) before the NP can practice (AANP, 2017). APN Professional Development Plan

Florida is a restricted practice state. Per Florida’s administrative code, Rule 64B9-4.010(1), an ARNP “shall only perform medical acts of diagnosis, treatment, and operation pursuant to a protocol between the ARNP and a Florida-licensed medical doctor, osteopathic physician, or dentist” (FLBON, 2016, para. 1). The protocol delineates the professional agreement between the physician and the ARNP. Protocols must include the ARNPs information, the physician’s information, the practice’s information, a description of the ARNPs duties such as procedures the NP can perform, conditions for which the ARNP is allowed to manage and treat, medications the ARNP may prescribe, and situations in which the NP must contact the physician (FLBON, 2016). Currently, NPs in Florida are also restricted from signing a Baker Act, signing a death certificate, certifying DNR orders, and are not recognized by Medicare and Medicaid as primary care providers (FLBON, 2016). In March 2017, bill HB 7011 was presented during the March legislative session; this bill recommended independent practice for ARNPs (FLANP, 2017). As of April 2017, the bill is in the House, specifically being evaluated by the Health and Human Services Committee (The Florida Senate, 2017).

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One exciting landmark for NPs in Florida came in April of 2016; bill HB 423 passed, which allows NPs and PAs to prescribe schedule I, schedule II, and schedule III controlled substances (FLBON, 2016). As of January 2017, NPs were allowed to apply for a DEA license. However, there were some stipulations put in place with the passing of this bill. NPs must have an updated protocol filed with the Florida Board of Nursing (FLBON) stating the NP has the authority to prescribe controlled medication (FLANP, 2017). NPs must complete a minimum of three continuing education unit (CEU) hours relating to the safe and effective prescribing of controlled substances (FLBON, 2016). The NP must distinguish on their practitioner profile that they prescribe controlled medications. If the NP prescribes a schedule II medication, they are restricted to prescribing for a maximum of seven days (FLBON, 2016). Lastly, unless the NP is a certified psychiatric nurse, NPs cannot prescribe psychotropic medications to anyone under the age of 18 (FLBON, 2016).

Personal Assessment

Completing a personal assessment tool is beneficial for anyone; they can help determine one’s strengths, weaknesses, goals, and objectives. For NPs, personal assessment tools also allow them to explore their interests, discover passions, and to determine which areas of practice would suit them best. To care for others, one must have a true understanding of themselves, from what they want in life to what their strengths and weaknesses are.

Knowing one’s strengths is the first step to having a true understanding of who they are. The strengths this author possesses are good communication skills, good listening skills, determination, and patience. These strengths, especially communication and listening, are important to anyone wanting to work in the healthcare industry. Effective communication and listening skills are vital to ensuring one accurately assesses, diagnoses, and treats the patient. Aside from diagnosing and treating the patient, patients want to feel as if their concerns have really been heard. How a patient perceives the provider will influence the message they receive and ultimately their care. If the patient feels the provider does not listen, cuts them off, or is too hasty in their diagnosis, it is likely the patient will not fully comply with the treatment options, lifestyle changes, and/or follow-up appointments ordered by the provider.

Just as everyone has their strengths, everyone also has weaknesses. The good thing about weakness is that it can be turned into a strength. If one is aware they are weak in certain areas, one can work on improving in these areas until they are no longer weaknesses. The weaknesses this author deals with are the fear of being an advanced beginner and time management skills. According to Benner’s Novice to Expert Model, the advanced beginner is one who has some clinical knowledge but they still require support and assistance, such as a mentor/preceptor who can help set priorities and give constructive feedback (Davis & Maisano, 2016). Luckily, time builds knowledge and confidence; the new NP should keep in mind that over time they will navigate through all of Benner’s stages. Time management skills are essential if one wants to provide quality care. New NPs often feel they must be the one to complete all tasks, which makes time management even more difficult. The new NP needs to learn that delegating certain tasks is actually beneficial to their patients because it allows the NP to spend more time with them.

Having career goals is important for the NPs professional development. Most often, people have long-term goals and short-term goals. One should always be evaluating their goals and revising them as necessary to make sure they continue to be relevant as they move forward in their life and their career. This author’s short-term goal is to work in Dermatology once NP school is complete; a long-term goal is to become a knowledgeable and confident NP that can help other new graduates find their way. Being a preceptor/mentor to new NPs would be a way of giving back to the profession as well as helping patients.

Having objectives is important because they will help one meet their goals. There are objectives that one should have when seeking a job and once they secure that job. This author’s objective is to obtain clinical sites where employment is of interest. This would be a way of networking. With so many NPs going out into the workforce, one has to think of ways to stand out. It is very difficult to apply to jobs and rely on resumes alone. When an NP student is allowed to do their clinical hours in places they can envision working in one day, they can show the potential employer exactly why they should be hired.

Networking and Marketing Strategies

The new NP must network and market themselves in order to find employment after they obtain certification. Marketing and networking are also an important part of the professional development plan. The NP should begin networking while still in school. There are a number of national and local professional nursing associations that advertise employment opportunities for NPs. Some of the professional nursing organizations in Florida include the Florida Nurse Practitioner Network (FNPN), the Florida Association of Nurse Practitioners (FLANP), and the Tampa Bay Advanced Practice Nurses Council (TBAPNC). These organizations provide a plethora of information, for new and seasoned NPs, with options such as employment opportunities, upcoming events in the area, important information on new bills that are being presented to the legislature, rejected bills, and passed bills, rules and regulations, ways to connect and network with other NPs in the area, access to a preceptor list, and the opportunity to volunteer to be a preceptor. The Florida Nurses Association (FNA) is another website Florida NPs can utilize for help finding employment as well as other resources. The FNA is actually a division of the American Nurses Association (ANA) and it is the only nursing organization that provides information for all nurses in all specialties and all areas of practice (About the Florida Nurses Association, 2012).

Nationally, the American Association of Nurse Practitioners (AANP) is the largest professional membership organization that provides full service to NPs in all areas of practice. For example, the AANP provides information on current healthcare topics and policy updates, advocacy at the state and national levels, employment, resources to assist with professional growth, resources for new graduates as well as retiring NPs, conference information, and free CEUs (“Membership Categories & Benefits”, 2017). The AANPs job link allows non-members access to the available jobs although, members are able to see job postings five days before non-members. Another national organization NPs can utilize is NP Central. Not only does NP Central provide information on job opportunities, it also provides CE opportunities, classes on how to improve your practice, access to certain resources such as Medicare information, legislative contacts, press releases, and product and book reviews. NP Central is also a resource NPs can use to meet other NPs. When googling “local and national organizations that advertise employment opportunities”, this author found an article listing the 75 top professional organizations for nurse practitioners; AANP and NP Central were both listed in the top five choices (“75 Top Professional Organizations for Nurse Practitioners”, 2017). These days, social media is also a great way to network and market oneself; some of the popular websites/applications include Facebook, LinkedIn, and Doximity. APN Professional Development Plan

 

Nurs 6551

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Assignment 1: Application – Best PracticesFor over 20 years, the Women’s Health Initiative (WHI) study has conducted research trials to examine factors that impact risks and development of conditions that impact women such as heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women. Health care providers use results from these trials to develop guidelines for delivering care to patients. In your role in clinical settings, you must be familiar with these guidelines, and you must be aware that through clinical practice, guidelines frequently evolve and change. Often, what is considered a best practice today might not be a best practice in the future. For this Assignment, you compare guidelines outlined in the WHI study to current best practices for assessing and managing conditions.By Day 7 of Week 11To Prepare:Review the Women’s Health Initiative website in this week’s Learning Resources. Select one disorder presented in this study.Locate a research article focused on women’s health issue that you have learned about on the Women’s Health Initiative project. Be sure that the research article you select is from a reputable source.Discuss the best practices presented in the article about the health issue. Explain if there are any differences in the literature about best practices about health issue.Explain whether you think the current best practices in the article you selected should be used in clinical practice. Support your position with evidence-based research.To Complete:Write a 2- to 3-page paper that addresses the following:Describe the disorder you selected from the Women’s Health Initiative study.Explain the current best practices for assessing and managing this disorder as suggested in the research article you selected.Compare the best practices presented in the WHI study to the current best practices presented in the article. Explain how the differences in best practices might impact women’s health.Explain whether you think the current best practices in the article you selected should be used in clinical practice. Support your position with evidence-based research.

data sets

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ASSIGNMENT: Data SetsDemonstrate compliance with healthcare data sets (Blooms 3)Instructions:Part I: Review the information on Data Sets from your lesson.Study the Table 1 provided in the lesson. Create your own table with 3 columns and copy the information from the table in the lesson for the first 2 columns for DEEDS, MDS, OASIS, UACDS, and UHDDS.Part II: Research each of these online and/or in the Peden textbook- In the 3rd column, show 4 data elements that are required for each of the data sets.Part III: Open the inpatient record provided as an attachment below- Analyze the documentation in the record to see if it would meet the requirement for the UHDDS data elements you included in your table.- Type a Yes or a No after each of the data elements to indicate if you were able to find the data element in the chart.

Rough Draft Quantitative Research Critique and Ethical Considerations

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Details:Use the practice problem and a quantitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment.In a 1000-1,250 word essay, summarize the study, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.Refer to the resource “Research Critique Guidelines” for suggested headings and content for your paper.Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Assessment for Health Promotion

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Maria’s vitals today are as follows; T 98.6, R 20, HR 88, BP 148/90Using the lesson and text as your guide, answer the following questions.What additional assessment data (subjective and/or objective) would you like to gather from Maria?What actual health concerns and risk factors have you identified?What are some opportunities to promote health and wellness for Maria?Write one nursing diagnosis for Maria (actual, wellness or risk), based on one of the health concerns or opportunities you have identified. (Please use one of the formulas outlined in the text and lesson!)

Community Health Assessment Model Discussion

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Community Health Assessment Model Discussion

Community Health Assessment Model Discussion

Discussion Question:

Identify a Community Health Assessment Model. (This document from the CDC lists commonly used community assessment models: https://www.cdc.gov/stltpublichealth/cha/assessment.html ) What are some benefits of using a specific model to assess a community? What agencies should be included with the assessment? What is a reasonable time frame in which to complete a community wide assessment? What is the role of the public nurse in implementation of the chosen model?

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Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook.

Assignment:

The final community assessment paper will be submitted in Module 8. This week please add the hours you have spent completing the community assessment to your practice experience hours in Project Concert for Module 7. Practice hours relate to time spent on your ‘Community Assessment’ activities. (Discussion Board work does not apply). You should have approximately 10-14 hours for Module 7’s portion of the community assessment. Minimum required hours must be entered into Project Concert in order to receive a grade for the assignment. Some states/entities require hour logs for certification or employment. It is the student’s professional responsibility to ensure all hours are entered correctly in order to meet these requirements. Review the document in the Learning Materials on directions on how to enter hours. Access Project Concert. To ensure you do not receive notice of inactivity in D2L, please submit a screenshot of your hours to the Module 7 dropbox. Access Project Concert. Community Health Assessment Model Discussion

Examination & Treatment of Anxiety Disordered

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Examination & Treatment of Anxiety Disordered

Examination & Treatment of Anxiety Disordered

Examination & Treatment of Anxiety Disordered

Question Description
I need support with this Nursing question so I can learn better.

Assignment: Assessing and Treating Patients With Anxiety Disorders
Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt patients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, patients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with anxiety disorders.

TO PREPARE FOR THIS ASSIGNMENT:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring anxiolytic therapy. Examination & Treatment of Anxiety Disordered
THE ASSIGNMENT: 5 PAGES
Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)

Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)

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Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

CASE STUDY:

Generalized Anxiety Disorder
Middle-Aged White Male With Anxiety
Middle aged male

BACKGROUND INFORMATION

The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL. Examination & Treatment of Anxiety Disordered

He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.

In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.

Client has never been on any type of psychotropic medication.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.

You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.

Diagnosis: Generalized anxiety disorder

RESOURCES

§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Decision Point One

Select what you should do:

Begin Zoloft 50 mg po daily

Begin Imipramine 25 mg po BID

Begin Buspirone 10 mg po BID. Examination & Treatment of Anxiety Disordered